comfort and pain/ sleep and rest
What is sleep hygiene?
Practices that a patient associates with sleep such as walking, avoiding foods, and caffine reductions.
How does the nurse promote sleep for the hospitalized patient?
Preparing a restful enviornment, promoting bed time rituals, offering approriate bed time snacks and drinks, promoting relaxation, promoting comfort, minimizing sleep distractions.
What are the patient's rights in treatment of pain as the fifth vital sign?
Routine measurement of vital signs accompanied by a pain assessment was thought to raise awareness of the existence of pain, place additional emphasis on optimizing pain relief, and move patients more quickly toward comfort and recovery.
How are responses to pain differ among cultures?
Cultural norms, also known as social norms, dictate much of our daily behavior, attitudes, and values.
analgesic
drug that relieves pain - reduce the perception of pain and alter responses to discomfort
What are factors affecting the pain experience?
duration, its localization/location, or its etiology.
chronic pain
episode of pain that lasts for 6 months or longer; may be intermittent or continuous -rheumatoid arthritis
acute pain
episode of pain that lasts from seconds to less than 6 months ~"protective in nature" (warns an individual of tissue damage or disease)
Hypersomnia
excessive daytime sleepiness
phantom pain
pain felt in a body part that is no longer there
psychogenic pain
pain for which no physical cause can be identified
neuropathic pain
pain from damage to neurons of either the peripheral or central nervous system - result of surgery, diabetes, spinal cord injury, trauma, disease, chemicals, infections, tumors -phantom leg pain
somatic pain
pain originating from muscle, bone, joints, tendons, or blood vessels - diffuse/ scattered pain
referred pain
pain that is felt in a location other than where the pain originates
Parasomnias
patterns of waking behavior that appears during sleep Abnormal behaviors such as nightmares or sleepwalking that occur during sleep.
What are common responses to pain?
physiologic, behavioral, affective
visceral pain
poorly localized pain that originates from organs or smooth muscles
Endorphins
"morphine within"--natural, opiatelike neurotransmitters linked to pain control and to pleasure. (opioid neruomodulator) ~chemical released in the body during relaxation to relieve pain
Key Concepts, Chapter 23 - The Aging Adult
- Biologic, psychosocial, and environmental factors influence the aging process. - Adults from 40 to 65 years of age are considered middle adults, while anyone older than 65 years is an older adult. - Middle-aged adults who practice preventive health practices often have improved quality and quantity of life. - Chronic diseases in middle-aged adults can have a major effect on self-concept and may precipitate changes in life structure. - Adjustments associated with the middle adult years may include changes in employment, changes in spousal relationships, and increased caregiver responsibilities. - Eighty percent of older adults suffer from at least one chronic illness. - Pain is often experienced by older adults but is not a normal consequence of aging. - Older adults use more health care than any other age group. - Prolonged social isolation has been associated with declining health and higher mortality rates. The complicated medical regimens typical of care for older adults are a challenge for them and require careful attention and diligence. - Falls are the most common cause of injury and hospital admissions for older adults. - Family members are most often the perpetrators of older adult abuse. - A medical or surgical event can trigger a sequence of adverse events in a frail older adult that is referred to as cascade iatrogenesis. - The focus of nursing care for older adults is to assist them to function as independently as possible and to support their individual strengths.
Key Concepts, Chapter 8 - Communication
- Communication is the process of exchanging information and generating and transmitting meanings between two or more people. - The components of the communication process include a stimulus, a source, the message, the channel of communication, a receiver, and feedback. - Messages can be sent and received through verbal and nonverbal communication techniques. - Verbal communication depends on language, while nonverbal communication involves body language. - The challenges of using social media to communicate include protecting patient privacy and confidentiality and preventing unintended consequences for the nurse and the employer. - The four levels of communication include intrapersonal communication, interpersonal communication, small-group communication, and organized communication. - Factors influencing communication include level of development; biological sex; sociocultural differences; roles and responsibilities; space and territoriality; physical, mental and emotional state; and environment. - Assessment related to communication involves gathering information in both verbal and nonverbal forms. - The SBAR technique (Situation, Background, Assessment, and Recommendations) is one format for hand-off communication used in health care. - A helping relationship exists among people who provide and receive assistance in meeting human needs. - A helping relationship has three phases: the orientation phase, the working phase, and the termination phase. - When developing professional therapeutic communication skills, nurses should develop conversation and listening skills; use silence, touch, and humor appropriately; and improve interviewing techniques. - The failure to verbalize clearly and compassionately blocks effective communication. - Disruptive behavior has a negative effect on clinical outcomes, patient safety, and interpersonal communication. - Incivility and bullying, horizontal violence and lateral violence are all forms of disruptive behavior and communication.
