RNSG 1430 Comfort Concepts I PDF

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