Presented by,

Mr.Pramod Suryawanshi
Msc Nursing (CVTS)
 Comfort Devices :

They are invented articles which would add to comfort of patients

when used in appropriate manner.
 Mechanical/Comfort devices:

o Pillows
o Backrest
o Rolls
o Footrests /
Footboards
o Sandbags
o Air & Water
mattress
- Air
o Rings
Cushion
o Bed Cradle
 1) Pillows :

They are used to give comfortable position to the patient.

Purpose :
- To maintain proper body alignment.
To support body pan.
- To reduce pressure.
- Used to support head, neck, arm,
legs.
 2) Backrest :
It is a mechanical device which provides suitable support & rest for
the
back of patient in sitting position.
Purpose :
To supports back
- To facilitates easy breathing
- For Heart problem patients & asthma patients
- For post operative patient.
 1) Hand Roll :
They are made up of cloth ft at rolled into a cylinder shout four to
fivc
inchcs long & two io three inches in diamcicr & stulTcd firmly.
They are used to keep the fingers from being held in tight fist leading
to
flexion contracture. (paralysis patients)

2)Thigh Rolls:
They are made by folding a sheet into desired length of two to three feet &
then rolled into tight cylinder.
They are used to support hips & thigh preventing themfrom
outward
 4 Footrest :
They are the mechanical devices used to give rest to the
feet.

Purpose:
- Helps to maintain the normal position of feet.
- Used for the comfort.
To prevent foot drop.
FOOT BOARD/ FOOT REST
 5) Sandbags :
• They are canvas. rubber or plastic bags filled with sand.
• They are 1,5 & 10 pounds in weight and are used to immobilize a
part.

Purpose :
To relieve discomfort
- Used to support the body part
- Used to support as in fracture bones
- To prevent foot drop or wrist drop.
 6} Air & water mattresses:
o They are plastic mattresses with two sets of chambers.
o Here, pressure exerted by body will be distributed equally in all directions.
o To use them place the matresses on the bed & fill the air or water in
the compartment.

•Purpose:
To improve circulation
- To prevent pressure sores
- To provide comfort.
- Used in very thin or obese patients & chronic bed ridden patients.
 Bed cradle:
o It is a frame used to prevent the bed clothes from touching all or part
of the client's body.
o it is Used for clients with fracture, extensive burn and open or
painfull wounds.
o A wide cradle fits all the way along bed lengthwise.
o A narrow cradle can be used over one arm or leg.
 Purposes :

Used to prevent the top cloth is coming in contact with the patients in
burns.
- To apply heat in case of drying plaster casts.
Electronic bed cradles are used to supply the desired warm in the case of
shock.
 Bed Blocks :
They are made up of wood, size may be high or low.
They are placed under the foot of bed for various
reasons.
Purposes :
 To prevent shock.
 To arrest hemorrhage.
 To retain enema
 After spinal anesthesia.
 To provide traction.
 To position in postural
drainage.
 Air Cushion :
• They are round in shape & made up of
rubber.
• These can be inflated with air.
• They are used to take of the weight of body.

• Purpose :
 To relieve pressure
 It provide relaxation
 Cardiac Table :

 It is used to maximize safety of both patients and staff.

 Improve patient's surrounding.
 It can be placed in front with a pillnw on it, patient can l e a n forward
and take rest.
 Table without pillow is used for meals & writing.
 position should be changed to relieve fatigue.
 Trapeze Bar :

 A horizontal bar hanging on chains.

