Basic Needs and Comfort Measures

Objectives
Define basic human needs
Define: self-actualization, self-esteem, love, security,
belonging and physiologic needs according to
Maslow’s Hierarchy of Needs
Explain and list physiologic needs
Define the terms associated with pain: agonist,
analgesic, biofeedback, antagonist, relaxation,
mediation, PCA endorphins
Understand pain measurement techniques
Describe techniques used to relieve pain
Evaluate effectiveness of pain control measures
Objectives
List causes of discomfort for patients
List nursing measures to promote comfort and ease
discomfort for patients
Comfort and Discomfort
List some attributes associated with comfort:
Examples:
 Warmth, softness, rest, quiet, coolness, cleanliness,
space, safety
Name some more that you associate with comfort
Comfort and Discomfort
List some attributes that you might associate with
discomfort
Examples: pain, nausea, fear, hunger, thirst, dark,
worry
List some other examples
Human Needs
Basic human needs: those which are common to all
people and essential for survival
Some can be met independently; some are dependent
on relationships with others
Food, water, shelter, warmth
Connection, love, security, spirituality
Abraham Maslow (1908 - 1970)
Maslow
Professor of psychology at Brandeis University who
founded humanistic psychology
Created the Theory of Basic Human Needs
Useful for understanding the relationships of basic
human needs and for establishing priorities of care
Theory of Basic Human Needs is a foundation for
nursing care and interventions
Basic Human Needs have the following characteristics

The absence of a basic human need results in illness.

The presence of basic human needs helps prevent
illness or signals health.
Meeting basic human needs restores health.
It is preferred over other satisfactions when unmet
One feels something missing when needs are unmet.
One feels satisfaction when needs are met.
Maslow’s Hierarchy of Needs
Certain needs are more basic than others
All people have the same needs all of the time, people
generally strive to meet certain of their needs before
attending to others
Level 1: Physiologic needs
Level 2: Safety and security needs
Level 3: Love and belonging needs
Level 4: self-esteem needs
Level 5: Self-actualization needs
Basic Human Needs
Level 1: Physiologic - oxygen, water, food,
temperature, elimination, sexuality, physical activity
and rest
Most basic needs and have the highest priority
Usually can be met through self-care, but many people
who are ill require assistance
Level 2: Safety and security - safe environment,
protection from violence, safe emotional environment
Level 3: Love and belonging needs - understanding
and acceptance of others; belonging to a community
Basic Human Needs
Level 4: Self-Esteem needs - need to feel pride and a
sense of accomplishment, respect, appreciation
Can be affected by body image, role changes
Level 5: Self-Actualization needs - need to reach
one’s own full potential
Level 1: Physiologic Needs
 A need which must be met at least minimally to maintain
life; the most basic in the hierarchy and therefore with the
highest priority
 Most healthy children and adults can meet these needs
through self-care
 Very young, old, disabled and ill people requires assistance
in meeting them
 The lack of any of the following cause discomfort
 Oxygen: respiratory diseases, cardiac disease
 Water: dehydration, hypovolemia,
 Food: starvation, NPO
 Warmth
Level 2: Safety and security needs
Involves both physical and emotional components
Physical security:
1. Using hand hygiene and sterile techniques to prevent
infection
2. Using electrical equipment properly
3. Administering medications knowledgeabley
4. Using skill when moving and ambulating patients
5. Assessing patients for potential risks, such as falling,
bleeding, infection
Level 2: Safety and security needs
Emotional safety and security: being free from fear,
anxiety and apprehension
Patients entering health care system face fear of the
unknown, their prognosis, unfamiliar surroundings,
unfamiliar personnel
All patients have anxiety
Comfort measures: explain procedures, friendly,
unhurried approach, continuity of caregivers,
relationship building.
Level 3: Love and Belonging Needs
All humans have this need
Called a higher-level need
Includes understanding, acceptance and a feeling of
belonging to families, peers, friends, community
Nursing interventions to help meet this need:
Including family and friends in the care of the patient
Establishing a nurse-patient relationship based on
mutual understanding and trust (by demonstrating
caring, encouraging communication and respecting
privacy)
Level 4: Self-Esteem Needs
Need for the person to feel good about him or her self,
pride and a sense of accomplishment
Factors which impact self-esteem: role changes, body-
image changes as a result of illness, surgery
Nursing interventions: respecting patients values and
beliefs, encouraging patients to meet attainable goals
Level 5: Self-Actualization Needs
The need for individuals to reach their full potential
through development of their unique capabilities
In general, the lower level needs must be met before
this need can be satisfied.
Self-Actualization
Characterized by:
1. acceptance of self and others as they are
2. focus of interest on problems outside oneself
3. ability to be objective
4. feelings of happiness and affection for others
5. Respect for all people
6. Ability to discriminate between good and evil
7. Creativity in solving problems and pursuing interests
Nursing Process
Nursing Process
Assessment: gathering information, data
Diagnosis: Name the problem
Planning: State an achievable goal
Interventions: Actions that work toward the stated
goal
Evaluation: Did the plan/interventions meet the stated
goal
Nursing Interventions to Meet Patient
Needs
Physiologic needs usually take priority
Basic human needs are interrelated
Examples:
ER patient with an MI:
Level 1 needs?
Level 2 needs?
Level 3,4,and 5 needs?
Post-surgical patient in pain
Pt. NPO for surgery
 Question
A nurse who focuses attention on the strengths and
abilities of his patients rather than their problems is
helping them to achieve which of Maslow’s basic
human needs?
A. Self-actualization
B. Self-esteem
C. Love and belonging
D. Safety and security
E. Physiologic
 Answer
Answer: A. Self-actualization
Rationale:
To meet patient self-actualization needs, nurses provide a sense of direction and
hope and maximize patient potential.
Self-esteem needs are met by respecting patient values and beliefs and setting
attainable goals for them.
Love and belonging needs are met by including family and friends and
establishing caring relationships with patients.
Safety and security needs are met by encouraging spiritual practices and
independent decision making.
Physiologic needs are needs that must be met to maintain life.
Comfort and Discomfort
Physiologic Discomfort can come from:
Pain
Nausea and Vomiting
Shortness of breath
Hunger
Thirst
Inactivity
Constipation
Comfort Measures - Pain
Pain
Def: an unpleasant, subjective sensory and emotional
experience associated with actual or potential tissue
damage or described in terms of such damage
It is a red flag indicating that something is wrong:
“Protective in nature”
Such an indicator of health that it is called the “5th
Vital Sign”
Pain
American Bar Association: Pain relief is a legal right

