UNIT 03

"MEETING. THE BASIC NEEDS. OF PATIENT

Comfort Devices ÷›
Definition =>:
• Comfort: absence of irritating Stimuli. that distract ones
attention from the task at hand.
Comfort Devices: these are the mechanical devices planned
to provide optimal comfort to an individual
List of Comfort Devices :.
Pillows
Back Rest
Bed Caradle
Cardiac table
Mattresses
Trapeze Bar
Footboard
Trochanter Rolls.
Sandbags
Side rails
wedge / Abductor pillow
knee rest.
Bed blocks
Air Cushion
Rubber 8 Cotton rings
Hand Ralls

PILLOWS:.
Purposes
Used for support to maintain correct body allignment.
Used under head, arms, legs and along spine abdomen to provide
comfort.
Back Rest:
Support patient's back at an angle, so that he may maintain a sitting
position
Can be adjusted to desired angle,
Extra Pillow are needed.
Arms of patient are well Supported
Used for patient suffering with Cardiac and pulmonary distress.

BED CRADLE :.
It is a frame used to hold the bed line from the touching the patient.
Cradle is a semicircular/Rectangular frame
of metal.
May be made of wood or bamboo.

Purposes:
To prevent pressure from the weight of linen.
To allow air to circulate around lower limbs.

CARDIAC TABLE:
Bed table placed in front with a pillow on it, patient Can lean lean
forward and take rest.
Table without pillow is used for writing and meals.
Used for patient with Cardiac Conditions and asthama.
Position should be changed should be changed to relieve fatigue.
Purposes:
Patient Can rest over the table with the help of pillow.
Helps to take meal and in writting.

MATTRESSES
mainly of two types:
(1) Air mattresses
2. Water Mattresses

Purposes:
• To provide Comfort.
• Used for very thin and obese patients and those who are prone
pressure sores.
TRAPEZE BAR:
Patient can grasp the bar to raise the trunk off the bed Surface or to move
up in bed.

FOOT BOARD :
Device that is placed towards the foot of patients bed to serve as
support for his feel.
Usually made up of wood/plastic /heavy Canvas.
Purposes:
To support patient's feet.
To prevent foot drop.

TROCHANTER ROLLS:
A Cotton bath blanket/Sheet is folded length wise to width extending
from greater trochanter of femur to lower border of poplileal space .
Purpose:
Prevent external rotation of legs when patient in Supine position.

SANDBAGS
They are Sand filled plastic bags that can be Shaped to body
Contours.
It Can be used in place of or in addition to trochanter rolls.
Purposes:
Provide Support & Shape to body.
Immobilize extremites & maintain specific body alignment.

SIDE RAILS →
Side rails are the bars positioned along the sides of the length of the
bed.
Purposes :
Ensure patient's Safety and are useful for increasing mobility.
Provide assistance in rolling from side to side or sitting up in bed.

WEDGE/ABDUCTOR PILLOW:
• it is triangular Shaped pillow made of heavy fome
Purposes:
used to maintains legs in abducting, following total hip replacement
Surgery.

KNEE REST:
This is the device placed under the Knees to provide comfort.
Purposes:
This gives relaxation and relieves pain on tendons beneath the knees.

BED BLOCKS:
Made up of wood or metal
Purposes:
These are used to raise foot end or head end of the bed.

AIR CUSHION:
Air Cushion are made up of rubber & it can be inflated with air.
Purposes:
Used to take off the weight of the body and release pressure on
certain parts of the body.

RUBBER AND COTTON RINGS:

These are circular rings made of rubber or Cotton.
Purposes:
These are used to relieve pressure on certain parts of the body like
elbow & heels.

Hand Rolls:
Made by folding a Washcloth in half lengthily and seeking roll with
tape.
Roll is placed against palmer surface of hand.
Purpose
Maintain thumb Slightly adducted and in opporation to fingers.
REST AND SLEEP
Definition: Rest is a Condition in which the body is in a condition
state of activity without physical emotional stress & freedom from
anxiety.
Sleep is a state of rest accompanied by altered level of consciouness
and relative inactivity and perception environment.
Physiology of Sleep;
the cycle nature of sleep is thought to be controlled by centres
located in the brain and by cardiac rhythms.