Key Concepts, Chapter 22 - Conception Through Young Adult
- Growth and development occur during all stages in life. - Health risks are prevalent in all stages of development. - The growth and development of the embryo and fetus are orderly and continuous. - Health difficulties that may occur during the neonate phase include difficulties during the birth process and the transition to extrauterine life, and congenital anomalies. - Nurses promote health during the infant stage by teaching family members and caregivers about immunizations, infant colic, failure to thrive, and the risks for sudden infant death syndrome (SIDS), and child maltreatment. - Nurses promote health for toddlers by teaching caregivers and parents to encourage their child's independence while setting firm limits. - Preschoolers are prone to accidents, at risk for communicable diseases and respiratory infections, and at risk for developing future health consequences if they are obese. - Common health-related problems in school-aged children include accidents, obesity, attention-deficit hyperactivity disorder (ADHD), learning disability (LD), and enuresis. - Adolescence and young adulthood are times of maximum physiologic development, including profound changes in reproductive functioning.
What are the components of a pain assessment?
- Patient's verbalization and description of the pain - Duration of the pain - Location of the pain - Quantity and intensity of the pain - Quality of the pain - Chronology of the pain - Aggravating factors - Alleviating factors - Physiologic indicators of the pain - Behavioral responses - Effect of the pain experience on activities and lifestyle ~should ask direct and specific questions about the nature of the pain; avoid irrelevant and closed-ended questions
Define the following: referred pain, nociceptive pain, neuropathic pain, intractable pain, phantom pain, psychogenic pain
- Referred Pain: pain in an area removed from that in which stimulation has its origin - Nociceptive Pain: pain from a normal process that results in noxious stimuli being perceived as painful - Neuropathic Pain: pain that results as a direct consequence of a lesion or disease affecting abnormal functioning of the peripheral nervous system (PNS) or central nervous system (CNS) - Intractable Pain: severe pain that is extremely resistant to relief measures - Phantom Pain: sensation of pain without demonstrable physiologic or pathologic substance; commonly observed after the amputation of a limb - Psychogenic Pain: pain for which no physical cause can be identified
What are common misconceptions related to pain and pain management?
- The doctor has prescribed pain-relieving medication for me, which I will be given routinely. - If I ask for something for my pain, I will immediately become addicted to the medication. - Sometimes it is better to put up with the pain than to deal with the side effects of the pain medication.
Key Concepts, Chapter 21 - Developmental Concepts
- The processes of growth and development result from the interaction between heredity and environment. - Growth and development are orderly and sequential as well as continuous and complex. - Many factors influence growth and development, such as genetics, environment, and nutrition. - Genetics, genomics, and epigenetics affect growth and development, including the expression of risk factors and manifestations of specific disease processes. - Multiple theorists have developed theories to explain human responses at certain ages during life. - Sigmund Freud's theory of psychoanalytic development emphasizes the effect of instinctual human drives on behavior. - Jean Piaget developed a theory of cognitive development that progresses from infancy through adolescence. - The theories of psychosocial development proposed by Erik Erikson are based on stages of development, developmental goals or tasks, psychosocial crises, and the process of coping. - Robert Havighurst believed that living and growing are based on learning and adjustment to changing social conditions. - Laurence Kohlberg's theory of moral development recognized the influence of cultural effects on a person's perception of justice in interpersonal relationships. - James Fowler's theory focuses on the spiritual identity of humans. - Nurses must plan care based on a person's general and unique health needs with attention to growth and development processes and alterations in health status.
