Comfort

Definition

  • State of well-being, pleasure, and absence of pain and distress

Scope of comfort

  • Ranges from severe discomfort to mild discomfort to comfort

  • Includes physiological (physical pain, maintenance of homeostasis, relief) psychospiritual (mental and emotional), sociocultural (relationship, social roles, cultural practice), environmental (external conditions and surroundings)

Risk

Population

  • Infant and children: pain sensitivity, unable to verbalize, fear/anxiety, susceptibility to injury

  • Older adults: sensitivity to pain and slow healing, inadequate relief, depression, and reduction of mobility

Individual

  • Trauma, surgery

  • Neuropathy (cognitive impairment)

  • Diagnostic and treatment procedures (injection, incubation, radiation)

  • Communication barrier

  • Fatigue, anxiety, fear

  • Culture: how they express pain and the meaning of pain

  • Support system and coping style: presence can decrease pain

Physiologic consequence of decreased comfort

Stress leads to

  • increased endocrine activity (production of cortisol signaling pain)

  • respiratory system (increased breathing, muscle tension, and change of oxygen)

  • blood clot

  • increased heart rate and blood pressure

  • affects physical function (mobility)

  • decrease in peristalsis

Non-physiologic factors of increased comfort

  • Psychospiritual: spiritual beliefs (how they interpret and manage pain)

  • Sociocultural: culture, support systems, gender and societal role can alter perception of pain

  • Environmental: noise/light/temperature, external stressors, and access to resources

Assessment

  1. Describe pain

  2. Pain scale

    • Numeric (children/cancer pain)

    • Visual analog

    • FACES (children 3 yrs old)

    • FLACC (children and cognitive disability)

    • CRIES (infants)

    • Non-verbal

Subjective Pain

  • pain is unique to an individual cannot be objectively measured

  • defined by individual experiencing pain

  • exists whenever the person says it is

Objective Pain

  • Vital signs, assessments —- nurse

Interventions to promote comfort

  • Education on self-management of chronic conditions

  • Nutrition

  • Sleep hygiene

  • Body mechanics

  • Exercise

Interventions for pain

Pharmacological

  • Non-opioid: NAIDs— acetaminophen

  • Opioid: morphine

  • Adjuvant analgesic: antidepressant, anticonvulsant, corticosteroid (enhance effect of opioid)

Non-pharmacological

  • massage, acupuncture

  • cutaneous stimulation

  • heat/cold therapy

  • position change

  • electronic stimulation unit

Acute and Chronic Pain

Pathophysiology

Acute

  • activation of nociceptive receptors

  • processing in the central nervous system— > perception of pain

  • modulation of pain either amplying or inhibiting

Chronic

  • peripheral and central sensitivity— heightened the sense of pain

  • structural and functional changes

Etiology

Acute

  • injury, inflammation, surgery, ischemia (reduced blood supply)

Chronic

  • long-term condition, nerve damage, stress/fear/anxiety

Manifestations

Acute

  • localized, increased heart rate, sweating, guarding, and reduced mobility

Chronic

  • localized/systemic, persistent pain, fatigue, decreased appetite, reduced quality of life

Cause

Acute

  • cut, fracture, sprain, surgery, obstruction

Chronic

  • diseases/conditions, trauma, injury, surgery, idiopathic

Risk factors

Acute

  • injury, trauma, infection, medical procedures

Chronic

  • disease/condition, medical and surgical complications, lifestyle, psychologic

Prevention method

Acute

  • pain management, timely treatment, safety equipment and protocols

Chronic

  • management, early intervention, healthy lifestyle (diet, sleep, stress management)

Factors that alter pain perception and patient response

  1. Biological

    • severity of pain, inflammatory response, brain function, nociception

  1. Psychological

    • mood, catastrophizing, stress, coping

  1. Social

    • cultural, environment, economic, social support

Characteristics and Consequences

Acute

  • protective, temporary, self-limiting, direct cause, resolves with tissue healing

  • physiological: tachycardia, hypertension, anxiety, diaphoresis, muscle tension

  • behavioral change: grimacing, moaning, flinching, guarding

  • can lead to chronic if left untreated

Chronic

  • ongoing/re-occuring

  • physiological: fatigue, depression, decreased level of functioning

  • psychological can lead to disability

Developing nurse care plain

  1. Assessment

    • onset, duration, local, intensity, characteristics

    • impacts on daily activities and patient response: coping, support

  2. Goals

    • alleviate pain, enhance functional abilities and evaluate for patient feedback

  3. Pharmacological

    • analgesic, antidepressant, anticonvulsant

  4. Non-pharmacological

    • physical therapy, heat/cold therapy, education