Unit Two: The Concept Of Comfort Flashcards
Katharine Kolcaba’s Comfort theory
The immediate state of being strengthened by having the needs of relief, ease, and transcendence addressed in the four contexts of holistic human experience: physical, psycho spiritual, sociocultural, and environmental.
Domains of comfort
Physical, sociocultural, psychospirital, enviormental
Physical comfort
Homeostasis
Sociocultural
Culture, family, finances
Psychospiritual comfort
Sexuality, spirituality
Environmental comfort
Room temp, back ground noise
Comfort is _____________.
Subjective
A client indicates an intensity for 8 on the 0-10 pain scale. The best action for the nurse to take is which of the following?
A. Check back in 30 mins to see wether the pain has changed
B. Give pain medication
C. Further assess pain to determine the best intervention
D. Do nothing because pain is at a tolerable level
C
When describing pain, the client states the pain is a dull aching pain. The nurse determines that this description tends to indicate that the client’s pain is most likely: A. Neuropathic pain B. Visceral Pain C. Referred pain D. Phantom Pain
B.
Neuropathic pain
Stabbing, burning; usually from fibromyalgia. Chronic pain. Sending incorrect pain signals. Tissue injury.
Visceral pain
Deep pain from organs
Referred pain
Coming from a site other than its point of origin
Phantom Pain
Usually coming from a site of amputation. Shooting, burning, stabbing pain.
The nurse is evaluating a client’s pain. The client states that the pain is at level 2. The client is indicating which of the following about the pain? A. Duration B. Quality C. Intensity D. Onset
C
Pain management is important because:
A. Determines whether the pt and family give good evaluations to the hospital and caregivers
B. It determines when the patient can be discharged from the hospital
C. It is defined as a pt right by the Joint Commission on the Accreditation of Healthcare Organization
D. It is the fifth vital sign
C.
Risk factors effecting comfort
Poor nutrition Smoking Excessive alcohol intake Illicit drug use Poor hygiene Occupational hazards including heavy lifting, long hours, or repetitive movements Participation in team or extreme sports
________ is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Pain
Pain is always ______________.
Subjective
Pain is the ______________.
Fifth vital sign
_________ is the most common reason for seeking healthcare.
Pain
Pain experiences
Pain perception, Pain threshold, pain tolerance
Acute pain is:
Temporary(Less than 6 months)
Protective
Sudden onset
Identifiable cause
Examples of Acute pain:
Muscle spasms, toothaches
Three types of acute pain:
Somatic, visceral, referred
Chronic pain is:
Prolonged (longer than 6 months)
Non protective
May not be identifiable cause
Can be malignant or non-malignant
Examples of chronic pain:
Back pain, arthritis, Crohn’s disease
Factors that effect clients response to pain:
Age Developmental stage Sociocultural Factors Emotional Status Past experiences Meaning of pain Knowledge deficit
Somatic pain
Acute; comes from skin or surface of body. Like an overstretched muscle.
Physical response to Acute pain
Increased HR, Increased pulse, Increased BP, Increased muscle tension, dry mouth, Nausea, and vomiting. (fight or flight)
Physical response to chronic pain
No autonomic nervous system response, usually because their body has gotten used to the pain.
Breakthrough pain
Pain caused by some kind of trigger. Can be Incident pain or Ideopathic pain
Breakthrough, Incident pain
Pain caused by doing something i.e. wound care or walking after surgery
Breakthrough, Idiopathic pain
Has an unsure cause
End of dose medication failure
Pain that happens right before it is time to give them their next dose of medication. Can be fixed by recommending to provider to change med schedule.
Questions you need to ask when assessing pain:
Location Intensity Quality Duration Aggravating and Relieving Factors Signs and Symptoms
Pain Assessment tools
Visual analog scale 0-10 Numeric Pain Intensity Scale Simple descriptive Pain Intensity Scale FACES pain Scale CNPI Scale FLACC
FLACC pain scale
Face Legs Activity Cry Consolability Used fo infants
CNPI
Checklist of Nonverbal Pain Indicators
ICU patients, unconscious patients
Nonpharmacologic Nursing interventions for pain
Relaxation Guided Imagery Distraction Massage Heat/cold Therapy Therapeutic touch TENS Unit
Pharmacological Therapies for pain
Non-opioid analgesics/NSAIDS Weak/partial opioid analgesics Mixed opioid analgesics Strong opioid analgesics Co-analgesics
Nonopioids
Used to treat mild to moderate pain. Many are over the Counter and have a ceiling effect narrow therapeutic index
Examples of nonopioids used to treat pain
NSAIDS
Acetaminophen
Aspirin
Nonopioids Salicylates—ASA
Used to treat mild to moderate pain Used as: -Analgesic (reduces plain) -Anti-inflammatory -Antipyresis -Antiplatelet
Nonopioid Acetaminophen
Similar properties as ASA. More people are allergic to this ASA than to Acetaminophen. TYLENOL when used in high doses or long term use may cause liver damage. Do not take on empty stomach
Antidote is Acetylcystine.
Nonopioid NSAIDs
Nonsteroidal Anti-Inflammatory Drugs.
Ibuprofen, Aspirin, Naproxen.
Common S/E: gastric ulcers, increased bleeding
Take with full glass of water
DO NOT give with antacids; reduces absorption of drug.
Opioids
Formerly called narcotic analgesics
Controlled substances
Capable of controlling any type of pain
Most common S/E: sedation, nausea, and constipation AND RESPIRATORY DEPRESSION
POSS
Palermo Opioid-induced Sedation Scale
S-sleep; easy to arouse
1. Awake and Alert
2. Slightly drowsy, easily aroused
3. Frequently drowsy, arousable, drifts off to sleep during conversation
4. Somnolent, minimal or no response to verbal of physical stimulation
INCLUDE RESPIRATORY RATE AND QUALITY INITAL AND 30 MINS AFTER
Narcan
Opioid antagonist; reverses the respiratory depressant effect of an opioid.
Typically .4mg
S/E: of opioids
Respiratory depression Nausea and Vomiting Urinary retention Constipation Pinpoint pain Light-headedness/dizziness Confusion and disorientation Orthostatic Hypotension
Adjuvant or Co-analgesics
Used to enhance the effects of opioids but also have other purposes.
Can help reduce S/E of the opioid or lessen anxiety about pain
Commonly used adjuvant drugs:
Corticosteroids, anticonvulsants, and antidepressants
Methods to distribute Pain Meds
PCA pumps Local Nerve block Oral IM IV Pain Pump Spinal Chord Stimulator Epidural/spinal block Transdermal Transmuscousa
When assessing pain while using pain meds
Evaluate continually; 30-90 mins after admin
Assess for increased drug tolerance
Identify need for route of admin change, dosage change, or S/E
Ongoing assessment is imperative as long as pain persists
Timing is important
PRN drug regimen has not been proven effective for acute pain
Opioid use with children
- Assessment is crucial (use appropriate scale; face scale)
- Good communication with family
- Children need a routine postoperative analgesics or by continuous infusion b/c they do not speak up
Opioid use with the elderly
- Chronic pain is most common in the elderly
- Pain is not a natural occurrence in the elderly so pain is sometimes underrated
With the elderly avoid the use of ______________, _____________, ___________, and _______________ due to increased risk of toxicity.
Demerol, Davonte products, Talwin, Indocin
Avoid ________________ whenever possible for the elderly because of diminished muscle, fat stores, and circulation.
IM injections
