MNAMosby’s Long Term Care Assistant Chapter 27 Comfort, Rest and Sleep

ComfortState of well being

No physical and emotional pain

OBRA has certain room requirements to promote comfort

Comfort

OBRA requirements:

No more then 4 to a room

Clean, comfortable

Curtain for privacy

Appropriate linens

Odor free

Temp btw 71 – 81

Appropriate lighting

Adequate ventilation

Pain

SubjectiveA warning from

the bodyTypes:Acute

Chronic

Radiating

Phantom

Sudden, last short timeLasts longer then 6 months, constant or on and off. Felt at site of tissue damage and in nearby areasFelt in a body part that is no longer there

Factors effecting pain

Past experience

Anxiety

Rest and Sleep

Attention

Personal and family duties

Value or meaning of pain

Support from others

Culture

Age/illness

Words Used to Describe Pain

Aching

Burning

Cramping

Crushing

Dull

Gnawing

Knifelike

Piercing

Pressure

Sharp

Sore

Squeezing

Stabbing

Throbbing

Vise-like

Signs and Symptoms

Location

Onset and Duration

Intensity

Description

Factors causing pain

Vital signs

Other signs and symptoms

On a scale of 1 - 10

10 is the worst

Nursing Measures for Pain control

Distraction - change the person’s center of attention

Relaxation - free from mental or physical stress

Guided Imagery - creating and focusing on an image

Watch for S&S from drugs used to relieve pain.

Wait 1 hour after pain medicine to

provide assistance with ADLs.

RestBeing calm, at ease and relaxed

Reading, music, hobbies

You can promote rest by meeting patient’s needs:•Physical

•Safety and security

•Love and belonging

•Self-esteem

Injured or ill people need to rest more often

Sleep

A state of unconsciousness,reduced voluntary muscle activity and lowered metabolism

A basic need

A person thinks and functions better after sleep

Insomnia – inability to fall asleep or stay asleep.

Sleep

Two phases of sleep:

NREM – non rapid eye movement. Starting to fall asleep

REM – rapid eye movement. Deep sleep

Need for sleep decreases with

age.

Avg. sleep req. for older adults: 5 – 7 hours

Factors Effecting Sleep

Illness - need for sleep

Nutrition - sleep needs with weight gain. Foods with caffeine prevent sleep

Exercise - improves health and fitness. Improves sleep

Environment

Factors Effecting Sleep

Drugs and other substances

Life style changes

Emotional problems - fear, worry, anxiety interfere with sleep

Nursing Measures to Promote Sleep

Organize care for uninterrupted sleep

Provide comfortable room temp

Avoid caffeineHave the resident void

before bedtimeFollow bedtime rituals

Nursing Measures to Promote Sleep

Dress in comfortable nightwear

Reduce noiseDarken the roomMake sure linens,

depends are clean & dryPosition in good

alignmentBack massage

Sleep Walking

Protect the resident from injury

Guide the resident back to bed

Gently wake the resident

Residents with Dementia

Sleep problems are common

Restlessness & confusion @ night

Allow safe wandering if possible

Redirect to room

Review

Pain is an objective sign.

True or False

Review

Person’s with dementia will usually sleep well at night.?

True False

Review

Pain that is sudden and short lasting is called

____________________Acute pain

Review

The nurse gave Mr. Johnson a drug for pain. You should wait how long before providing assistance with ADLs?

One hour

Review

The inability to fall asleep or stay asleep is

___________________________. insomnia

Review

Feeling pain in a body part that is no longer there:

______________________.Phantom pain

Review

What is REM sleep?

Rapid eye movement:

deep sleep

Review

HS

Ad lib

prn

Stat

qod

Hours of sleep

As desired

As needed

immediately

Every other day

Review

Bid

Tid

C

S

X

Twice a day

Three times a day

with

without

except

Review

Mr. Marshall has dementia. He cannot tell you that he is in pain. How can you tell?

His behavior will change

Review

Use the resident’s exact words when reporting pain to the nurse.

True or False

Review

You find a resident sleepwalking. You should do all of the following except:

A. Protect the resident from injury

B. Guide the resident back to bed

C. Gently wake the resident

D. Turn on the lights

PiercingPressureSharpSoreSqueezingStabbingThrobbingVise-like

What are some words used to describe pain?

Aching

Burning

Cramping

Crushing

Dull

Gnawing

Knifelike

Review

Mr. Parker is 72 years old.

He needs approx. ________

hours of sleep each night .

5-7

Questions??