Therefore: Nurses are legally and ethically responsible

for managing pain and suffering

McCaffrey: “Pain is whatever the experiencing person

says it is, existing whenever he says it is.”
Common Responses to Pain

Physiologic: increased BP, RR and pulse; pupil

dilation, muscle tension, pallor; increased adrenalin,
increased blood sugar
Behavioral: moving away from painful stimuli,
crying, moaning, restlessness
Affective: withdrawal, stoicism, anxiety, depression,
fear, anger, anorexia, fatigue, hopelessness,
powerlessness
Categories of Pain
Duration
Location or source
Mode of transmission
Etiology
Pain: Duration
Acute pain: rapid in onset, varies in intensity from
mild to severe; warning signal that something
is wrong (cut finger, sore throat, headache)

Chronic pain: may be limited, intermittent or persistent,

but lasts belong the normal healing
period. Can be periods of remission or exacerbation.
(cancer pain, back pain). Interferes with normal
functioning
Pain: Location or Source
Cutaneous Pain (superficial) usually involves the skin
of subcutaneous tissue: paper cut
Somatic Pain originates in tendons, ligaments, bones,
blood vessels and nerves: sprains, broken bones
Visceral pain is poorly localized and originates in body
organs in the thorax, cranium, and abdomen: stomach
pain
 Question
A patient who has bone cancer is most likely
experiencing which of the following types of pain?
A. Cutaneous
B. Somatic
C. Visceral
D. Referred
 Answer
Answer: B. Somatic
Rationale:
Deep somatic pain is diffuse or scattered and originates
in tendons, ligaments, bones, blood vessels, and nerves.
Cutaneous pain usually involves the skin or
subcutaneous tissue.
Visceral pain is poorly localized and originates in body
organs.
Referred pain is pain that originates in one part of the
body and is perceived in an area distant to that part.
Origin of Pain
Physical—cause of pain can be identified
Psychogenic—cause of pain cannot be identified
Referred—pain is perceived in an area distant from its
point of origin
Pain: Mode of transmission
Referred Pain: pain which is perceived in an area of
the body distant from its point of origin
Heart Attack or Myocardial Infarction: pain is felt in
shoulder, jaw, or arms
Referred Pain
Pain: Etiology
Neuropathic pain: pain resulting from an injury of or
abnormal functioning of peripheral or central nervous
system (fibromyalgia, peripheral neuropathy)
Intractable: pain that is very resistant to treatment
Phantom Pain: pain in an amputated limb
Peripheral Neuropathy
Terms to know
Agonist: a drug that binds with a receptor to produce a
therapeutic response
Analgesic: drug that relieves pain
Antagonist: a drug that binds to a receptor to prevent
the action of an agonist
Placebo: “an inactive substance that gives satisfaction
to the person using it”
Nociceptors: Peripheral nerve fibers that transmit pain
The Pain Process
Transduction—activation of pain receptors
Transmission—conduction along pathways (A-delta
and C-delta fibers)
Perception of pain—awareness of the characteristics of
pain
Modulation—inhibition or modification of pain
Pain Process: Transduction, Transmission,
Perception, Modulation
Stimulator of Nociceptors or
Pain Receptors
Bradykinin: powerful vasodilator, trigger release of
histamine (redness, swelling, inflammation)
Prostaglandins: hormone-like substances that send
additional pain stimuli to the CNS
Substance P: sensitized receptors on nerves to feel
pain

