Comfort & Pain_231203_124830........pptx

Comfort & Pain

1. The Me a ning of Com f o r t : T o gi v e st r ength and ho p e, t o cheer , and t o e a se the grief or trouble of anothe r . One of the greatest challenges for the nurse is to provide comfort to the patient. Promot i ng p h ysi c al com f o r t i s a vital pa r t of the role of a nu r se .

2. Definition: Com f o r t i s a st a te of f r eedom discom f o r t, tension & anxiet y . f r om pain, Comfort is define as “the contented enjoyment in physical or mental well-being, freedom from pain or trouble & anxiet y . ” Discomfort is define as want of comfort or ease due t o client or ann o yanc e .

3. Causes of discom f o r t: Pain. R estrict i on of m o v ements due t o weaknes s . I m pr o per a r r angement of pil l o w s . Lack of e xer c is e . Ext r eme tempe r a tu r e . Inadequ a te v enti l a t i o n .

4. Causes of discom f o r t: Indiges t ion, i r r e gular b o wel m o v ement s . Uncom f o r table posit i o n . Lack of slee p . Noise. Fear & anxiet y . Insecurity f eeling s . In t e r ruption of dai l y routine s .

5. Comfort devices: Pillows. Back Rest. Knee Rest. Rolls. Foot Rests/Foot Boards. Sand Bags. Air & Water Mattress. Rings Bed Cradle. Bed Blocks. Air Cushion.

6. Pillows

7. Back Rest

8. Knee Rest:

9. Rolls:

10. Foot Rests/Foot Boards:

11. Sand Bags:

12. Air & Water Mattress:

13. Rings:

14. Bed Cradle:

15. Bed Blocks:

16. Air Cushion:

17. Factor Influencing Com f o r t: Lack of comfort can be the result of many factors and can take ma n y f o r ms such as: An x iety & Naus e a. Dep r ession & P ain. D i a r rhea & P o we r lessnes s . Dyspnea & Urina r y R etent i on. F a t i gue Incontinence. Fear & H yp o xia

18. Pain Definition Unpleasant, subjecti v e senso r y and emotional e xpe r ie n ce as s oc i a ted with an a ctual or potential t i ssue dam a ge .

19. Nature of Pain: Subjective, highly individualized. Stimulus can be physical and/or mental in nature. P ain is tirin g , places deman ds o n per s o n ’ s ene r g y . Can i n t e r f e r e wi t h r el a t i o ns h ips a nd influ e nce the meaning o f li f e . Can n ot b e o b jecti v ely m e asu r e d . Ce r tain types o f pain prod u ce p r edictable s y mptom s . P ain A s se s sme n t - n u rse r elies o n clien t 's w o rds and behaviors. Pr o tecti v e p h y s iol o gic mechanism, changes be h avio r .

20. Type of Pain: Acute pai n . Chronic pai n . Idiop a thic pai n . Cancer pai n .

21. Physiological Response to Pain: PNS stimulated as pain impulses ascend the spinal cord. Pain of low to moderate intensity and superficial pain elicit the “fight or flight” reaction. Sympathetic stimulation results in physiologic responses (Increased heart rate, peripheral vasoconstriction, dilatation of bronchial tubes, increased blood sugar).

22. Physiological Response to Pain: Continuous pain or severe, deep pain (visceral) involving organs puts the parasympathetic system into effect. Parasympathetic stimulation results in pallor, muscle tension, decreased heart rate and BP, weakness, exhaustion.

23. Pain threatens physical & psychological well-being. Som e people choose not t o e xp r ess pain (belie f , v alue, cultu r al influences ) . Typical body m o v ements that indicate pain: clenchi n g teeth, grimace, holding area, bent posture. Behavioral Responses to Pain:

24. Acute P ain: Follows acute injury, disease, surgical intervention. R apid onset. V aries in intensi t y (mi l d - s e v e r e). Lasts a brief period of t i me (less than 6 months).

25. Examples of A cute P ain: Acute posto p e r a t i v e pai n . P ost t r au m a Fractures. Sof t t i s s ue in j u r y . Fla i l chest. Sta b i n ju r y . Labour pai n . P ost b u r n. Pain associated with cancer, acute zoster, neurological disease s , he m a to l ogi c al disorde r .

26. Chr o nic P ain: Prolonged. V aries i n in t ensi t y . Lasts longer t han 6 month s . Also known as chronic non-malignant pain. Examp l e: A r thri t i s , headache, m y o f ascial pain, l o w back pain.

27. Factors Influencing P ain: Age. Gender. Culture. M e ani n g of pai n . Attention. Anxiety. Fatigue. P r e vi o us Ex p er i enc e . Co p ing S t yl e . Fam i ly & Socia l Suppo r t.

28. Factors Affect Perception of Pain Age 🞑 Child – may not recognize sensation of pain or may have paradoxical reaction 🞑 Adolescent – may be expressed as “attitude,” anger, aggression 🞑 Older adult – may have trouble verbalizing because of perception that pain is “normal” part of aging

29. F ac t ors that m a y Affect P ain Culture 🞑 May impact level of pain one is willing to endure 🞑 Need to use assessment tools that are culturally sensitive

30. P erception of pain i s impact e d b y a g e and culture.

31. Nursing Process Assessment

32. H o w? B e gin with a pain histo r y: 🞑 Do you have pain now? 🞑 When did the pain begin? (Onset) 🞑 Where i s the p ain located ? (Loc a t i on) 🞑 H o w do y ou r at e y our p a in ? (use a p a i n scale) (Intensity) 🞑 How would you describe your pain? (Quality)