 It is a triangle shaped metal bar. It hangs from metal
frame,which is attached to the headboard.
lt is attached to large overhead frame, which itself attaches to the bed.
lt is used by patient to pull up to a sitting position or to the shoulders
and hips of bed.
Trapeze Bar:
 Role of Nurse :

- Identify comfort needs of

-patients.
Design interventions to meet needs.
- Engage in health seeking behaviours.
- Help patients to gain better health related
outcomes.
• It is definedas placingthe person to
perform therapeutic interventions to promote the health of
an individual.
• It is placing a person in a proper body alignment for the purpose of
preventive, promotive, curative and rehabilitative aspects of health.
 Purposes
:
- To provide comfort & proper body alignment to the
patient
- To relieve pressure on various parts
- To improve circulation
- To prevent pressure sore & deformity
- To conduct delivery / labor
- To carry our nursing interventions.
 Principles :

Systematic & orderly

 Cooperation between two
 Follow safety measures to prevent accidents
Active participation
Using a right technique at right time.
 Types of patient need special care:

- Unconscious
patient
- Infant & children
- Hemiplegic & Paraplegic patients
- Immediate Post operative patients
- Orthopedic patients
- Cardiac patients
 Preliminary assessment :

- Monitor the patients for general condition.

- Check the physician's order for limited movements
- Arrange the comfort devices near bedside.
- Assess the self care ability of an individual.
- Identify the deformed extremity & plan for rational before
positioning.
• Extra manpower if needed
• Extra pillows

• Sheets & sheet rolls

• Comfort devices such as backrest, cardiac table,
sandbag, etc.
 Supine position :

The patient lies on his back with head & shoulders are slightly elevated.
• One pillow is given under the head.
• A pillow is placed under his knees (if needed).

Indications:
Regular position used by patient.
- For the examination o f chest & abdomen.
 Dorsal Recumbent position:
Paticnt lies on his back. knees fully flexed, thighs flexed and externally rotated,
feet flat on the bed.

• Used for catheterization, vaginal douche, vulval, rectal

vaginal &
examination.
• Used for vaginal operations & insertion of tampons.
• Patients with some gastric & chest disease conditions.
• Patients with pelvic surgery unless sitting position is
contraindicated.
 Lithotomy Position :

• Patient lies on her back.

• Legs are separated & thighs are flexed on the abdomen & legs are on
the
thighs.
• Patient's buttocks are kept at edge of table
• legs are supported by stirrups.
 Prone position :
• A patient lie flat on abdomen, head turned to sideways & a pillow is
given under head.
• An extra pillow is given under the ankles to keep toes from touehing
the bed.

Indications :
- In postoperative patients to prevent aspiration of
saliva.
- To prevent bedsores.
- To relieve abdominal distension.
- In patients having injuries & burns on back.
 Lateral
position
• Patient lies on left / right side : fiexed at thighs,
with legs
• The upper leg is more flexed than lower.
• A pillow is kepi in front of the abdomen & at the back and one
under the upper leg.

Indications :
- Used for giving back care, enemas & colonic irrigations.
- Used for examination o f perineum or rectum, for inserting suppositories.
- For taking rectal temperature.
- As a relaxing position.
 Sim’s Position :
o It is Similar to the lateral position except t h at, patient's weight is on
anterior aspect o f patient’s shoulders girdle and hip.
o Patient's lower arm is behind him and upper arm is flexed at shoulders
& elbow.

Indications :
- Used in unconscious patients.
- Used for rectal & vaginal examination
- Used for relaxation in antenatal exercises.
 Knee Chest / genupectoral position :

• Patient rest on knees and chest. The head is turned to one side with
one
cheek on pillow.
•• A pillow is placed under the chest, the weight is on the chest &
knees.

Indications :
Used for sigmoidoscopy.
- Used for vaginal & rectal examinations.
- Used in first aid treatment in cord prolapse or retroverted uterus.
- Used as exercise for postpartum & gynecology patients.
 Trendelenburg's position:
• Patient lies on his back, head is low & root of the bed is elevated at
45
degree angle.
• The body is on inclined place & the legs hang downward over end of table.

Indications :
• Used in conditions like shock &
hemorrhage
• Used in Vaginal surgeries
• Used during operations on the pelvic organs
• To arrest bleeding from tower limb.
 Fowler’s Position :

• lt is Sitting position, in which head is elevated to 45 degree

angle.
• backrest and pillows are use d for the back and head.

Indicatlons :
- To relieve dyspnoea
- To improve circulation & present thrombosis
- To relax muscles of abdomen, back & th
ighs
- To relieve tension on abdominal sutures
- To promote comfort.
 REST AND SLEEP

• Sleep is considered as an important physiological need / requirement.

