UNIT 11: NURSING SUPPORT OF COPING, SLEEP, & PAIN MANAGEMENT

A nurse is explaining the use of sleep hygiene to a client experiencing insomnia. Which statement accurately describes recommended guidelines for the use of this technique? Select all that apply. Drink an alcoholic beverage before bedtime. Eat a light meal before bedtime. Sleep in a dark room that is as warm as possible. Take a warm bath before bedtime.

Eat a light meal before bedtime. Take a warm bath before bedtime.

TYPE OF INJECTION

Intramuscular Angle of injection is 90-degrees. Acceptable volume of solution for injection is 1 to 5 mL. Intradermal Angle of injection is between 5-to 15-degrees. Recommended injection site for sensitivity tests. Subcutaneous Recommended injection site for heparin and insulin. Injection can be administered at a 45-or 90-degree angle.

The nurse is managing the environment for clients on a busy hospital unit. Which interventions would the nurse perform to facilitate a more restful environment? Select all that apply. Schedule procedures separately to avoid tiring out the clients. Keep the doors to the clients' rooms open. Medicate for pain if needed. Maintain a brighter room during daylight hours and dim lights in the evening.

Medicate for pain if needed. Maintain a brighter room during daylight hours and dim lights in the evening.

T/F: When using the Z-track technique the nurse should release the displaced tissue before withdrawing the needle.

False.

ACTIVITY 1

NSG122.11.01.01 FUNCTION OF SLEEP

ACTIVITY 2

NSG122.11.01.02 SLEEP DISORDERS

ACTIVITY 3

NSG122.11.01.03 NURSING PROCESS TO SUPPORT SLEEP & REST

ACTIVITY 4

NSG122.11.02.01 MAINETENANCE OF HOMESOSTASIS

ACTIVITY 5

NSG122.11.02.02 SOURCES AND EFFECTS OF STRESS

ACTIVITY 6

NSG122.11.02.03 ASSESSMENT & DIAGNOSIS STRESS OF COPING

ACTIVITY 7

NSG122.11.02.04 NURSING INTERVENTIONS STRESS

ACTIVITY 8

NSG122.11.03.01 PHYSIOLOGY OF PAIN

ACTIVITY 9

NSG122.11.03.02 PAIN EXPERIENCE

ACTIVITY 10

NSG122.11.03.03 PAIN ASSESSMENT & DIAGNOSES

ACTIVITY 11

NSG122.11.03.04 PAIN MANAGEMENT

ACTIVITY 12

NSG122.11.04.01 PRINCIPLES OF PARENTERAL MEDICATIONS

ACTIVITY 13

NSG122.11.04.02 ADMINISTRATION INTRADERMAL SUBQ & IM

PAIN PROCESS

Perception Involves the sensory process that occurs when a stimulus for pain is present. It includes the person's interpretation of the pain. Modulation The process by which the sensation of pain is inhibited or modified. Transduction The activation of pain receptors. Pain Threshold The "minimum intensity of a stimulus that is perceived as painful".

T/F: Most nurses and student nurses enjoy their education and work, coping with physical and emotional demands effectively. Some, however, become overwhelmed and develop symptoms of stress, or a complex of behaviors called burnout.

True.

T/F: The benefits of exercise include an improved musculoskeletal system, more effective cardiovascular function, weight control, and relaxation.

True.

T/F: During REM sleep, the client's temperature, pulse, blood pressure, and respirations increase.

True. During REM sleep, the client's temperature, pulse, blood pressure, and respirations increase. The client may experience small muscle twitching, such as facial muscles twitching, and irregular pulse rate and respirations. During non-eye movement sleep, the client will exhibit a decrease in body temperature, pulse, blood pressure, and respirations. During non-eye movement sleep, the client will exhibit a decrease in body temperature, pulse, blood pressure, and respirations. During non-eye movement sleep, the client will exhibit a decrease in body temperature, pulse, blood pressure, and respirations.

T/F: Sympathetic nervous system is responsible for initiating the fight-or-flight response to stress.

True. Functions of the sympathetic nervous system under stressful conditions bring about the fight-or-flight response. Sometimes called the rest-and-digest system, the parasympathetic system conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood. The respiratory system is a series of organs responsible for taking in oxygen and expelling carbon dioxide. The gastrointestinal system digests food and eliminates waste products.

T/F: In some religions, people view pain and suffering as a lack of goodness in themselves. Thus, pain and suffering are viewed as a means of purification or of making up for individual and community sin.

True. Religious beliefs can be a powerful influence on the person's experience of pain. In some religions, people view pain and suffering as a lack of goodness in themselves. Thus, pain and suffering are viewed as a means of purification or of making up for individual and community sin. This meaning helps the person to cope with pain, thus becoming a source of strength.

Which of the following should the nurse do when removing medication from a single-use vial? Inject a similar quantity of air into the vial before withdrawing the medication. Avoid tapping the barrel of the syringe if any air bubbles accumulate. Label the vial with the date and time it was opened. Scrub the self-sealing rubber stopper with alcohol after removing the plastic cap covering the vial.

