Study Notes on Comfort, Sleep, and Fatigue

Comfort, Sleep, Fatigue Objectives

  • Objective 1: Discuss subjective and objective manifestations of altered comfort. (CLO 2)

  • Objective 2: Explore pain assessment tools across the lifespan. (CLO 2, 4)

  • Objective 3: Describe factors that influence pain perception and comfort. (CLO 2)

  • Objective 4: Explore comfort interventions including complementary and alternative modalities. (CLO 1, 2, 5)

  • Objective 5: Compare and contrast non-pharmacological and pharmacological interventions. (CLO 1, 2, 3, 4, 5)

  • Objective 6: Describe physiologic and psychosocial factors that impact sleep. (CLO 2, 5)

  • Objective 7: Discuss common sleep alterations (CLO 5)

  • Objective 8: Identify client’s usual sleep patterns (CLO 2, 3, 5)

  • Objective 9: Explore nursing interventions to promote rest (CLO 1, 2, 5)

  • Objective 10: Explore means of reinforcing patient teaching to support optimal rest. (CLO 1, 3, 5)

Nature and Physiology of Pain and Its Transmission

  • Definition of Pain:

    • A sensory and/or an emotional experience which can vary significantly in meaning from person to person.

    • Serves as a warning sign indicating that damage has occurred or that there may be a potential for damage to tissue.

    • The response to pain varies across cultures and individuals.

    • Holistic Perspective: Nurses must view pain holistically, taking into account its multi-faceted nature.

Effects of Pain

  • Pain can significantly impede:

    • Activities of daily living

    • Rest and restorative sleep

    • Eating

    • Normal body movements and exercise

    • Family relationships

    • Job performance and maintenance of employment

    • Social interactions and friendships

    • Cognitive abilities

    • Focusing on spiritual beliefs

Gate Control Theory

  • Concept: The transmission of pain impulses to the central nervous system is regulated by a “gate” mechanism.

  • The gate:

    • Opens and closes in response to sensory input.

    • Must** be open for the pain impulse to be transmitted to the CNS.

    • Factors affecting the opening and closing of the gate include:

    • Stress

    • Anxiety

    • Exercise

    • Temperature (heat and cold)

    • Massage

    • Electrical stimulation (TENS)

Classifications of Pain

  • Acute Pain:

    • Sudden onset and duration of less than 6 months.

  • Chronic Pain:

    • Duration exceeds 6 months.

  • Intermittent Pain:

    • Comes and goes at intervals.

  • Intractable Pain:

    • Pain that cannot be relieved and is resistant to treatment.

  • Referred Pain:

    • Pain felt in an area other than where it was produced.

  • Radiating Pain:

    • Begins at a specific site and extends to a larger area beyond the site of origin.

Pain Assessment

  • Comprehensive pain assessment should include:

    • Use of reliable and valid tools to determine pain intensity.

    • Acceptance of client’s self-report of pain.

    • Assistance for the client in establishing a comfort-function goal.

    • Application of the Hierarchy of Pain Measures for clients unable to report pain.

Pain Assessment Tools

  • Numeric Pain Scale:

    • Rates pain from 0 to 10, where:

    • 0 = No pain

    • 1-3 = Slight pain

    • 4-7 = Moderate pain

    • 8-10 = Severe pain

  • Visual Pain Rating Scale:

    • Example: Wong-Baker FACES scale with six facial expressions:

    • 0: Smiling face, no hurt

    • 2: Hurts a little bit

    • 4: Hurts a little more

    • 6: Hurts even more

    • 8: Hurts a whole lot

    • 10: Crying face, hurts worst

Responses to Pain

Physiological Signs

  • Acute Pain Signs:

    • Recent onset, diminishes with healing.

    • Fight/flight response: Increased heart rate, increased respiratory rate, increased systolic blood pressure, pupil dilation.

    • As pain worsens: Diaphoresis, blood pressure drops, syncope, pupil constriction.

  • Chronic Pain Signs:

    • Onset longer than 6 months.

    • Few physiological changes, but laziness and sleep disturbances may occur.

Behavioral Signs

  • Acute Pain:

    • Wincing, facial grimacing, moaning, crying, restlessness, rigid posture, slow movement, guarding of the area, worsens with anxiety.

  • Chronic Pain:

    • Withdrawal from social interactions, low self-esteem, fatigue, depression, anger.

Psychological Signs

  • Acute Pain:

    • Reduced attention span, focused solely on pain, heightened fear or irritability.

  • Chronic Pain:

    • Ongoing anger, irritability, low energy levels.

Management and Treatment of Pain

  • Considerations in managing pain:

    • Level of pain and site of pain.

    • Characteristics and duration of pain (acute or chronic).

    • Patient's desires concerning pain management.

Nonpharmaceutical Methods

  • Techniques for pain management include:

    • Hot and cold packs

    • Massage and effleurage

    • Transcutaneous electrical nerve stimulation (TENS)

    • Acupressure and acupuncture

    • Relaxation techniques

    • Distraction methods (music, tablets, TV)

Pharmaceutical Methods

  • Categories of medications for pain management:

    • Non-opioid analgesics

    • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

    • Opiate/opioid analgesics (narcotics)

    • Adjuvant analgesics

Restorative Sleep

  • Definition of Restorative Sleep:

    • Period during which an individual awakens feeling rested, refreshed, rejuvenated, and energized, ready to meet new challenges.

Consequences of Lack of Restorative Sleep

  • Without restorative sleep, the following may occur:

    • Decreased immunity

    • Decreased tolerance to stress

    • Increased susceptibility to fragile emotions and impatience, negatively affecting relationships.

    • Impaired cognitive functions such as concentration and decision-making abilities.

    • Poor work performance and increased accident rates.

Sleep Cycle

Stages of Sleep

  • NREM Sleep:

    • Stage One: Lightest sleep, easily awoken, lasts a few minutes; metabolism and vital signs start to slow down.

    • Stage Two: Begins deeper relaxation; lasts 10-20 minutes; sound sleep, but still easily aroused.

    • Stage Three: Starts deep sleep; lasts 15-30 minutes; arousal becomes more difficult, complete muscle relaxation occurs.

    • Stage Four: Deep sleep occurs; exceptionally difficult to awaken, lasts 15-30 minutes; body is restored during deep sleep, dreaming may occur.

  • REM Sleep:

    • Occurs at the end of each NREM cycle, starting approximately 90 minutes after falling asleep; characterized by rapid eye movements, fluctuating vital signs, and vivid dreams that may be remembered upon waking; duration increases with each cycle and averages 20 minutes.

Sleep Requirements

  • Newborns: 16 to 18 hours per day.

  • Infants (up to 2 years): 12 to 14 hours per day, including naps.

  • Children (3 to 6 years): 12 hours per day, including naps.

  • Children (7 to 12 years): 10 hours per night.

  • Adolescents: 8.5 to 9.5 hours per night.

  • Young Adults: 7.5 to 8 hours per night.

  • Older Adults: Sleep requirement decreases gradually to 5.5 or 6 hours per night.

Factors Affecting Rest and Restorative Sleep

  • Lifestyle choices

  • Levels of stress and anxiety

  • Environmental factors

  • Presence of illnesses and health problems

  • Sleep disorders or interruptions

Interventions to Promote Restorative Sleep

  • Preparing the sleep environment for comfort

  • Ensuring relaxation and pain relief

  • Use of sleep medications as necessary.