RNSG1430_Comfort.pptx
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Comfort RNSG 1430 Health Care Concepts I San Antonio College Department of Nursing Education Objectives Explain the concept of Comfort (including definition, antecedents, and attributes). Explain (CSLO - 1, 2) Analyze Analyze conditions which place a...
Comfort RNSG 1430 Health Care Concepts I San Antonio College Department of Nursing Education Objectives Explain the concept of Comfort (including definition, antecedents, and attributes). Explain (CSLO - 1, 2) Analyze Analyze conditions which place a patient at risk for impaired Comfort. (CSLO - 1, 2) Identify Identify when impaired Comfort is developing or has developed. (CSLO - 2, 3) Compare exemplars of common disruptions of patient Comfort and how nursing care Compare varies. (CSLO- 1, 3) Apply the nursing process (including collaborative interventions for individuals Apply experiencing comfort imbalance. (CSLO- 1, 3) Concept Map Antecedents- Individual/ Physiological Pathophysiology Effective circulatory system Able to discern from comfort to discomfort Without noxious stimuli Intact neurological/sensory system Comfort Theory Comfort is not just the absence of pain Four contexts of this holistic human experience Physical Psycho-spiritual Sociocultural Environmental Pain Nociceptiv Neuropathi Mixed Pain e c Syndromes Peripherall Centrally- Visceral Somatic y generated generated Visceral Referred Pain Antecedents- Structural/Environment al Risk Factors Support systems/coping skills Cultural and Societal Attitudes Lack knowledge/information Cultural attitudes about addiction Attributes-Normal Clinical Manifestations Assess the patient’s ability to distinguish between comfort and discomfort Reports being comfortable Indicates pain scale zero Relaxed facial expression and body posture Vital signs within the normal limits for baseline Assess patient’s Use of pain scale comfort level Nursing Care to P= Provocation/Palliation Attributes of Detect Q = Quality/Quantity pain R = Region/Radiation S = Severity Scale Attribute T = Timing Changes Use of open Contributing symptoms ended questions Effects of pain Nursing Care to Detect Attribute Changes Documentation Patient’s understanding Patient’s pain goal Patient satisfaction Timely re-assessment Communication with provider Patient education Attributes- Laboratory & Diagnostic Tests Used to assess root cause of pain Consequences- Positive Social interactions Perform ADL’s Adapt to stressors Calm demeanor Consequences- Negative Shock Tissue Damage Limited Movement Human Suffering Increased heart rate, respiratory rate and blood pressure Developmental Issues Developmental Considerations Populations at risk for undertreatment of pain Infants Children Older Adults Patients with Substance Abuse History Developmental Considerations Pain scales for nonverbal patients Wong-Baker Faces Pain Rating Scale Visual Analog Scale PAINAD FLACC Exemplar: Acute Pain in Post-Operative Patient Exemplar: Acute Pain in Post-Operative Pt Antecedent Changes-Pathophysiology Normal Physiology of the Pain Response Transduction Transmission Pain Threshold Pain Tolerance Perception or Awareness of Pain Modulation Exemplar: Acute Pain in Post-Operative Pt Nursing Interventions to Restore Antecedents Assess surgical site Position to minimize pain Minimize noise and other irritants Sleep hygiene Monitor for infection Exemplar: Acute Pain in Post-Operative Pt Attribute Changes-Clinical Manifestations Short term pain lasting less than 3 months Vital Sign Changes Increased heart rate, blood pressure Patient reports of pain or nonverbal signs of pain 0-10 Numeric Rating Scale, PQRST Grimacing, moaning, crying or protecting the painful area or perspiration Other discomfort pruritus, thirst, cramping, nausea and vomiting Anxiety, fear, hopelessness, sleeplessness Exemplar: Acute Pain in Post-Operative Pt Complications-Consequences-Negative