Pain Theories
-Pattern theory -Specificity theory -Gate control theory -Neuromatrix theory
Remissions and exacerbations
-may mark the course or progress of a disease -During a remission, the manifestations of the disease subside, whereas during an exacerbation the signs increase. -Rheumatoid arthritis typically has periods of remission when pain and swelling are minimal, alternating with acute periods when swelling and pain are severe.
pain distractions
1. tactile kinesthetic= holding, stroking a loved one, pet or toy; rocking; slow breathing 2. project distraction= playing a challenging game or doing meaningful work 3. visual distraction= reading or watching television 4. auditory distraction= music
Melatonin
A hormone manufactured by the pineal gland that produces sleepiness. -produced at night to promote sleep and decrease wakefulness
What is naloxone (Narcan)?
A narcotic antagonist that reverses the effects of opioids
What is REM Sleep?
A state of active, irregular sleep associated with dreaming; rapid eye movement associated with it
What is an antianxiety?
An anxiolytic is a medication, or other intervention, that reduces anxiety.
How do developmental factors affect sleep?
As you get older, the less sleep is required to preform bodily functions. ~children and adolescence require 10-14 hours ~adults is 7-9 *obesity is more common in children and adults who do not get enough sleep
What are challenges facing assessment of pain in older adults?
Assessing pain in the older adult population can be challenging. Adults over the age of 65 experience pain more frequently than do younger adults. -boredom, loneliness, and depression may affect and older adults perception and report of pain
CPAP vs BiPAP
CPAP: -blows constant (+) pressure while you breathe in to keep airway open -blows the same pressure when you exhale BiPAP: -blows set pressure while you breathe in -blows lower pressure while you breathe in so it's easier to exhale
What are common terms used to describe the quality of pain?
Descriptors such as "beating," "penetrating," and "hot" are used to describe pain quality.
What factors affect sleep?
Developmental Considerations, Motivation, Culture, Lifestyle and Habits, Environmental, Psychological Stress, Illness and Medications. - exercising within 2 hours of bedtime can hinder ability to sleep
sedative-hypnotics
Drugs that can act in the body either as sedatives or as hypnotics. ~loses effectiveness after 1-2 weeks
What are physical and psycological effects of insufficient sleep?
Insufficient sleep in children may affect normal growth and development and could be a contributing factor in performance deficits and behavioral problems.
What are non-pharmacological approaches to pain management?
Education and psychological conditioning, Hypnosis, Comfort therapy, Physical and occupational therapy, Psychosocial therapy/counseling, and Neurostimulation
What is Restless Leg Syndrome (RLS)?
Patients cannot lie still and report unpleasant creeping, crawling or tingling sensation
What is a patient-controlled analgesia (PCA)?
Method of drug delivery that permits the client to self-administer opioids on an "As needed basis". PCA device has a timing control, limits the total dose that can be administered each hour. -nurse should verify settings with another nurse before programming PCA **Patient controlled, NOT FAMILY!!
What is NREM Sleep?
Non-rapid eye movement (NREM) sleep has 3 stages: Stage N1 occurs right after you fall asleep and is very short (usually less than 10 minutes). It involves light sleep from which you can be awakened easily. Stage N2 lasts from about 30 to 60 minutes. During this stage, your muscles become more relaxed and you may begin to have slow-wave (delta) brain activity. Stage N3 is deep sleep and lasts about 20 to 40 minutes. During this stage, delta brain activity increases and a person may have some body movements. It is very hard to wake up someone in stage N3. ~parasympathetic NS dominates throughout the stages; decreases in temperature, pulse, respirations, and BP
Discuss sleep cycle.
Normally during a , a person passes consecutively through the four stages of NREM sleep. This pattern is then reversed, and the person returns from stage IV to stage III to stage II. Instead of reentering stage I and awakening, the person enters into the REM stage of sleep, after which the person reenters NREM sleep at stage II and returns to stages III and IV. A person awakened from sleep at any time will return to sleep by starting at stage I of NREM sleep.
What is sleep apnea?
