Regents College Nursing

Study Guide Expanded Notes

Commonalities in Nursing Care: Area A

Study Guide

II. Comfort, Rest, and Sleep

The restless night when one has a cold or flue. The disterbed sleep patterns, and increased fatique, all when the body needs more rest to combat the illness. The OTC medications taken to relieve fever and muscle ache, in the attempt to obtain comfort. Such is the nature of comfort, rest, and sleep in a simple situation.
There are many situation in which these factors come into consideration. Most hospitalizations involve the administration of pain relieveing medications. Pain is a central factor in most illnesses and injuries.
The nature of the situations encountered run from the simple to the complicated. Comfort, rest, and sleep are central elements in health care.

A. Theoretical framework: basis for care

1. Principles related to comfort, rest, and sleep (e.g., pain management, sleep cycles, circadian rhythms)

2. Common disturbances in comfort: general concept and nature of pain (e.g., acute vs. chronic, types of pain, gate control theory, pain threshold, pain tolerance)

3. Factors affecting pain

a. Development level: infancy through senescence

b. Individual preferences and patterns (e.g., pain relief practices)

c. Physical condition (e.g., debilitation, fatigue)

d. Ethnic and cultural considerations (e.g., stoicism)

e. Socioeconomic factors (e.g., lack of health insurance)

f. Environmental factors (e.g., isolation, time of day, heat and cold)

g. Psychological factors (e.g., powerlessness, anxiety)

4. Common disturbances in rest and sleep (e.g., insomnia, sleep apnea, sensory deprivation, sleep pattern disturbances)

5. Factors affecting rest and sleep

a. Developmental level: infancy through senescence

b. Individual preferences and patterns (e.g., sleep patterns, lifestyle, shift changes, use of caffeine and alcohol)

c. Physical condition (e.g., health status, pain, activity level)

d. Socioeconomic factors (e.g., living conditions)

e. Environmental factors (e.g., temperature extremes, ventilation)

f. Psychological factors (e.g., security, stress)

6. Theoretical basis for interventions to promote comfort, rest, and sleep

a. Medications (e.g., narcotics, analgesics, sedatives, hypnotics,)

b. Environmental modifications (e.g., room temperature, ventilation)

c. Physical modifications (e.g., positioning, backrubs, warm milk, elevate head of bed, use of pillows, call light, time for uninterrupted sleep, noise reduction)

d. Psychological modifications (e.g., distraction, imagery)

B. Nursing care related to theoretical framework

1. Assessment: gather and synthesize data about the patient's needs for comfort, rest, and sleep in relation to the patient's functional health patterns

a. Obtain information about the patient's comfort, rest, and sleep patterns (e.g., verbalization of pain level, patient naps daily, sleeps five hours a night, daytime drowsiness, pain relief measures)

b. Assess factors affecting comfort, rest, and sleep (see IIA3 and IIA5)

c. Obtain objective data (e.g., alteration in vital signs; body position; facial expressions; onset, intensity, frequency, duration, and location of pain)

2. Analysis: identify the nursing diagnosis (patient problem) and determine the expected outcomes (goals) of patient care

a. Identify nursing diagnoses (e.g., pain related to physical injury, sleep pattern disturbance related to change in environment, fatigue related to altered sleep patterns)

b. Set priorities and establish expected outcomes (patient-centered goals) for care (e.g., patient will state that pain has been relieved, patient will demonstrate decreased signs of sleep deprivation, patient will verbalize feeling refreshed after awakening)

3. Planning: formulate specific strategies to achieve the expected outcomes

a. Plan nursing measures to help the patient achieve the expected outcomes (e.g., use measures to relieve pain such as backrub, distraction, and repositioning; provide analgesics as ordered; reduce environmental distractions such as noise and lighting; position the patient to aid muscle relaxation)

b. Incorporate factors affecting comfort, rest, and sleep in planning the patient's care (e.g., discourage the use of caffeine prior to bedtime, adhere to a child's usual bedtime routine, consider the patient's usual pain relief measures, consider the patient's cultural response to pain) (seeIIA3 and IIA5)

4. Implementation: carry out nursing plans designed to move the patient toward the expected outcomes

a. Use nursing measures to promote comfort, rest, and sleep (e.g., promote bedtime rituals, encourage voiding before bedtime, administer a backrub, use of heat and cold, positioning, active listening)

b. Administer prescribed medications (e.g., administer pain medication before the pain becomes severe, schedule administration of medications to avoid nocturnal awakenings, schedule pain medication prior to ambulation)

c. Use nursing measures to modify the environment (e.g., eliminate noises, provide soft music, decrease lighting)

d. Provide information and instruction regarding comfort, rest, and sleep (e.g., instruct patient about relaxation techniques, instruct patient regarding patient-controlled analgesia [PCA], instruct patient in use of transcutaneous electrical nerve stimulation [TEMS])

5. Evaluation: appraise the effectiveness of the nursing intervention relative to the nursing diagnosis and the expected outcomes

a. Record and report the patient's response to nursing actions (e.g., changes in sleeping patterns, chart patient reports of pain relief, note nonverbal behaviors)

b. Reassess and revise the patient's plan of care as necessary (e.g., encourage the patient to request a change in pain medication)