Elevated High HR Immobilit stress and BP y Loss of Loss of sleep appetite Exemplar: Acute Pain in Post-Operative Pt Medical/Surgical Management WHO Analgesic Ladder Opioids IV in OR and post-op PCA when patient awake in 1-2 days post-op PO as soon as able Non-opioids NSAIDS Adjuvants Nonpharmacological Exemplar: Acute Pain in Post-Operative Pt Nursing Interventions to Maintain Attributes Pharmacological Administer scheduled and PRN medications as ordered Assess effect of medications at expected peak effect based on route IV: 5-30 minutes PO: About 1 hour Advocate for changes in orders as needed for breakthrough pain Provide education to patient on medications Exemplar: Acute Pain in Post-Operative Pt Nursing Interventions to Maintain Attributes Nonpharmacological Distraction Humor Listening to music Using imagery Employing relaxation TENS Hypnosis Biofeedback Therapeutic touch Animal therapy Exemplar: Acute Pain in Post- Operative Pt Drug Therapy Therapeutic class: Analgesic Pharmacologic class: Opioid agonist, short-acting Example: Morphine Immediate Release (IR) IV or PO Mechanism of Action: Stimulates central opioid receptors Side Effects: Constipation, Sedation Adverse Effects: Respiratory depression, N/V Patient’s “Need to Know” Exemplar: Acute Pain in Post- Operative Pt Drug Therapy Therapeutic class: Overdose Treatment Pharmacologic class: Opioid antagonist Example: Naloxone IV or Intranasal Mechanism of Action: Block central opioid receptors Side Effects Adverse Effects Patient’s “Need to Know” Barriers to Pain Management Fear of Addiction Terms to know: Addiction Physical dependence Tolerance Among nurses Exaggerated fear of respiratory depression Myth of speeding up end of life Exemplar: Acute Pain in Post-Operative Pt Nursing Patient Education Opioids Patient Controlled Analgesia (PCA) Only patient can press button Patient cannot exceed set number of doses Side effects Exemplar: Procedural Pain with Physical Therapy or Dressing Changes Exemplar: Procedural Pain Antecedent Changes Patients participate in physical therapy (PT) on post-op day (POD) 0 or POD 1 after total hip arthroplasty Minimizes negative impact of immobility Blood clots Altelectasis/Pneumonia Muscle mass loss Constipation Delirium Nurses are responsible for regularly scheduled dressing changes Expect first dressing change after surgery Wound Care RN may help Frequency depends on dressing type Exemplar: Procedural Pain Attribute Changes-Clinical Manifestations Breakthrough pain Often severe with manipulation of wound/operative site Acute Somatic Exemplar: Procedural Pain Complications- Consequences-Negative Increased stress and change in vital signs due to pain Inability to participate in PT leads to longer hospital stays and more complications due to immobility Refusing dressing changes can lead to worsening of wound or infection Decreased trust in health care team Exemplar: Procedural Pain Nursing Interventions to Maintain Attributes Anticipate the need for PRN medication Coordinate with other parties involved Give medication prior to procedure IV: 5-30 minutes PO: 45 minutes-1 hour Assess patient pain during and after procedure Administer additional doses PRN Provide patient education on how to use PRN medications upon discharge Exemplar: Procedural Pain Medical/Surgical Management PRN or as needed medication should be ordered for every patient in the hospital The order should specify what pain level the drug is for Patients may have multiple PRN pain medications Drugs may address the root cause of the pain or just the pain itself Exemplar: Procedural Pain Drug Therapy Therapeutic class: Analgesic/Antipyretic Pharmacologic class: Acetaminophen Example: Acetaminophen Mechanism of Action Side Effects Adverse Effects Patient’s “Need to Know” Recommended max dose 3g/day Absolute max dose 4g/day Exemplar: Procedural Pain Drug Therapy Therapeutic class: Anti-inflammatory/Analgesic