Basic Human Needs, Pain Comfort, Rest and Sleep
 TNS (Transcutaneous Electrical Nerve
Pain. A sensation of physical or mental hurt or suffering
that causes distress or agony to the one experiencing it.
 It is whatever the patient says it is
 It exists whenever the patient says it does
 It is subjective in nature; only the person
experiencing it may describe it
 It is protective because it provides warning
signal for tissue injury. It helps minimize
injury and is often a protective injury-
prevention
 Factors Influencing Pain
 Age
 Sex
 Childhood
 Cultural background
 Psychological factors
 Previous experience
 Religious beliefs
 Expected response
 Setting
 Diagnosis
 Physical/Mental health
 Knowledge / Understanding
 Non-verbal Responses to Pain
 Facial expression
 Vocalizations like moaning and groaning or
crying and screaming
 Immobilization of the body or body part
 Purposeless body movements
 Behavioral changes such as confusion and
restlessness
 Rhythmic body movements or rubbing
 Barriers to Effective Pain Management
 Lack of knowledge of the adverse effects of
pain
 Misinformation regarding the use of
analgesics
 Misconceptions about pain
 May not report pain
 Fear of becoming addicted
 Nursing Care of Patient with Pain
A. Techniques that stimulate the skin (enhance of
serotonin, a neurotransmitter that blocks the
transmission of pain impulses)
 Therapeutic touch (energy is transmitted
from one person to another
 Contralateral stimulation. Stimulating the
skin in an area opposite to the painful area.
 Vibration
 Heat and cold application
 Counterirritants. (Liniments, plasters) – they
increase circulation to the area
 Acupuncture / acupressure
stimulation)
B. Techniques that distract attention – to close
the gate by acting on the thalamus.
 Staring
 Slow, rhythmic breathing
 Recite, sing
 Describe something in detail
 Listen to music
 Conversation
 Read, play games
 Busy oneself (chores, hobbies)
 Favorite toy
C. Techniques that promote relaxation
 Conversational methods
 Relax muscles
 Listen to music
 Guided imagery. Use of images or fantasy to
achieve specific health-related goals
 Meditation, Yoga,
 Autogenic Training – involves relaxation
and physiologic control by a system of self-
suggestion in which the client repeats
phrases to themselves
 Analgesic
 Placebo - non-organic substance that
satisfies the patient’s request for analgesic; it
requires doctor’s order
REST AND SLEEP
 Rest. Diminished state of activity,
calmness, relaxation without emotional
stress; freedom of anxiety.
 Sleep. A state of consciousness in which the
individual’s perception and reaction to the
environment are decreased.
 Serotonin- is a major neurotransmitter
associated with sleep. It is derived from its
precursor Tryptophan, a naturally occurring
amino acid. It decreases activity of RAS,
thereby inducing and sustaining sleep. Other
neurotransmitters – acetylcholine and
norepinephrine appear to be required for the
REN sleep cycle.
Theories of Sleep
 Active Theory of Sleep. Proposes that there
are centers that cause sleep by inhibiting
other brain centers.
 Passive Theory of Sleep. States that the
RAS of the brain simply fatigues and
therefore becomes inactive thus, sleep
occurs.
Stages of Sleep Common Sleep Disorders
1. NREM (non-rapid eye movement) stage 1. Insomnia
A. Very slight sleep  Difficulty in falling asleep
 Drowsy, relax  Intermittent sleep
 Readily awakened.  Premature awakening
B. Light deep 2. Hypersomnia
 Eyes are still  Excessive sleep (daytime or nighttime)
 Heart and respiratory rate decrease slightly  Related to psychologic problems, CNS
 Body temperature falls. damage, metabolic disorders
C. Domination of PNS 3. Narcolepsy “Sleep Attack”
 Body process slows further  Overwhelming Sleepiness
 difficult to arouse  REM uncontrolled
Deep sleep 4. Sleep Apnea
D. Difficult to arouse  Periodic cessation of breathing during
 Decrease BP, RR, and PR, temp; asleep. It is characterized by snoring.
 ↓ Metabolism, brain waves, muscles relaxed 5. Parasomnias
 Somnambolism. Sleep Walking
2. REM (Rapid Eye Movement) Stage  Night Terrors. After having slept for few
 Eyes appear to roll. hours, the child bolts upright in bed, shakes,
 “Paradoxical Sleep” screams, appears pales and terrified.
 Close to wakefulness but difficult to arouse.  Nocturnal Enuresis. Bed wetting
 Dream state of sleep  Soliloqy. Sleep Walking
 Sympathetic Nervous System dominates  Nocturnal Erections. “Wet Dreams”,
 Flow of gastric acid increases. usually experienced by adolescent males.
 Restores a person mentally-learning,  Bruxism. Clenching and grinding of teeth
psychologic adaptation and memory. during sleep. May erode and diminish the
 The sleeper reviews the day’s events and height of dental crowns and may cause the
processes and stores information teeth to become loose.

Functions of Sleep
 NREM – body restoration
 REM – increase in synthetic processes in
the brain.

Nursing Interventions to Promote Sleep

 Helping nurse-patient relationship.
 Promote comfort and relaxation
 Create restful environment
 Attend to bedtime rituals
 Adequate exercise. Exercise at least 2 hours
before sleep to enhance NREM; not
immediately before sleep
 High protein food. Protein contains
tryptophan, which is a CNS depressant
 Observe habits of sleep periodicity and
wake-up time.
 Avoid caffeine and alcohol in the evening
 Go to bed when sleepy
 Use the bed mainly for sleep
 Use sedative-hypnotics judiciously