Obstructive sleep apnea (OSA) is a potentially serious sleep disorder in which the throat muscles intermittently relax and block the airway during sleep, causing breathing to repeatedly stop and start ~irregular snoring and silence, followed by a snort is an indicator
Morphine
Opioid Analgesic - common side effects= sedation, nausea, constipation
What are challenges facing assessment of pain in children?
Previously, it was believed that young children lacked the neurologic development to sense pain the way adults do. Thus, pain relief was not a priority when children were hospitalized. -children are unable to understand the the concept and cause of pain, and may have difficulty describing it. -crying and touching/ grabbing the painful body part are observations that may indicate pain in a child
What is the difference between sleep and rest?
Rest refers to a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed. Sleep is a state of rest accompanied by altered consciousness and relative inactivity
RAS
Reticular Activating System Part of brain stem involved in arousal and attention, sleep and wakefulness, and control of reflexes. -wakefulness occurs when the RAS experiences stimuli (including pain) prom peripheral organs and cells
TENS unit
Transcutaneous electrical nerve stimulation; Allows the client to wear an electronic device and trigger an electrical stimulation when he or she feels pain; Gentle electric shock blocks pain signal before it can reach the brain, allowing muscles to relax; Stimulates the production of endorphins
How is obstructive sleep apnea treated?
Weight loss and CPAP Refractory: surgical resectoin of uvula, palate, and pharynx
What is a hypnotic drug?
a drug that produces drowsiness and sleep
nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? Select all that apply. A. A patient who has uncontrolled hypothyroidism. B. A patient with coronary artery disease. C. A patient who has GERD. D. A patient who is HIV positive. E. A patient who is taking corticosteroids for arthritis. F. A patient with a urinary tract infection.
a, b, c. A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has GERD may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.
A nurse is caring for an older adult who is having trouble getting to sleep at night and formulates the nursing diagnosis Disturbed sleep pattern: Initiation of sleep. Which nursing interventions would the nurse perform related to this diagnosis? Select all that apply. A. Arrange for assessment for depression and treatment. B. Discourage napping during the day. C. Decrease fluids during the evening. D. Administer diuretics in the morning. E. Encourage patient to engage in some type of physical activity. F. Assess medication for side effects of sleep pattern disturbances.
a, b, e, f. For patients who are having trouble initiating sleep, the nurse should arrange for assessment for depression and treatment, discourage napping, promote activity, and assess medications for sleep disturbance side effects. Limiting fluids and administering diuretics in the morning are appropriate interventions for Disturbed Sleep Pattern: Maintaining Sleep.
A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? Select all that apply. A. Daily mental activities B. Daily physical activities C. Morning and evening body temperature D. Daily measurement of fluid intake and output E. Presence of anxiety or worries affecting sleep F. Morning and evening blood pressure readings
a, b, e. A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is not usually kept in a sleep diary.
The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of behavioral responses to pain? Select all that apply. A. A patient cradles a wrist that was injured in a car accident B. A child is moaning and crying due to a stomachache C. A patient's pulse is increased following a myocardial infarction D. A patient in pain strikes out at a nurse who attempts to provide a bath E. A patient who has chronic cancer pain is depressed and withdrawn F. A child pulls away from a nurse trying to give an injection
a, b, f. Protecting or guarding a painful area, moaning and crying, and moving away from painful stimuli are behavioral responses. Examples of a physiologic or involuntary response would be increased blood pressure or dilation of the pupils. Affective responses, such as anger, withdrawal, and depression, are psychological in nature.
A nurse is monitoring patients in a hospital setting for acute and chronic pain. Which patients would most likely receive analgesics for chronic pain from the nurse? Select all that apply. A. A patient is receiving chemotherapy for bladder cancer B. An adolescent is admitted to the hospital for an appendectomy C. A patient is experiencing a ruptured aneurysm D. A patient who has fibromyalgia requests pain medication E. A patient has back pain related to an accident that occurred last year F. A patient is experiencing pain from second-degree burns
a, d, e. Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain. Acute pain is generally rapid in onset and varies in intensity from mild to severe, as occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.
