The nurse assesses the person's sleep pa erns. Report any of the signs and symptoms listed in Box 35-6 and your observations about how the person slept. Measures are planned to promote sleep (Box 35-7). Follow the care plan.
Box 35-7
Promoting Sleep
• Plan care for uninterrupted rest.
• Encourage the person to avoid business or family ma ers before bedtime.
• Allow a flexible bedtime. Bedtime is when the person is tired, not a certain time.
• Provide a comfortable room temperature.
• Let the person take a warm bath or shower.
• Provide a bedtime snack.
• Avoid caffeine (coffee, tea, colas, chocolate).
• Avoid alcoholic beverages.
• Have the person void before going to bed.
• Make sure incontinent persons are clean and dry. Change a baby's diaper.
• Follow bedtime rituals and routines.
• Have the person wear loose-fi ing sleepwear.
• Provide for extra warmth (blankets, socks) as needed.
• Make sure linens are clean, dry, and wrinkle- free.
• Position the person in good alignment and in a comfortable position.
• Support body parts as ordered.
• Give a back massage.
• Provide measures to relieve pain.
• Let the person read, listen to music, or watch TV.
Read to children. You can read to an adult if he or she prefers.
• Assist with relaxation exercises as ordered.
• Sit and talk with the person.
• Reduce noise.
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• Darken the room—close window coverings and the privacy curtain. Shut off or dim lights.
• Dim lights in hallways and the nursing unit.
Bedtime rituals and routines are important. They are allowed if safe. The person may have a bedtime snack or perform hygiene in a certain order. Some watch TV in bed.
Others read religious writings, pray, or say a rosary before sleep.
The person is involved in care planning. The person chooses when to nap or go to bed. The person chooses the measures that promote comfort, rest, and sleep. Follow the care plan and the person's wishes.
See Focus on Long-Term Care and Home Care: Promoting Sleep.
Focus on Long-Term Care and Home Care
Promoting Sleep Long-Term Care
Some persons like to check on other residents before going to bed. Some have the duty of turning off lights at bedtime. These actions promote the person's dignity and mental comfort.
Focus on Pride
The Person, Family, and Yourself Personal and Professional Responsibility
Unmanaged pain decreases quality of life. You have an important role in assisting with pain relief. You talk with patients and residents and listen to their needs.
Report signs and symptoms of pain. Report what the person said and what you observed. The nurse uses this information to assess, plan, and evaluate pain relief.
Rights and Respect
Your care can either promote comfort and relaxation or cause stress, discomfort, and worry. For example:
• Are you prompt to meet needs?
• Do you ask about the person’s preferences?
• Do you communicate in a respectful way?
• Do you allow time for rest?
• Do you leave the person’s room clean, neat, and safe?
Take pride in providing care in a way that protects the right to quality of life.
Independence and Social Interaction
A person's emotional, spiritual, and social needs affect comfort. Time spent with friends and family can be comforting. For some, religious ceremonies or rituals promote peace and healing. Allow time and privacy for those needs. Small gestures show that you care.
You can:
• Ask: “How are you feeling today?”
• Give the person time to pray before meals or at bedtime if this is something he or she values.
• Ask about the person's friends and family while giving care.
Delegation and Teamwork
The health team coordinates care and therapies with pain-relief measures and rest periods. It is common to wait 30 minutes after a pain-relief drug is given to perform procedures and provide care. The nurse tells you how long to wait. The person is allowed to rest after tiring activities, procedures, and therapies.
Planning and communication are needed for effective teamwork and quality care.
Ethics and Laws
You may question what the person tells you about his or her pain. For example, a person rates headache pain as 9 on the 0 to 10 pain rating scale while working a crossword puzzle and listening to music. When you have a severe headache, you need to rest in a dark, quiet room. You doubt that the person's pain is really a 9 on the scale. You decide not to tell the nurse.
The person's pain really was severe. The crossword puzzle and music were distractions from the pain.
Because you did not report the pain, the person did not receive pain-relief measures.
Ignoring a person's pain is wrong. Reporting a different pain rating is wrong. Avoid making judgments about the person's pain. Accurate reporting is needed for proper pain management.
Focus on Pride: Application
Family and visitors often provide comfort. How will you welcome the person's visitors? How will you show you value them and their time with the person?
Review Questions
Circle T if the statement is TRUE or F if it is FALSE.
1. T F Pain is a warning from the body.
2. T F Pain differs for each person.
3. T F Pain can be seen.
4. T F Changes in usual behavior may signal pain.
5. T F A person's culture may affect reactions to pain.
6. T F A back massage relaxes muscles and stimulates circulation.
7. T F After lunch, a person asks for a back massage.
You must wait until evening to give the massage.
8. T F Persons with dementia usually sleep well at night.
9. T F Tissue healing and repair occur during sleep.
10. T F Voluntary muscle activity increases during sleep.
11. T F Sleep refreshes and renews the person.
12. T F Sleep increases stress, tension, and anxiety.
13. T F Sleep deprivation can affect functioning.
14. T F Older persons may nap during the day.
Circle the BEST answer.
15. A person has complained of knee pain on and off for several years. This type of pain is
a Acute pain b Chronic pain c Radiating pain d Referred pain
16. A person is restless and complains of pain. You should
a Rate the intensity based on the person's behavior
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b Give a pain-relief drug and tell the nurse
c Tell the nurse only if you think the person has pain d Report the person's exact words
17. A person received a pain-relief drug. When should you give scheduled care?
a When you have time
b Right after the drug is given c 30 minutes after the drug is given d The next day
18. A drug was given for pain relief. To promote safety a Keep the bed in the raised position
b Quickly change positions to avoid dizziness c Check on the person every hour
d Provide help if the person needs to get up
19. Which measure promotes comfort and pain relief?
a Providing a blanket b Speaking loudly
c Keeping the lights on in the room d Asking about comfort every 5 minutes 20. When giving a back massage
a Massage for 15 to 20 minutes b Warm the lotion before applying it c Massage reddened areas
d Position the person in Fowler's position
21. A person tires easily. You are giving morning care.
When should the person rest?
a After you complete morning care b After the bath and before hair care c After you make the bed
d When the person needs to
22. A healthy 70-year-old person needs about a 11 to 12 hours of sleep per day
b 9 to 10 hours of sleep per day c 7 to 8 hours of sleep per day d 5 to 6 hours of sleep per day 23. Which prevents sleep?
a Cheese b Chocolate c Milk d Beef
24. Which measure before bedtime promotes sleep?
a Having the person urinate b Having the person walk c Providing hot tea
d Leaving the hallway light on
See Review Question Answers at the back of the text.
Focus on Practice
Problem SolvingPrioritize the following comfort needs. Which would you do first, second, third, and last?
• Provide a blanket.
• Report chest pain that began suddenly.
• Help a person who received a pain-relief drug 1 hour ago to the bathroom.
• Provide a back massage before bedtime.
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