These are Neurotransmitters: substances that excite or

inhibit target nerve cells
Pain Reception
Pain Receptor Stimulators
Mechanical - friction
Thermal - heat or cold
Chemical - acid
Electrical- static electricity
Perception of Pain
Pain threshold: lowest intensity of a stimulus that is
recognized as pain
Adaptation: “getting used to the stimulus”
Modulation of pain: sensation of pain is modified or
lessened by naturally produced chemical substances
Neuromodulators
Endorphins, dynorphins, enkephalins
Gate Control
Theory of Pain
States that certain small nerve fibers conduct pain
impulses toward the brain
Certain large nerve fibers appear to block pain
impulses toward the brain
A “gating mechanism” occurs when too much
information is sent to the brain and the pain signal is
interrupted
The brain can influence its own gating mechanism
through past experiences and learned behaviors
Gate Control Theory
Factors Affecting Pain Experience
Culture
Ethnic variables
Family, gender, and age variables
Religious beliefs
Environment and support people
Anxiety and other stressors
Past pain experience
General Assessments of Pain
Patient’s verbalization and description of pain
Duration of pain
Location of pain
Quantity and intensity of pain
Quality of pain
Chronology of pain
Pain Scale
Symptom Analysis
P, Q, R, S, T
P = Place: where is the pain (or other symptom)?
Q= Quality: what does it feel like?
R = Radiation: does it go anywhere else?
S = Severity:how bad is it? Rate it on a 1-10 scale
T = Time: how long have you had this?
Nursing Interventions for Pain
Establishing trusting nurse–patient relationship
Manipulating factors affecting pain experience
Reviewing additional pain control measures
Initiating nonpharmacologic and pharmacologic pain
relief measures
Considering ethical and legal responsibility to relieve
pain
Teaching patient about pain
Establishing a Relationship
Manipulating Factors Affecting Pain
1. Remove or alter the cause of pain: change body
positions, empty distended bladder, loosen tight
bindings
2. Alter factors affecting pain tolerance: promote rest,
sleep; encourage use of pain medication
3. Initiate non-pharmacologic relief measures:
distraction, humor, music, imagery, relaxation
techniques, cutaneous stimulation (TENS unit),
hypnosis, biofeedback, therapeutic touch
Transcutaneous electrical nerve
stimulation (TENS unit)
Pharmacologic Pain Relief Measures
Selecting analgesics
Pharmacological – Analgesics
1. Non-opiods – act on peripheral nerve ending at the
injury site (Tylenol, NSAIDS)
2. Opiods – Act on the CNS (Morphine, Codeine,
Demerol; also synthetic opiods like Dilaudid)
3. Adjuvants/Co-analgesics – Used in combination with
opiods (benzodiazapines: Valium, Ativian)
Selecting analgesics - WHO Ladder
Additional Methods for
Administering Analgesics
Patient-controlled analgesia
Epidural analgesia
Local anesthesia
PCA pump: Patient Controlled
Analgesia
PCA: Patient Controlled Analgesia
Placement of an Epidural Catheter
Scheduling Analgesic Doses
Preventive approach to pain management is crucial
Nurses should be able to anticipate procedures and
activities which will cause pain and pre-medicate the
patient
Pain should be controlled “ATC” or around the clock
with long-acting medications and/or prn with “break-
through” medications
When pain is out of control, larger doses are required
Comfort Measures
 Provide quiet, clean, uncluttered environment
 Provide warmth or coolness as indicated
 Provide personal hygiene: keep patient clean and dry, linen
changes, oral care
 Provide activity as indicated: TV, radio, reading material
 Explain all procedures, tests, hospital routines
 Facilitate family visits and support
 Check with patient at regular intervals about his
comfort/discomfort
 Keep call light within reach and encourage patient to call
you if needed
Focus on the Patient