A nurse caring for patients in a long-term care facility is implementing interventions to help promote sleep in older adults. Which action is recommended for these patients? A. Increase physical activities during the day. B. Encourage short periods of napping during the day. C. Increase fluids during the evening. D. Dispense diuretics during the afternoon hours.
a. In order to promote sleep in the older adult, the nurse should encourage daily physical activity such as walking or water aerobics, discourage napping during the day, decrease fluids at night, and dispense diuretics in the morning or early evening.
A nurse observes involuntary muscle jerking in a sleeping patient. What would be the nurse's next action? A. No action is necessary as this is a normal finding during sleep. B. Call the primary care provider to report possible neurologic deficit. C. Lower the temperature in the patient's room. D. Awaken the patient as this is an indication of night terrors.
a. Involuntary muscle jerking occurs in stage I NREM sleep and is a normal finding. There are no further actions needed for this patient.
To promote sleep in a patient, a nurse suggests what intervention? A. Follow the usual bedtime routine if possible. B. Drink two or three glasses of water at bedtime. C. Have a large snack at bedtime. D. Take a sedative-hypnotic every night at bedtime.
a. Keeping the same bedtime schedule helps promote sleep.
A nurse is caring for patients in a hospital setting. Which patient would the nurse place at risk for pain related to the mechanical activation of pain receptors? A. An older adult on bedrest following cervical spine surgery B. A patient with a severe sunburn being treated for dehydration C. An industrial worker who has burns caused by a caustic acid D. A patient experiencing cardiac disturbances from an electrical shock
a. Receptors in the skin and superficial organs may be stimulated by mechanical, thermal, chemical, and electrical agents. Friction from bed linens causing pressure sores is a mechanical stimulant. Sunburn is a thermal stimulant. An acid burn is the result of a chemical stimulant. An electrical shock is an electrical stimulant.
The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient? A. CRIES scale B. COMFORT scale C. FLACC scale D. FACES scale
a. The CRIES Pain Scale is a tool intended for use with neonates and infants from 0 to 6 months. The COMFORT Scale, used to assess pain and distress in critically ill pediatric patients, relies on six behavioral and two physiologic factors that determine the level of analgesia needed to adequately relieve pain in these children. The FLACC Scale (F—Faces, L—Legs, A—Activity, C—Cry, C—Consolability) was designed for infants and children from age 2 months to 7 years who are unable to validate the presence or severity of pain. The FACES Scale is used for children who can compare their pain to the faces depicted on the scale.
When the nurse assists a patient recovering from abdominal surgery to walk, the nurse observes that the patient grimaces, moves stiffly, and becomes pale. The nurse is aware that the patient has consistently refused pain medication. What would be a priority nursing diagnosis for this patient? A. Acute Pain related to fear of taking prescribed postoperative medications B. Impaired Physical Mobility related to surgical procedure C. Anxiety related to outcome of surgery D. Risk for Infection related to surgical incision
a. The patient's immediate problem is the pain that is unrelieved because the patient refuses to take pain medication for an unknown reason. The other nursing diagnoses are plausible, but not a priority in this situation.
What is a non-opioid analgesic?
acetaminophen and NSAIDs, are usually the drugs of choice for both acute and persistent moderate chronic pain.
PRN drug order
as needed ~effective later in the post operative period to relieve occasional pain episodes ~most common method for ordering sleep medications
PAINAD scale
assessment tool for pain in individuals with advanced dementia/ cognitive impairment; assesses 5 common behaviors: breathing, vocalization, facial expression, body language, and consolability. A score of 4 or above indicates a need for pain management.
A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep? Select all that apply. A. A patient who is taking iron supplements for anemia. B. A patient with Parkinson's disease who is taking dopamine. C. An older adult taking diuretics for congestive heart failure. D. A patient who is taking antibiotics for an ear infection. E. A patient who is prescribed antidepressants. F. A patient who is taking low-dose aspirin prophylactically.
b, c, e. Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems.
