Pain as an alterative to comfort
- 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
How pain is described
- duration
- intensity
- etiology
- location
sleep-rest disorders
- insomnia
- narcolepsy
- parasomnias
- RLS
- sleep apnea
Non-modifiable risk factors for alterations ofcomfort
- 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
Modifiable risk factors for alterations ofcomfort
- personal perference
- lifestyle habits
- nutrition
- smoking
- alcohol use
- sleep hygiene
- occupation
- culture
Assessment of sleep
patient hx
- nursing interview
- client’s culture affects how client perceives discomfort and pain
nursing interview for sleep assessment
- client description of symptoms
- pain scale
- depression assessment
common questions for sleep assessment
- when did it start?
- meds?
- environment conducive for sleep?
- creepy, crawling legs?
- limb jerking?
- snore?
- shift worker?
- bedtimes?
- caffeine, tobacco, alcohol?
- street drugs?
diagnostic tests for sleep
- primary test: Polysomnography (PSG) - sleep study
* Electroenceohalogram (EEG)
Polysomnography (PSG)
records client’s :
- SpO2
- HR
- RR
- eye and leg movement
Surgical procedures for sleep
- usually surgery to remove obstruction
- adenotonsillectomy
- partial removal of the soft palate, uvula, and posterior lateral pharyngeal wall
Surgery is only considered if…
CPAP is not tolerated
adenotonsillectomy
commonly performed to treat OSA in children
OSA
obstructive sleep apnea
* surgery is done to remove the obstruction
sleep hygiene
variety of sleep practices that help individuals attain good-quality sleep
sleep practices for sleep hygiene
- 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
medications for sleep
- primary: sedative-hypnotics
- occasionally used: antiparkinson drugs, opioids, and anti convulsants
sedative-hypnotic
~anxiolytics
~barbiturates
~benzodiazepines
Important characteristic for sleep meds
half-life of the drug
infant considerations for comfort
~challenging to discern cause of discomfort
~may percieve pain to greater extent
older adult considerations for comfort
~may have higher pain threshold but lower tolerance
~cognitive impairment and sleep disorders
ethnicity considerations for comfort
be culturally competent
age & developmental stage affect ability to describe pain
special considerations for assessing discomfort and promoting comfort for each stage
NREM
~activity in the RAS is inhibitied
~75%-80% of sleep during the night
~4 stages
