Chapter 27
Comfort, Rest, and Sleep
LEARNING OUTCOMES:
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Define the key terms and key abbreviations listed in this chapter
Explain why comfort, rest, and sleep are important
List the OBRA room requirements for comfort, rest, and sleep
Describe the four types of pain and the factors affecting pain
Explain why pain is personal
List the signs and symptoms of pain
List the nursing measures that relieve pain
Explain why meeting basic needs is important for rest
Identify when rest is needed
Explain how circadian rhythm affects sleep
Describe the stages of sleep
Know the requirements for each age-group
Describe the factors that affect sleep
Describe the common sleep disorders
List the nursing measures that promote rest and sleep
Explain how dementia affects sleep
The total person is affected
Discomfort and pain:
by comfort, rest, and sleep problems.
•Can be physical or emotional
•Affect rest and sleep
•Decrease function and quality of life
Rest and sleep restore energy and well-being.
COMFORT
Comfort
is a state of well-being.
•The person has no physical or emotional pain.
•He or she is calm and at peace.
Comfort is affected by:
•Age, illness, and activity
•Temperature, ventilation, noise, odors, and lighting
PAIN
Pain or discomfort means to ache, hurt,
Comfort and discomfort are subjective.
or be sore.
•You must rely on what the person says.
Pain is personal.
If a person complains of pain or discomfort, the person has pain or discomfort.
Pain is a warning from the body.
•It means there is tissue damage.
•Pain often causes the person to seek health care.
Types
of pain
•The doctor uses the type of pain when diagnosing.
•The nurse uses it for the nursing process.
•Acute pain is felt suddenly from injury, disease, trauma, or surgery.
•Chronic pain lasts longer than 6 months.
•Radiating pain is felt at the site of tissue damage and in nearby areas.
•Phantom pain is felt in a body part that is no longer there.
Factors
affecting pain
•Past experience
Knowing what to expect can help or hinder how the person handles pain.
•Anxiety
Pain can cause anxiety.
Anxiety increases how much pain the person feels.
Reducing anxiety helps lessen pain.
•Rest and sleep.
Rest and sleep restore energy.
Pain seems worse when tired or restless.
•Attention
The more a person thinks about the pain, the worse it seems.
•Personal and family duties
•The value or meaning of pain
•Support from others
•Culture
•Illness
•Age
Signs
and symptoms
•Location
•Onset and duration
When did the pain start?
How long has it lasted?
•Intensity
Mild, moderate, or severe pain
•Description
•Factors causing pain (precipitating factors)
•Factors affecting pain
What makes the pain better?
What makes it worse?
•Vital signs
•Other signs and symptoms
Nursing
measures
•The nurse uses the nursing process to promote comfort and relieve pain.
•Other measures include distraction, relaxation, and guided imagery.
Distraction means to change the person’s center of attention.
Relaxation means to be free from mental and physical stress.
Guided imagery is creating and focusing on an image.
•Doctors often order drugs to control or relieve pain.
Such drugs can cause orthostatic hypotension, drowsiness, dizziness, and coordination
problems.
The nurse and care plan alert you to needed safety measures.
YOU
PROMOTE REST BY:
physical needs
•Meeting thirst, hunger, and elimination needs
•Helping to relieve pain or discomfort
•Providing a comfortable position and good alignment
•Providing a quiet setting
•Providing a clean, dry, and wrinkle-free bed
•Providing a clean, neat, and uncluttered room
Meeting
Meeting
safety and security needs
•Keeping the signal light within reach
•Explaining the reasons for care
•Explaining how care is given
•Following routines and rituals whenever possible
Meeting love and belonging needs
•Promoting visits or calls from caring family and friends
•Reading cards and letters
Meeting self-esteem needs
•Promoting personal choice in sleepwear
•Assisting with hygiene and grooming measures as needed
SLEEP
IS A BASIC NEED.
It lets the mind and body rest.
The body saves energy.
Body functions slow.
Vital signs are lower than when awake.
Tissue healing and repair occur.
Sleep lowers stress, tension, and anxiety.
The person regains energy and mental alertness.
Sleep
is part of circadian rhythm.
•Circadian rhythm is a daily rhythm based on a 24-hour cycle.
•It affects functioning.
Circadian rhythm includes a sleep-wake cycle.
There are two phases of sleep.
•NREM sleep (non-REM sleep) is the phase of sleep where there is no rapid eye
movement.
•The rapid eye movement phase is called REM sleep.
Sleep needs vary for each age-group.
Factors
affecting sleep
•Illness increases the need for sleep.
Signs and symptoms of illness can interfere with sleep.
Treatments and therapies can interfere with sleep.
Care devices can cause uncomfortable positions.
The emotional effects of illness can affect sleep.
•Nutrition
Sleep needs increase with weight gain and decrease with weight loss.
Foods with caffeine prevent sleep.
The protein tryptophan tends to help sleep.
•Exercise improves health and fitness.
Exercise before bedtime interferes with sleep.
•Environment
People adjust to their usual sleep settings.
•Drugs and other substances
•Life-style changes can affect sleep.
•Emotional problems
Fear, worry, depression, and anxiety affect sleep.
Sleep
disorders involve repeated sleep problems.
•The amount and quality of sleep are affected.
•Insomnia is a chronic condition in which the person cannot sleep or stay asleep all night.
•With sleep deprivation, the amount and quality of sleep are decreased.
Sleep is interrupted.
•With sleepwalking, the person leaves the bed and walks about.
Promoting
sleep
•The nurse assesses the person’s sleep patterns.
•You need to:
Report signs and symptoms of sleep disorders.
Follow the care plan for measures to promote sleep.
Report your observations about how the person slept.