A nurse instructor is teaching a class of student nurses about the nature of pain. Which statements accurately describe this phenomenon? Select all that apply. A. Pain is whatever the health care provider treating the pain says it is B. Pain exists whenever the person experiencing it says it exists C. Pain is an emotional and sensory reaction to tissue damage D. Pain is a simple, universal, and easy-to-describe phenomenon E. Pain that occurs without a known cause is psychological in nature F. Pain is classified by duration, location, source, transmission, and etiology
b, c, f. Margo McCaffery offers the classic definition of pain that is probably of greatest benefit to nurses and their patients, "Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does" (1968, p. 95). The International Association for the Study of Pain (IASP) further defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP, 2014b). Pain is an elusive and complex phenomenon, and despite its universality, its exact nature remains a mystery. Pain is present whenever a person says it is, even when no specific cause of the pain can be found. Pain may be classified according to its duration, its location or source, its mode of transmission, or its etiology.
A nurse on a maternity ward is teaching new mothers about the sleep patterns of infants and how to keep them safe during this stage. What comment from a parent alerts the nurse that further teaching is required? A. "I can expect my newborn to sleep an average of 16 to 24 hours a day." B. "If I see eye movements or groaning during my baby's sleep I will call the pediatrician." C. "I will place my infant on his back to sleep." D. "I will not place pillows or blankets in the crib to prevent suffocation."
b. Eye movements, groaning, grimacing, and moving are normal activities at this age and would not require a call to the pediatrician. Newborns sleep an average of 16 to 24 hours a day. Infants should be placed on their backs for the first year to prevent SIDS. Parents should be cautioned about placing pillows, crib bumpers, quilts, stuffed animals, and so on in the crib as it may pose a suffocation risk.
When assessing pain in a child, the nurse needs to be aware of what considerations? A. Immature neurologic development results in reduced sensation of pain B. Inadequate or inconsistent relief of pain is widespread C. Reliable assessment tools are currently unavailable D. Narcotic analgesic use should be avoided
b. Health care personnel are only now becoming aware of pain relief as a priority for children in pain. The evidence supports the fact that children do indeed feel pain and reliable assessment tools are available specifically for use with children. Opioid analgesics may be safely used with children as long as they are carefully monitored.
A nurse is performing a sleep assessment on a patient being treated for a sleep disorder. During the assessment, the patient falls asleep in the middle of a conversation. The nurse would suspect which disorder? A. Circadian rhythm sleep-wake disorder B. Narcolepsy C. Enuresis D. Sleep apnea
b. Narcolepsy is an uncontrollable desire to sleep; the person may fall asleep in the middle of a conversation.
Applying the gate control theory of pain, what would be an effective nursing intervention for a patient with lower back pain? A. Encouraging regular use of analgesics B. Applying a moist heating pad to the area at prescribed intervals C. Reviewing the pain experience with the patient D. Ambulating the patient after administering medication
b. Nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain. The other choices do not involve attempts to stimulate large nerve fibers that interfere with pain transmission as explained by the gate control theory.
A nurse is assessing a patient receiving a continuous opioid infusion. For which related condition would the nurse immediately notify the primary care provider? A. A respiratory rate of 10/min with normal depth B. A sedation level of 4 C.Mild confusion D. Reported constipation
b. Sedation level is more indicative of respiratory depression because a drop in level usually precedes it. A sedation level of 4 calls for immediate action because the patient has minimal or no response to stimuli. A respiratory level of 10 with normal depth of breathing is usually not a cause for alarm. Mild confusion may be evident with the initial dose and then disappear; additional observation is necessary. Constipation should be reported to the health care provider, but is not the priority in this situation.
A nurse caring for patients in a busy hospital environment should implement which recommendation to promote sleep? A. Keep the room light dimmed during the day. B. Keep the room cool. C. Keep the door of the room open. D. Offer a sleep aid medication to patients on a regular basis.
b. The nurse should keep the room cool and provide earplugs and eye masks. The nurse should also maintain a brighter room environment during daylight hours and dim lights in the evening, and keep the door of the room closed. Sleep aid medications should only be offered as prescribed.
A patient reports abdominal pain that is difficult to localize. The nurse documents this as which type of pain? A. Cutaneous B. Visceral C. Superficial D. Somatic
b. The patient's pain would be categorized as visceral pain, which is poorly localized and can originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually involves the skin or subcutaneous tissue. A paper cut that produces sharp pain with a burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain.
