Basic Needs and Comfort Measures

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

ObjectivesList causes of discomfort for patientsList nursing measures to promote comfort

and ease discomfort for patients

Comfort and DiscomfortList some attributes associated with

comfort:Examples: Warmth, softness, rest, quiet, coolness,

cleanliness, space, safetyName some more that you associate with

comfort

Comfort and DiscomfortList some attributes that you might

associate with discomfortExamples: pain, nausea, fear, hunger,

thirst, dark, worryList some other examples

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

Abraham Maslow (1908 - 1970)

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

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.

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

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

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

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

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

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.

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)

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

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.

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

Nursing Process

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

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

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

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 DiscomfortPhysiologic Discomfort can come from:PainNausea and VomitingShortness of breathHungerThirstInactivityConstipation

Comfort Measures - Pain

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”

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.”

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 PainDurationLocation or sourceMode of transmissionEtiology

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

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

QuestionA patient who has bone cancer is most likely experiencing which of the following types of pain?A. CutaneousB. SomaticC. VisceralD. Referred

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.

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

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

Referred Pain

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

Peripheral Neuropathy

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

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

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 StimulatorsMechanical - frictionThermal - heat or coldChemical - acidElectrical- static electricity

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

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

Gate Control Theory

Factors Affecting Pain Experience

CultureEthnic variablesFamily, gender, and age variablesReligious beliefsEnvironment and support peopleAnxiety and other stressorsPast pain experience

General Assessments of PainPatient’s verbalization and description of

painDuration of painLocation of painQuantity and intensity of painQuality of painChronology of pain

Pain Scale

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?

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

Establishing a Relationship

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

Transcutaneous electrical nerve stimulation (TENS unit)

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)

Selecting analgesics - WHO Ladder

Additional Methods for Administering Analgesics

Patient-controlled analgesiaEpidural analgesiaLocal anesthesia

PCA pump: Patient Controlled Analgesia

PCA: Patient Controlled Analgesia

Placement of an Epidural Catheter

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

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

Focus on the Patient