• Getting enough quality sleep at the right time can help protect your
mental health, physical health, quality of life and safety.

Definition :
• It is a normal state of altered consciousness during which the body rests..
• The resting state in which the body is not active & the mind is
unconscious.
• It is an active state of unconscious produced by body where the brain is
in a relative state of rest.
 FUNCTIONS OF SLEEP :

Reducing fatigue
- Stabilizing mood, improving blood flow to the
brain
Increase protein synthesis
- Improve immune system
- Promoting cellular growth & repair
- Increase the capacity for learning & memory
storage.
 Sleep hour requirements :

Neonates : usually sleep 14 to 17 hours a

day.
I nfants
: 1 2 to 15 hours a day
Toddlers
: 11 to 14 hours a day.
Pre — : 10 13 hours a
day.
schoolers
: 9 to 11 hours a day.
Schloolers
: 8 to 10 hours a day
Adolescents
: 7 to 9 hours a day
Young adults
: 7 to 8 hours a day.
Older adults
 Factors Affecting Sleep :

Quality & Quantity of sleep are affected by number of factors.

1) Motivation
2) Culture
3) Lifestyles & Habits
4) Physical activity & Exercise
S) Dietary habiis
6) Alcohol Intake
7) Caffeine containing Beverages
8) Smoking
9) Environmental Factors
 Sleep Disorders:

1} Insomnia : persistent fal ling & staying asleep or a common sleep

disorder that can make it hard to fall asleep.
Interventions :
• Adherence to regular bed routine.
• Avoidance of alcohol & exercise prior to sleep.
• Using the bed for sleep only (not for watching TV or doing work)
• Use of stress & relaxation techniques
• Avoidance of caffeine & heavy meals prior to bed.
• Medications to promote sleep.
Hypersomnia
:
Exccssivc sleepiness that are not due to underlying disease. Exeessive day time
Sleepiness .

Narcolepsy :

• Day time sleepiness & sleep attacks that cause person to fall
asleep at
unpredictable times like while driving an automobile.
• Treat the patients with central nervous system stimulant medications
like Amphetamine or an antidepressant to control this disorder.
It is potentially a serious sleep disorder, in which breathing repeatedly stops &
restarts.

Treatment depends on the

cause.
o Laser reduction — enlarged oropharyngeal anatomy
o Weight reduction diet - Obesity
o CPAP if the cause is untreatable, provide Continuous Positive
Airway
Pressure by using full face mask, partial face mask or nasal
prong. Full face mask is recommended for mouth breathers.
• A person who walks around, eats or performs other motor acts
while sleeping.
• It involves getting up and walking around while in a state of sleep.

Interventions :
Sleep hygiene programs
- Elimination of problematic medications
- Avoidance of alcoholism.
 Nocturnal Diuresis / Nocturia :

• It is a condition that causes patient to’ake

w up during the night to
pass
urine.
• It is also called as Global Polyuria.
• They usually caused due to diabetes m ellitus, excess fiuid intake &
poor
kidney function.
• It is treated with bed wetting alarm, positive reinforcement and medications
like Imipramine, Desmopressin.
 Somniloquy / Sleep talking :

O It is formally called as talking during

sleep. O It is a type of parasomnia.
O It is generally harmless and random
event.

Interventions :
• lt can be avoided by creating relaxing bed
time routine.
• Minimize stress.
 HEALTHY HABITS :

Sleep in a cool quite place, avoid artificial light.

Go to sleep & wake up around same time every
day.
- Avoid caffeine, nicotine & alcohol close to
bedtime.
- Get regular physical activity during day time.
- Avoid day time naps & late night dinners.
- Learn new way to manage stress.
- Limit the fluid you drink close to bedtime.
 PHYSIOLOGY OF
SLEEP:
Sleep is a cyclical physiological process that alternates with longer periods
of wakefulness.
Sleep — wake cycle influences and regulates body function and
behavioural
response.
 STAGES OF SLEEP :

• Normally adult's routine pattern begins with pre-slecp period.