A nurse observes a slight increase in a patient's vital signs while he is sleeping during the night. According to the patient's stage of sleep, the nurse expects what conditions to be true? Select all that apply. A. He is aware of his surroundings at this point. B. He is in delta sleep at this time. C. It would be most difficult to awaken him at this time. D. This is most likely an NREM stage. E. This stage constitutes around 20% to 25% of total sleep. F. The muscles are relaxed in this stage.
c, e. This scenario describes REM sleep. During REM sleep, it is difficult to arouse a person, and the vital signs increase. REM sleep constitutes about 20% to 25% of sleep. In stage I NREM sleep, the person is somewhat aware of surroundings. Delta sleep is NREM stages III and IV sleep. In stage IV NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.
A nurse is caring for a patient who states he has had trouble sleeping ever since his job at a factory changed from the day shift to the night shift. For what recommended treatment might the nurse prepare this patient? A. The use of a central nervous system stimulant B. Continuous positive airway pressure machine (CPAP) C. Chronotherapy D. The application of heat or cold therapy to promote sleep
c. Chronotherapy requires a commitment on the part of the patient to act over a period of weeks to progressively advance or delay the time of sleep for 1 to 2 hours per day. Over time, this results in a shift of the sleep-wake cycle. The use of a central nervous system stimulant is recommended for narcolepsy. Continuous positive airway pressure machine (CPAP) is used for OSA, and the application of heat or cold therapy to the legs is used to treat RLS.
A nurse uses a whirlpool to relax a patient following intense physical therapy to restore movement in the patient's legs. What is a potent pain-blocking neuromodulator, released through relaxation techniques? A. Prostaglandins B. Substance P C. Endorphins D. Serotonin
c. Endorphins are produced at neural synapses at various points along the CNS pathway. They are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that endorphins are released through pain relief measures, such as relaxation techniques. Prostaglandins, substance P, and serotonin (a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vasoconstriction) are neurotransmitters or substances that either excite or inhibit target nerve cells.
When developing the care plan for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain not related to cancer or palliative/end-of-life care is most effectively relieved through which method? A. Using the highest effective dose of an opioid on a PRN (as needed) basis B. Using nonopioid drugs conservatively C. Using consistent nonpharmacologic and nonopioid pharmacologic therapies D. Administering a continuous intravenous infusion on a regular basis
c. Nonpharmacologic and nonopioid pharmacologic therapies are the preferred choices for chronic pain that is not related to active cancer, palliative care, or end-of-life care.
A nurse working the night shift in a pediatric unit observes a 10-year-old patient who is snoring and appears to have labored breathing during sleep. Upon reporting the findings to the primary care provider, what nursing action might the nurse expect to perform? A. Preparing the family for a diagnosis of insomnia and related treatments. B. Preparing the family for a diagnosis of narcolepsy and related treatments. C. Anticipating the scheduling of polysomnography to confirm OSA. D. No action would be taken, as this is a normal finding for hospitalized children.
c. OSA (pediatric) is defined by the presence of one of these findings: snoring, labored/obstructed breathing, enuresis, or daytime consequences (hyperactivity or other neurobehavioral problems, sleepiness, fatigue). According to the American Academy of Pediatrics children and adolescents with symptoms of OSA, including snoring, should have polysomnography to confirm the diagnosis. Although OSA may cause insomnia, this is not the primary diagnosis in this case. Narcolepsy is a condition characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. This scenario is not usually a normal finding in hospitalized children during sleep.
drugs that decrease sleep
diuretics, steroids, antidepressants
A nurse is discussing with an older adult patient measures to take to induce sleep. What teaching point might the nurse include? A. Drinking a cup of regular tea at night induces sleep. B. Using alcohol moderately promotes a deep sleep. C. Having a small bedtime snack high in tryptophan and carbohydrates improves sleep. D. Exercising right before bedtime can hinder sleep.
c. The nurse would teach the patient that having a small bedtime snack high in tryptophan and carbohydrates improves sleep. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity within a 3-hour interval before normal bedtime can hinder sleep.