Pharmacologic class: Nonsteroidal Anti- inflammatory Drug (NSAID) Example: Ibuprofen Mechanism of Action Side Effects Adverse Effects Patient’s “Need to Know” Take with food Exemplar: Procedural Pain Drug Therapy Therapeutic class: Analgesic Pharmacologic class: Combination Example: Hydrocodone- Acetaminophen (Norco) Mechanism of Action Side Effects Adverse Effects Patient’s “Need to Know” Exemplar: Chronic Pain in Osteoarthritis Exemplar: Chronic Pain in Osteoarthritis Antecedent Changes- Pathophysiology Osteoarthritis (OA) is a form of degenerative joint pain caused by wear and tear on your joints. Most often in weight bearing joints The cartilage that cushions joints starts to wear down, causing the bones to rub together which leads to inflammation of the joints. Exemplar: Chronic Pain in Osteoarthritis Antecedent Changes-Pathophysiology Exemplar: Chronic Pain in Osteoarthritis Attribute Changes-Clinical Manifestations Pain lasting more than 3 months Pain during and after use of affected joints Relieved by rest Stiffness and decreased range of motion (ROM) Crepitus Enlarged joint Joint effusion Gradual/insidious onset Exemplar: Chronic Pain in Osteoarthritis Attribute Changes- Laboratory & Diagnostic Tests X-rays CT MRI Exemplar: Chronic Pain in Osteoarthritis Complications- Consequences-Negative Stress Limited mobility Loss of independence Depression/Anxiety Exemplar: Chronic Pain in Osteoarthritis Nursing Interventions Nonpharmacological Alternate heat and cool to affected joint Joint protection device Integrative: Acupuncture Encourage moderate physical activity that does not stress joint Swimming Walking Encourage healthy weight Exemplar: Chronic Pain in Osteoarthritis Medical/Surgical Management Pharmacological PRN prior to activity Long-acting drugs Topical Antidepressants Antiinflammatory injections (steroids) Joint replacement may be indicated if cartilage loss is severe or patient activity is severely affected Exemplar: Neuropathic Pain in Degenerative Disk Disease Exemplar: Neuropathic Pain in Degenerative Disk Disease Antecedent Changes- Pathophysiology Neuropathic pain occurs due to radiculopathy when nerves are pinched Sciatica Phantom limb syndrome Degenerative disk disease Discs that separate the vertebrae wear down causing the bones to rub together Age is usually the reason, but sports and injuries can be culprits, too Can be acute or chronic condition Exemplar: Neuropathic Pain in Degenerative Disk Disease Attribute Changes-Clinical Manifestations Paresthesia in area of affected nerve Burning Tingling Electricity/Shock Numbness Pressure Sensitivity to touch Long term nerve damange may cause change in deep tendon reflexes Disks can be visualized best by MRI XR, CT may be used Exemplar: Neuropathic Pain in Degenerative Disk Disease Complications- Consequences-Negative Limited mobility Sleep Loss Stress Depression Exemplar: Neuropathic Pain in Degenerative Disk Disease Medical/Surgical Management Anticonvulsant drugs Antidepressant drugs Some neuropathic pain studies suggest the use of NSAIDs may ease pain Some patients may require narcotics Surgical intervention if pain is uncontrollable Diskectomy Spinal fusion Exemplar: Neuropathic Pain in Degenerative Disk Disease Drug Therapy Therapeutic class: Treatment of Neuropathic Pain Pharmacologic class: Anticonvulsant Example: Gabapentin & Pregabalin Mechanism of Action Side Effects Adverse Effects Patient’s “Need to Know” Exemplar: Neuropathic Pain in Degenerative Disk Disease Nursing Interventions Pharmacological Nonpharmacological Assess for depression Muddiest Point What part of today’s lecture did you find most difficult to understand? Reminders- Upcoming Due Dates ATI Engage Fundamentals 2.0: Pain Test Due prior to Exam 1 Unlimited time in quiz Open book Unlimited attempts 24 hours between each attempt Turn in highest grade report to Canvas Exam 1 Comfort, Nutrition, Elimination Family Night
