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Basic Needs and Comfort Measures
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ObjectivesDefine basic human needsDefine: self-actualization, self-esteem, love,
security, belonging and physiologic needs according to Maslow’s Hierarchy of Needs
Explain and list physiologic needsDefine the terms associated with pain:
agonist, analgesic, biofeedback, antagonist, relaxation, mediation, PCA endorphins
Understand pain measurement techniquesDescribe techniques used to relieve painEvaluate effectiveness of pain control
measures
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ObjectivesList causes of discomfort for patientsList nursing measures to promote comfort
and ease discomfort for patients
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Comfort and DiscomfortList some attributes associated with
comfort:Examples: Warmth, softness, rest, quiet, coolness,
cleanliness, space, safetyName some more that you associate with
comfort
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Comfort and DiscomfortList some attributes that you might
associate with discomfortExamples: pain, nausea, fear, hunger,
thirst, dark, worryList some other examples
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Human NeedsBasic 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, warmthConnection, love, security, spirituality
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Abraham Maslow (1908 - 1970)
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MaslowProfessor of psychology at Brandeis
University who founded humanistic psychology
Created the Theory of Basic Human NeedsUseful 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
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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
unmetOne feels something missing when needs
are unmet.One feels satisfaction when needs are met.
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Maslow’s Hierarchy of NeedsCertain needs are more basic than othersAll 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 needsLevel 2: Safety and security needsLevel 3: Love and belonging needsLevel 4: self-esteem needsLevel 5: Self-actualization needs
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Basic Human NeedsLevel 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
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Basic Human NeedsLevel 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
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Level 1: Physiologic NeedsA 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 discomfortOxygen: respiratory diseases, cardiac diseaseWater: dehydration, hypovolemia, Food: starvation, NPOWarmth
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Level 2: Safety and security needsInvolves both physical and emotional
componentsPhysical security:1.Using hand hygiene and sterile techniques to
prevent infection2.Using electrical equipment properly3.Administering medications knowledgeabley4.Using skill when moving and ambulating
patients5.Assessing patients for potential risks, such as
falling, bleeding, infection
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Level 2: Safety and security needsEmotional safety and security: being free
from fear, anxiety and apprehensionPatients entering health care system face
fear of the unknown, their prognosis, unfamiliar surroundings, unfamiliar personnel
All patients have anxietyComfort measures: explain procedures,
friendly, unhurried approach, continuity of caregivers, relationship building.
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Level 3: Love and Belonging NeedsAll humans have this needCalled a higher-level needIncludes 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
patientEstablishing a nurse-patient relationship based
on mutual understanding and trust (by demonstrating caring, encouraging communication and respecting privacy)
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Level 4: Self-Esteem NeedsNeed 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
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Level 5: Self-Actualization NeedsThe 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.
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Self-ActualizationCharacterized by:1. acceptance of self and others as they are2. focus of interest on problems outside oneself3. ability to be objective4. feelings of happiness and affection for others5. Respect for all people6. Ability to discriminate between good and evil7. Creativity in solving problems and pursuing
interests
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Nursing Process
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Nursing ProcessAssessment: gathering information, dataDiagnosis: Name the problemPlanning: State an achievable goalInterventions: Actions that work toward
the stated goalEvaluation: Did the plan/interventions
meet the stated goal
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Nursing Interventions to Meet Patient NeedsPhysiologic needs usually take priorityBasic human needs are interrelatedExamples:ER patient with an MI: Level 1 needs?Level 2 needs?Level 3,4,and 5 needs?Post-surgical patient in painPt. NPO for surgery
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QuestionA 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
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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.
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Comfort and DiscomfortPhysiologic Discomfort can come from:PainNausea and VomitingShortness of breathHungerThirstInactivityConstipation
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Comfort Measures - Pain
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PainDef: 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”
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PainAmerican 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.”
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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
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Categories of PainDurationLocation or sourceMode of transmissionEtiology
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Pain: DurationAcute 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
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Pain: Location or SourceCutaneous 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
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QuestionA patient who has bone cancer is most likely experiencing which of the following types of pain?A. CutaneousB. SomaticC. VisceralD. Referred
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AnswerAnswer: B. SomaticRationale: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.
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Origin of PainPhysical—cause of pain can be identifiedPsychogenic—cause of pain cannot be
identifiedReferred—pain is perceived in an area
distant from its point of origin
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Pain: Mode of transmissionReferred 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
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Referred Pain
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Pain: EtiologyNeuropathic 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
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Peripheral Neuropathy
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Terms to knowAgonist: a drug that binds with a receptor
to produce a therapeutic responseAnalgesic: drug that relieves painAntagonist: a drug that binds to a receptor
to prevent the action of an agonistPlacebo: “an inactive substance that gives
satisfaction to the person using it”Nociceptors: Peripheral nerve fibers that
transmit pain
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The Pain ProcessTransduction—activation of pain receptorsTransmission—conduction along pathways
(A-delta and C-delta fibers)Perception of pain—awareness of the
characteristics of pain Modulation—inhibition or modification of
pain
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Pain Process: Transduction, Transmission, Perception, Modulation
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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
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Pain Reception
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Pain Receptor StimulatorsMechanical - frictionThermal - heat or coldChemical - acidElectrical- static electricity
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Perception of PainPain threshold: lowest intensity of a
stimulus that is recognized as painAdaptation: “getting used to the stimulus”Modulation of pain: sensation of pain is
modified or lessened by naturally produced chemical substancesNeuromodulatorsEndorphins, dynorphins, enkephalins
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Gate Control Theory of PainStates that certain small nerve fibers
conduct pain impulses toward the brainCertain large nerve fibers appear to block
pain impulses toward the brainA “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
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Gate Control Theory
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Factors Affecting Pain Experience
CultureEthnic variablesFamily, gender, and age variablesReligious beliefsEnvironment and support peopleAnxiety and other stressorsPast pain experience
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General Assessments of PainPatient’s verbalization and description of
painDuration of painLocation of painQuantity and intensity of painQuality of painChronology of pain
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Pain Scale
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Symptom AnalysisP, Q, R, S, TP = 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 scaleT = Time: how long have you had this?
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Nursing Interventions for PainEstablishing trusting nurse–patient
relationshipManipulating factors affecting pain
experienceReviewing additional pain control measuresInitiating nonpharmacologic and
pharmacologic pain relief measuresConsidering ethical and legal responsibility
to relieve painTeaching patient about pain
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Establishing a Relationship
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Manipulating Factors Affecting Pain1. 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
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Transcutaneous electrical nerve stimulation (TENS unit)
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Pharmacologic Pain Relief Measures Selecting analgesicsPharmacological – Analgesics1.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)
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Selecting analgesics - WHO Ladder
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Additional Methods for Administering Analgesics
Patient-controlled analgesiaEpidural analgesiaLocal anesthesia
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PCA pump: Patient Controlled Analgesia
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PCA: Patient Controlled Analgesia
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Placement of an Epidural Catheter
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Scheduling Analgesic DosesPreventive approach to pain management
is crucialNurses 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
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Comfort MeasuresProvide quiet, clean, uncluttered environmentProvide warmth or coolness as indicatedProvide personal hygiene: keep patient clean
and dry, linen changes, oral careProvide activity as indicated: TV, radio,
reading materialExplain all procedures, tests, hospital routinesFacilitate family visits and supportCheck with patient at regular intervals about
his comfort/discomfortKeep call light within reach and encourage
patient to call you if needed
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Focus on the Patient