What is insomnia?
characterized by difficulty falling asleep, intermittent sleep, or difficulty maintaining sleep, despite adequate opportunity and circumstances to sleep. *most common sleep disorder
Pain Syndromes
clusters of causes, symptoms and problems EX. headaches (migraines), post-herpetic neuralgia (shingles), cancer pain, low back pain, fibromyalgia (chronic disease), trigeminal neuralgia (nerve pain in face), phantom pain
What is an opioid analgesic?
considered the major class of analgesics used in the management of moderate to severe pain because of their effectiveness. - common side effects= sedation, nausea, constipation
hypothalamus and sleep
control center for sleeping and waking -injury may cause a person to sleep for abnormally long periods
A nurse working in a sleep lab observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply. A. REM sleep constitutes much of the sleep cycle of a preschool child. B. By the age of 8 years, most children no longer take naps. C. Sleep needs usually decrease when physical growth peaks. D. Many adolescents do not get enough sleep. E. Total sleep decreases in adults with a decrease in stage IV sleep. F. Sleep is less sound in older adults and stage IV sleep may be absent.
d, e, f. Many adolescents do not get enough sleep due to the stresses of school, activities, and part-time employment causing restless sleep. Total sleep time decreases during adult years, with a decrease in stage IV sleep. Sleep is less sound in older adults, and stage IV sleep is absent or considerably decreased. REM sleep constitutes much of the sleep cycle of a young infant, and by the age of 5 years, most children no longer nap. Sleep needs usually increase when physical growth peaks.
A patient is postoperative following an emergency cesarean section birth. The patient asks the nurse about the use of pain medications following surgery. What would be a correct response by the nurse? A. "It's not a good idea to ask for pain medication regularly as it can be addictive." B. "It is better to wait until the pain is severe before asking for pain medication." C. "It's natural to have to put up with pain after surgery and it will lessen in intensity in a few days." D. "Your doctor has prescribed pain medications for you, which you should request when you have pain."
d. Many pain medications are ordered on a PRN (as needed) basis. Therefore, nurses must be diligent to assess patients for pain and administer medications as needed. A patient should not be afraid to request these medications and should not wait until the pain is unbearable. Few people become addicted to the medications if used for a short period of time. Pain following surgery can be controlled and should not be considered a natural part of the experience that will lessen in time.
A patient who is having a myocardial infarction reports pain that is situated in the neck. The nurse documents this as what type of pain? A. Transient pain B. Superficial pain C. Phantom pain D. Referred pain
d. Referred pain is perceived in an area distant from its point of origin, whereas transient pain is brief and passes quickly. Superficial pain originates in the skin or subcutaneous tissue. Phantom pain may occur in a person who has had a body part amputated, either surgically or traumatically.
A pregnant woman is receiving an epidural analgesic prior to delivery. The nurse provides vigilant monitoring of this patient to prevent the occurrence of what side effect? A. Pruritus B. Urinary retention C. Vomiting D. Respiratory depression
d. Too much of an opioid drug given by way of an epidural catheter or a displaced catheter may result in the occurrence of respiratory depression. Pruritus, urinary retention, and vomiting may occur but are not life threatening.
What is Delta Sleep?
deep sleep, occurring during stage III and especially stage IV in NREM sleep
recommendation for constipation
increase fluids and high fiber foods, and use a mild laxative
pains effects on vital signs
increased pulse and blood pressure
What is the Wong-Baker FACES pain rating scale?
it is a scale of faces that can be used for peds or other cases to assess pain.
intractable pain
severe pain that is extremely resistant to relief measures
cutaneous pain
superficial pain usually involving the skin or subcutaneous tissue
nociceptive pain
temporary pain from a normal process that results in noxious (harmful) stimuli being perceived as painful - a burn
gate-control theory
theory that explains how the nervous system blocks or allows pain signals to pass to the brain ~nursing interventions, such as a massage or warm compress to a pink lower back, stimulate large nerve fibers to close the gate, thus blocking nerve impulses from that area
Disturbed sleep pattern
time-limited interruptions of sleep amount and quality due to external factors (having and IV, receiving medications)