• The person usually pass through four to Six complete cycles.
• It involves Two Phases.

- Non Rapid Eye Movement (NREM) sleep : Tt progresses through 4

stages during a typical 90 minutes sleep cycle and the quality of sleep
becomes increasingly deep.
- Rapid Eye Movement (REM) sleep : It is the phase at the end of each
90 minute sleep cycle.
 Stage I : NREM
• lt includes lightest level of
sleep .
• It lasts for few minutes.
• Decreased physiological
activity

begins with gradual fall in

vital signs & metabolism.
• Person is easily aroused by sensory stimuli like
noise.
• Awakened person feels as though dream has
occurred.
 Stage 2 : NREM

• lt is a stage of sound sleep.

• Relaxation progresses.
• Arousal is still easy.
• Stage lasts for 10 to 20 minutes.
• Body functions continue to slnw.
 Stage 3 : NREM

• lt involves initial stages of deep sleep.

• Sleeper is di fficult to arouse and rarely moves.
• Muscles are completely relaxed.
• Vital signs decline but remain regular.
• It lasts for 15 to 30 minutes.
 Stage 4 : NREM

• It is the deepest stage of sleep.

• It is very difficult to arouse sleeper.
• Vital signs are significantly lower than during waking
hours.
• Stage lasts approximately 15 to 30 minutes.
• Sleepwalking and enuresis occur in this stage.
 REM Sleep :

• Vivid. colourful dreaming may occur.Less dreaming may occur

in other stages.
• This begins about 90 minutes after sleep has begun.
• It is typified by autonomic response of rapidly moving e yes,
fluctuating heart and respiratory rates.
• Loss of skeletal muscle tone occur.
• Gastric secretions occur.
• It is very difficult to arouse sleeper.
• Duration of sleep increases with each cycle & averages 20 minutes.
 PAIN

Definition :

• It is an unpleasant sensory & emotional e xperience associatcd with actual

or potentiel damage.
• It is a physiologic sensation caused by a specific stimulus.
• It is a mechanism that protects the individuel from liarinful stimulus.
• Pain can also considered as warning sign of tissue damage.
 Types of Pain :

It lS classified under many categories.

• Based on Duration
• Based on Location
• Based on Intensity
• Based on Etiology
 Based on Duration

Acut Chronic
e
T. Chronic Non Cancer
pain

2. Chronic Cancer pain

3. Chronic Episodic Pain

 Based oa Location :

O Headache

O Back pain

O Joint pain

O Stomach
pain

O Chest pain
 Based on Intensity

Mild Moderate Severe

(1-3) (4-6) (7-
10)
 Pricking or cutting pain : a sharp & localized pain. It is of cutaneous origin.
It is caused by pricking or cutting the skin by sharp
object.
Burning Pain : it is of cutaneous origin and caused by burns or
inflammation of skin.

Aching Pain : it is more diffuse & felt coming from deeper tissue.
Throbbing Pain. it is characterized by fluctuation of intensity with arterial
pulsation.
Colicky Pain : it results from spasm of plain muscles in the walls of
hollow viscera.
 Guidelines to assess Pain :

1. Characters of Pain :

- Severity
- Quality, Location, Duration, Rhythmicity of Pain.
- Tolerance
- Harmful effect on Recovery
- Concerns that patient has about pain.
 NUMERIC RATING SCALE

0 2 3 4 6 7 8 9 10
1 5
No Severe
Moderate
pain pain
pain

0 2 4 6 8 10
No heart hurts hurts hurts hurts hurts
little bit little more even more whole lot worst
2. Patient's Behavioural response to the
Pain :
O Physiologic manifestation — changes in pulse, BP, Respiratory
rate.
O Verbal statement.
O Vocal Response.
O Facial Expressions.
O Body Movements.
O Changes in response to environment.
O Adaptation to physiological & behavioural
response. O Effect on ability to communicate.
 assessme
nt