Scrub the self-sealing rubber stopper with alcohol after removing the plastic cap covering the vial.

A client is being seen in the clinic due to insomnia that has been increasing in severity and frequency in recent months. What questions would the nurse include in an assessment of this client's health problem? Select all that apply. "Do you smoke?" "What medications are you currently taking?" "How would you state your mood is lately?" "Did your parents have difficulty with sleep?" "Did your siblings have difficult with sleep?"

"Do you smoke?" "What medications are you currently taking?" "How would you state your mood is lately?"

A nurse is teaching an alert client how to use a PCA system in the home. How will the nurse explain to the client what they must do to self-manage pain? "I will teach your family what they need to do." "You don't have to do anything. The machine does it all." "When you push the button, you will get the medicine." "The medicine is going into your body all the time."

"When you push the button, you will get the medicine."

The nurse is providing client education for the parents of an obese child diagnosed with obstructive sleep apnea. What treatment measures would the nurse explain during the education session? Select all that apply. Counseling for depression A weight loss plan Treatment with sleeping pills Use of a mandibular advancement device (MAD)

A weight loss plan Use of a mandibular advancement device (MAD)

NURSING STRATEGIES - AGE-RELATED CHANGES (OLDER ADULT)

Altered Physiologic Response to Analgesics Caution about use of alcohol with analgesics. Use memory aid if necessary to avoid overdosing. Communication Difficulties Monitor for any behavior changes or confusion after medication has been taken. Include family or caregiver to assist with information-gathering. Denial of Pain Emphasize importance of reporting pain to caregivers. Express concern about pain and willingness to help. Explain pain is not a normal consequence of aging.

Which of the following are some negative affects from stress? Select all that apply. Becomes less dependent on others Change in appetite Feels threatened or nervous Accepts reality Withdrawn and isolated Change in elimination patterns

Change in appetite Feels threatened or nervous Withdrawn and isolated Change in elimination patterns

ASSESSMENT FACTORS - PAIN EXPERIENCE

Characteristics of the Pain Location Affective Responses Anxiety Interaction with others Behavioral Responses Verbal expressions Physiologic Responses Nausea Vital signs

Which of the following is the recommended site for vaccine injection for an adult client? Vastus lateralis Deltoid Ventrogluteal Dorsogluteal

Deltoid

Which of the following are ways to decrease anxiety upon admission to a hospital? Select all that apply. Ensure that all health care providers introduce themselves by name and title. Assess past experiences with the health care system, including medical-surgical treatment for illness or injury. Determine expected outcomes of the plan of care without concern for patients wishes. Assess amount and type of support systems available. Restrict information about all diagnostic procedures, surgical procedures, activity, and diet. Assess physical status, sensory status, and cognitive status.

Ensure that all health care providers introduce themselves by name and title. Assess past experiences with the health care system, including medical-surgical treatment for illness or injury. Assess amount and type of support systems available. Assess physical status, sensory status, and cognitive status.

T/F: There is a decrease in the awareness of the environment in rest; this does not happen during sleep.

False. There is a decrease in the awareness of the environment in sleep; this does not happen during rest. Motor and cognitive response to stimuli may be decreased in both sleep and rest. Sleep is a whole body phenomenon, whereas rest may involve the whole body system or only a part. Motor and cognitive response to stimuli may be decreased in both sleep and rest.

T/F: It is a therapeutic measure in a sleep hygiene routine to play upbeat, loud music at night help relax.

False. This is an expected finding in a sleep history and does not need follow-up. This is a therapeutic measure in a sleep hygiene routine. This is abnormal assessment finding in a sleep history and requires follow-up. Pain medication should be taken 30 minutes prior to going to bed.

Which of the following would be good nursing diagnoses related to stress? Ineffective Denial related to continued smoking behavior Anxiety related to conflicts about values and goals in life, threat to self-concept Moral Distress related to cultural conflicts Impaired physical mobility related to hemiparesis Altered bowel elimination related to constipation Stress Overload related to single parenthood

Ineffective Denial related to continued smoking behavior Anxiety related to conflicts about values and goals in life, threat to self-concept Moral Distress related to cultural conflicts Stress Overload related to single parenthood

TYPES OF PAIN

Neuropathic Pain Occurs when there is actual nerve damage. Psychogenic Pain Physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors; headache, back pain, or stomach pain are some of the most common types. Cutaneous Pain The receptors are the types of sensory receptor found in the dermis or epidermis. Visceral Pain Poorly localized and originates in body organs in the thorax, cranium, and abdomen. The pain occurs as organs stretch abnormally and become distended, ischemic, or inflamed.