33. Quality of Pain What does it feel l i k e? Sharp? Aching? Stabbing? Burning? Crushing? Tingling ?

34. Intensity or S e v erity of P ain 🞑 H o w m u c h does it hu r t? 🞑 Pain Rating Scales imperative – Allows assessment of level of pain and effectiveness of interventions 🞑 0-10 scale 🞑 F aces P ain R ating Scale

35. P ain scales: Faces

36. P ain scales: Numerical

37. H o w? ( P ain H i sto r y) H o w o f ten do y ou ha v e pain? (F r equen c y) What ma k es the p ain b etter? (All e vi a t i ng Factors) What ma k es it w ors e ? (Agg r a v a t i ng Factors) Do you have any other symptoms when you are experiencing pain, i.e. nausea/vomiting? (Associated Factors)

38. H o w? ( P ain H i sto r y) Have you experienced this type of pain in the past? If so, how did you manage/cope with it? (History of P r e vious P ain Experience) Have you used any medications to treat the pain? If s o , what ha v e y ou used and w as it eff e cti v e? What, if any, alternative treatments have you used for pain?

39. Asses s ment: Cl i en t 's e xp r ession of pai n . Cha r acte rist i cs of pai n . On set & du r a t i on. Location. In t ensity ( P ain s c ale s - nu m erical, Faces). Quality. P ain p a t t e r n. Co n com i tant Sy m pt o m s . Effect of pain on client (physical, behavioral, effect on acti v e dai l y l i v e).

40. Nursing Di a gnosis: Anxiety. P ain (A c ute or Chr o nic). Sel f - ca r e Defici t . Slee p P a t t e r n D ysf u nction.

41. Nursing Implement a tion: Non - P h a r ma c ol o gical Metho d s . P h a r ma c ol o gical Metho d s . Pr o vi d e ed u c a tion and c o u n seli ng . Non-pharmacologic methods-lessen pain, can be used a t h o me o r in h o s p ital. Utilize cognitive-behavioral & physical approaches.

42. Non-pharmacological Methods: Min d - B o dy the r a p y . He a t/C o ld the r a p y . Massage. Acupuncture. P h y s ical The r a p y . Transcutaneous Electrical Nerve stimulator (TENS).

43. Mind - body the r apies T o help the min d ’ s ab i l i ty t o a f f ect the fu n cti o ns and s ympt o ms o f the bod y . Mind-body therapies use various approaches, including relaxation techniques, meditation and R e l a x a ti o n techni q ues can help all e v i a t e h y p n o si s . di s com f o r t r el a ted to chr o nic pain .

44. Acupunctu r e: To decrease pain by increasing the release of chemicals that block pain, called endorphins. Many acu-points are near ne r v e s . When stimulated, these nerves cause a dull ache or f eeling o f fullne s s in the muscle . The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins (morphine-like chemicals produced in our own bodies during times of pain or st r ess) .

45. Massage : Is being increasingly used by people suffering from pain, mostly to manage chronic back and neck problems. Massage can reduce stress and relieve tension by en h anci n g bl o od fl o w . This treatment also can reduce the presence of substances that may generate and sustain pain. Massage has been found to relieve chronic back pain.

46. P h ysical The r a p y ( PT) : Is a form of rehabilitative therapy that uses equipment and exercises to help patients regain or improve their p h y s ical abilitie s . It may help adults suffering from sciatica or the after e f f ects o f inj u r y o r s u r ge r y . P T may e v en help elde r ly p o s t - stroke p a tient s .

47. T r anscutaneo u s electr i cal ne r v e stimul a tion ( TENS): Un i t ut i l i z es l o w - v ol t a ge e lectri c al s tim u l a t ion to the nerves to block pain signals to the brain. Electrodes are placed on the skin and emit the electrical charge. This is used primarily for chronic, localized pain, which is int r act a ble .

48. Pha r maco l o g ic metho d s r equ i r e a p h ysician's orde r : G u idelines set b y r e gul a to r y a gencie s . A n algesics mo s t c o mmon m eth o d. T en d ency to u n der t r e a t with pain med s . Non-opioid or non-narcotic agents & non-steroidal anti- inflam m a to r y a gents (NS A IDS). Narcotic s , Opi o id s . A d ju v ant s , C o - analge s ic s . Steroid.

49. Anal g esics Used f or P ain 3 common groups of drugs used f or pain management 🞑 Opioids 🞑 Nonopioids 🞑 Adjuvants

50. Pain Medications: Opioid Analgesics W o r k o n pain b y bl o cking r ecepto r s in the Cent r a l Ne r v o u s Sy s tem

51. Opioi d A nalgesics Morphine sulfate Fentanyl

52. Nonopioid Analgesics Used to relieve mild to moderate pain, acute or chronic (also may r eli e v e inflam m a t ion and f e v er) Acetaminophen (Tylenol) (minimal anti-inflammatory effect) NS A IDS (n o n s teroidal ant i - inflamm a to r y dr u gs) 🞑 aspirin 🞑 i b upro f en (Motr i n, Ad v i l ) 🞑 P r escrip t i o n N S A I DS: Celeb r e x, V o l ta r en, I n d ocin and o t hers

53. Adju vant Medic a tions 🞑 Enha n ce the an a lgesic e f f ect o f opioids 🞑 Anticonvulsants 🞑 Antidepressants 🞑 Sedatives 🞑 Steroids

54. P a tien t - Control l ed Analgesia Drug d eli v e r y s y stem. P a tients ha v e co n trol o v er p ain the r a p y . Safe method for post-op, traumatic, or cancer pain. Self-administration without risk of overdose. IV administration.