assessment.neur
opsychiatric
symtoms

Process of pain
management

treatment
 l

Prescription Non Physical

prescriptions Therapy
Opioids Acetaminophen Heat therapy
Anticonvulsant Acetylsalicylic Ice therapy
Antidepressants acid Massage
sedatives Ultrasounds
TENS
Acupuncture
Occupational
'
therapy ’
others
Ptæmædogical @ WHO %tep
analysis Adder
Non p|okB NS Ds!a
inophen
 Nursing Interx'entions :
Prov ide Therapeutic positioning.
Rest affected area.
Provide distraction.
Provide supportive
environment.
Help the patient to identify activities thai enhance
pain. Discuss the strategies to reduce enhancement of
pain.
Provide Music therapy.
Use hypnotic strategies.
Use counter stimulation such as : Aceupressure, Massage, Vibratinn, Heat /
Cold Application, External analgesics, Transcutaneous Nerve Stimulation.
 NON PHARM ACOLOGICA L THERAPIES :

1. DISTRAC “ION :
It involves diverting the patient's mention away from the sensation of
pain towards other thoughts.
- Encourage patient to recount recent pleasant experience.
- Encourage patient to actively listen music. Have a patient close eyes and
concentrate on music.
- Participate in rhythmic singing.
- Laughter Therapy
 VISUALIZATION :
O It is a form where images are used to modify the perception of pain.
O Images are shown for 20 minutes, 2 to 3 times per day.
O One common method is Guided Imagery.
O An imaginary “Magic Glove” or “Magic Blanket” is put in place
before a
painful procedure.

HY PNOSIS :

O It is usually executed by Registered Hypnotherapist.

O This technique involves achieving deep relaxation and then
listening to or
giving oneself positive suggestions.
 4IASSAGE :

O It is a type of integratix'e medicine in which a massage therapist rubs &

kneads skin, muscles, tendons & ligaments.
O The effect of massage is similar to heat.
li helps in improving circulation and removal of waste
products is
enhanced.
O It is a valuable technique for reducing anxiety and promoting
relaxation.
 MEDITATION :

O It is an ancient method, which involves focusing or clearing your

mind using combination of mental & physical technique.
O It is a useful relaxation technique for patients.
O Patient may close or leave eyes open to focus on the subject.
O Prior to beginning, patient selects a soothing word, relax or calm.
With
every breath in, patient silently says the word that was chosen.
 TH ERA PE UT IC
TOUCH :

O It is a method of directing the energy through the

hands.
O This technique produces a relaxation response a perception of
& pain
relief.
O It is a registered trademark in Canada.
O Practitioners of Therapeutic Touch claim thai, placing their
hands on or near a patieiTt, they are able to detect and manipulate
patient's energy field.
O It is a PSEUDO SCIENTIFIC energy therapy.
 BIOFEEDBACK

O It is a self awarcness & regulation technique.

O It uses sensitive electronics to detect & amplify internal body activities iii
order to bring them to individual's notice.
O It teaches people to develop greater awareness of their physical & mental
behaviour.
O People become more aware of unhealthy symptom perpetuating
behaviours such as tensed muscles, constricted blood vessels, rapid
heart rate, respiration, sweat gland activity and over reactive nervous
system activity.
 TENS (Transcutaneous Electrical Nerve Stimulation)

O It is a type of Pain relief therapy.

O lt uses low — voltage electi icat current to block the pain.
O A TENS unit is a battery powered device with electrodes that
deliver
electrical impulses through the surface of skin.
O The Electrical cuwent raises the level of “Endorphins” (body's
natural pain killing chemical), which thGn ttigget the body's pain
killing power.
O It is used to treat Back pain, Osteoarihtiiis, Fibromyalgia, Tendinitis,
Bursitis, etc.
 PCA (Patient Controlled
Analgesia)
O lt is a type of pain management that lets you decide when
you wit I get a dose of pain medicine.
Patient will not wait for the staff to give medicine, where as patient will get
smaller doses of medicine more oflen.
O A computcrized pump attached to the IV, it will release the pain
medicine
in a prescribed intcrvals by pressing a handheld button.
It is commonly used after the surgery, Pancreatitis, Sickle cell disease.