WORLD HEALTH ORGANIZATION THREE-STEP LADDER APPROACH - SUFFERING FROM CANCER PAIN

Nonopioid +/- Adjuvant Opioid for mild to moderate pain; +/- Nonopioid; +/- Adjuvant Opioid for moderate to severe pain; +/- Nonopioid; +/- Adjuvant

PAIN SCALE

Numeric Scale The scale is more appropriate for adults. Iowa Pain Thermometer The scale is more appropriate for older adults with cognitive impairment. Wong-Baker FACES Scale Children as young as three years of age can use this scale. CRIES Scale Scale is used with neonates < 6 months old.

PASERO AND MCCAFFERY (2011) - BASIC METHODS

Obtain the patient's self-report of pain. Identify pathologic conditions or procedures that may be causing pain; consider physiologic measures (increased blood pressure and pulse). However, most research verifies that reliance on vital signs to indicate the presence of pain should be minimized. The absence of an increase in vital signs does not mean that pain is not present. Consider patient behaviors that may indicate pain such as nonverbal behaviors (restlessness, grimacing, crying, clenching fists, protecting the painful area). Take into account the report of a family member, another person close to the patient, or a caregiver who is familiar with the patient. Attempt an analgesic trial and monitor the results.

PAIN MANAGEMENT

Opioid Analgesics (all controlled substances; e.g., morphine, codeine, oxycodone, meperidine, hydromorphone, methadone). Analgesic A pharmaceutical agent that relieves pain. Tolerance Occurs when the body becomes accustomed to the opioid and needs a larger dose (up to 10 times the original dose) for pain relief. Physical Dependence A phenomenon in which the body physiologically becomes accustomed to opioid therapy and suffers withdrawal symptoms if the opioid is suddenly removed or the dose is rapidly decreased. Diversion Any act that results in a drug not reaching the person who was originally prescribed the drug. Adjuvant Analgesics (anticonvulsants, antidepressants, multipurpose drugs).

What is the rationale for using CPAP to treat sleep apnea? Alternating waves of air stimulate breathing. Delivery of oxygen facilitates respiratory effort. Positive air pressure holds the airway open. Negative air pressure holds the airway closed.

Positive air pressure holds the airway open.

TYPES OF PAIN

Referred Pain Pain can originate in one part of the body but be perceived in an area distant from its point of origin. Acute Pain Generally rapid in onset and varies in intensity from mild to severe. It is protective in nature. Phantom Pain The pain that often occurs with an amputated leg where receptors and nerves are clearly absent, is a real experience for the patient. Chronic Pain Pain that lasts beyond the normal healing period. In clinical practice, the time frame associated with defining pain as chronic varies based on the cause and may be anywhere between 1 and 6 months, with three months commonly used in practice and six months used in research. Intractable Pain When pain is resistant to therapy and persists despite a variety of interventions.

The nurse is evaluating anxiety levels in the assigned client group. What should the nurse identify related to the four levels of anxiety that occur in people's lives? Select all that apply. Severe anxiety creates a very narrow focus on specific detail, causing all behavior to be geared toward getting relief. Although mild anxiety may interfere with sleep, it also facilitates problem solving. Moderate anxiety is present in day-to-day living, and it increases alertness and perceptual fields. During the panic stage, the person cannot learn, concentrates only on the present situation, and often experiences feelings of impending doom. Mild anxiety is manifested by a quivering voice, tremors, increased muscle tension, and a slight increase in respirations and pulse.

Severe anxiety creates a very narrow focus on specific detail, causing all behavior to be geared toward getting relief. Although mild anxiety may interfere with sleep, it also facilitates problem solving. During the panic stage, the person cannot learn, concentrates only on the present situation, and often experiences feelings of impending doom.

DESCRIBE PAIN

Severity Excruciating Moderate Quality Cramping Sharp Dull Periodicity Transient Continuous

Which behaviors represent positive coping mechanisms? Select all that apply. Taking a vacation Practicing yoga and meditation Learning relaxation techniques Sleeping 14 hours a night Avoiding crowds and social activity Setting limits with family members who upset you

Taking a vacation Practicing yoga and meditation Learning relaxation techniques Setting limits with family members who upset you

A client asks about general adaptation syndrome (GAS). Which details provided by the nurse are correct? Select all that apply. There are three stages to GAS. The resistance stage usually lasts for less than a day. The alarm stage of GAS can last from minutes to hours. It can be a response to physiologic or psychological stress.

There are three stages to GAS. The alarm stage of GAS can last from minutes to hours. It can be a response to physiologic or psychological stress.

The nurse should do which of the following when removing medication from an ampule? Change to a smaller gauge needle before administering the injection Use a filtered needle Cover the ampule if all the medication is not used Avoid inverting the ampule

Use a filtered needle

The technique that should be used for intramuscular injections to prevent leakage of medication into the needle track is known as the __________ method.

Z-track

The landmarks used to locate the ventrogluteal muscle for an intramuscular injection are the greater trochanter and ___________ crest.

iliac

Physical indicators of stress may include: Select all that apply. tense muscles amputations skin lesions hyperventilation hair growth cardiac dysrhythmias

tense muscles skin lesions hyperventilation cardiac dysrhythmias