m13 cna

Comfort

Having no physical or emotional pain; being calm, at ease, and relaxed

Pain

To ache, hurt, or be sore

Pain Is Subjective

Pain is different for each person and based on what the person says

Fifth Vital Sign

Pain is often called the fifth vital sign

Purpose Of Pain

Pain is a warning that signals tissue damage

Factors Affecting Pain

Past experience, anxiety, rest and sleep, personal and family duties, value or meaning of pain, support from others, culture, illness, age

Comfort Affected By

Age, illness, activity, temperature, ventilation, noise, odors, lighting

Discomfort Effects

Decreases function, rest, sleep, and quality of life

Acute Pain

Sudden pain from injury, disease, trauma, or surgery; usually lasts less than 6 months and lessens with healing

Chronic Pain

Pain lasting longer than 6 months; remains after healing; no longer tissue damage

Radiating Pain

Pain felt at the site of damage and nearby areas

Phantom Pain

Pain felt in a body part that is no longer there

Signs Of Pain

Location, onset, duration, intensity, description, factors causing pain, other signs and symptoms

Nonverbal Pain Signs

Appetite change, dizziness, nausea, numbness or tingling, increased pulse, respirations, and blood pressure, pale skin, difficulty sleeping, sweating, vomiting, weakness, crying, gasping, grimacing, groaning

FLACC Scale

Face, Legs, Activity, Cry, Consolability

Pain Interventions

Positioning, wrinkle free linens, assist with elimination, distraction, relaxation, guided imagery, medications, heat and cold

Sleep

A basic need that allows the mind and body to rest and restore energy

Benefits Of Sleep

Lowers stress and anxiety, saves energy, slows body functions, promotes tissue healing, restores mental alertness

Illness And Sleep

Illness and injury increase the need for rest and sleep

Factors Affecting Sleep

Illness, age, nutrition, exercise, environment, drugs, alcohol, caffeine, lifestyle changes, emotional problems

Insomnia

Chronic condition where a person cannot sleep or stay asleep

Sleep Deprivation

Decreased amount or quality of sleep

Sleepwalking

Person has no memory of the event; may last 3 to 4 minutes; guide gently back to bed

Promote Sleep

Flexible bedtime, comfortable temperature, warm bath or shower, bedtime snack, avoid caffeine and alcohol, bedtime routines, feeling safe, clean and dry if incontinent, loose sleepwear, warmth, reduce noise, darken room, massage, music, relaxation, sit and talk

Terminal Illness

Illness or injury with no reasonable expectation of recovery

Examples Of Terminal Illness

COPD, Alzheimer’s disease, CHF

Terminal Illness Outcome

Recovery is not expected and the condition ends in death

Cultural Beliefs About Death

Beliefs and practices differ and are often tied to religion

End Of Life Care

Support and care given during the time surrounding death

Hospice Care

Care focused on comfort for people with less than 6 months to live and no longer seeking curative treatment

Palliative Care

Care focused on relief of symptoms; the illness may still be treated

Goals Of Comfort Care

Prevent or relieve suffering and respect end of life wishes

Stages Of Dying

Denial, Anger, Bargaining, Depression, Acceptance

Denial

Avoiding or confusion

Anger

Frustration or irritation

Bargaining

Asking for one more time or making deals

Depression

Feeling helpless or overwhelmed

Acceptance

Moving on and understanding

Spiritual Needs

Meeting spiritual needs improves psychosocial and physical well being

Breathing Problems At End Of Life

Shortness of breath and noisy breathing are common

Death Rattle

Noisy breathing caused by mucus in the airway

Death Rattle Interventions

Side lying position, suctioning, medications to reduce mucus

Vision At End Of Life

Vision blurs and gradually fails

Hearing At End Of Life

Hearing is one of the last senses lost; always assume the person can hear

Speech At End Of Life

Speech becomes difficult or impossible

Nutrition At End Of Life

Loss of appetite, nausea, and vomiting are common

Eating At End Of Life

Person may be too weak to eat or may choose not to eat or drink

Elimination At End Of Life

Incontinence, constipation, and urinary retention are common

Family Needs At End Of Life

Families go through stages of grief and need support and time

Advance Directive

Legal document stating health care wishes when the person cannot decide

Living Will

Document describing treatments a person wants or does not want

Power Of Attorney

Person authorized to make health care decisions for another

DNR

Do Not Resuscitate order meaning no resuscitation will be performed

Signs Death Is Near

Restlessness, shortness of breath, anxiety, confusion, drowsiness, loss of appetite, swelling, pauses in breathing

Signs Of Death

No pulse, no respirations, no blood pressure, pupils fixed and dilated

Postmortem Care

Care of the body after death to maintain appearance and dignity

Rigor Mortis

Stiffening of muscles within 2 to 4 hours after death

Postmortem Precautions

Always follow standard and bloodborne pathogen precautions