Reticular Activating System

RAS located at the brain sterm and Cerebral plays an
important role in sleep wake cycle.
Sleep begins with the activation of preoptic area of the anterio
hypothalamus.
Sleep promoting neurons act over wake promoting neurons by
releasing GAMMA Amino Butyric Acid(GABA).
The Inhabitation of wake promoting neurons resulting in intensifying
Sleep process.
Another key factor to sleep is exposure to darkness.
Darkness and preparing for Sleep (e.g; lying down, decreasing noise)
the Cause in decrease in stimulation of the RAS.
During this time, the pincal gland in brain begins to activity secrete
the natural hormones melatonin, and the perion feels less alert.
With the beginning of day light melatonin is at lowest the body and
the Stimulating hormone Cortisal is at it's highest causing weak
fullness.
TYPES STAGES / PHASES of sleep
ELECTROENCEPHALOGRAM(EEG)
Patterns, eyes, movement and muscle activity are used to identify
stages of sleep. The stages of sleep are classified into 2 types.

TYPES STAGES / PHASES of sleep

The stages of sleep are classified into two stages.
(1)Non rapid eye movement(NREM)
Stage 1
Stage 2
Stage 3
Stage 4
(2) Rapid Eye movement [REM] sleep

Non- Rapid eye movement (NREM) sleep

First stage of sleep is known as NREM sleep.
About 75% - 80% of steep during a night is NREM Sleep.
It consists of 4 Stages:
Stage 1 [NREM]
Stage lasts a few minutes.
it includes lightest level of sleep.
Gradual fall in vital EEG frequency.
Eyes tend to roll slowly from side to side.
Sensory Stimuli such as noise. early arousal.
Sleeper may deny he is sleeping.
Stage 2: NREM
Stage lasts 10-30 minutes.
It is a period of Sound sleep.
Relaxation progress.
Further slowing of EEG.
Absent eye ball movement
Body functions continue to slow.
Arousal remains relatively easy
Stage 3. NREM:
Stage lasts 15-30 minutes..
It involves initial stage of deep sleep.
Muscles are completely relaxed.
large Slow wave in EEG.
Vital signs decline but remain regular.
Sleeper is difficult be arouse and relatively moves.

Stage4 NREM
Stage lasts approximately 15-30 minutes.
It is the deepest stage of sleep.
If sleep loss has occurred, sleeper spends considerable portion of
night in this stage.
Vital signs are significantly lower than during waking hours.
Further slowing of EEG.
Sleepwalking and enuresis [ bed wetting] sometimes осcur.
It is very difficult arouse sleeper.
Rapid eye movement (REM) Sleep.
Stage usually begins about 90 minutes after sleep has begun.
Dreaming occurs in this stage
Stage is typified by rapidly moving eyes, fluctuating heart rate
respiratory rates increased of fluctuating blood pressure, loss of
special muscle tone and increase of gastric secretions.
EEG pattern resembles that of awake state.
It is very difficult to arouse sleeper.

Function of Sleep:-
Conservation of energy.
Restoration of tissues and growth.
Thermoregulation.
Regulations of emotions. Sleep deprivation causes emotional
disorders like irritability, anxiety depression. etc.
Neutral maturation.
Memory and learning: there will be information
transfer between cerebral cortex and hippocampus during sleep.
Normal Sleep requirement:.
Newborn-16- 18 hours/ day
Infant- 12-16 hours/day
Toddler-10-19 hours/day.
Pre Schoolar - 11 - 12 hour/day
School age- 8-12 hours/day.
Adolescent- 8-10 hours / day
Adult- 6-8hours
Elder- 6-hours.

Factors Affecting sleep

Age:-
Illness: illness that causes pain distress or physical distress.
[eg: arthritis, back pain] can result in sleep problem.
Environment: it can promote or hinder sleep.
Any Change for example, noise in the environment can inhabit sleep.
The absence of usual stimuli: of presence of unfamiliar stimuli can
prevent people from sleeping.
Light level can be another factor.
Another influence includes the comfort and size of the bed.
A persons Partner who has different Sleep habits, snores or has other
sleep difficulties may become the problem for the person also.

Life style:
Following an irregular morning and night schedule can affect sleep.
Night Shift workers frequently obtain less sleep than other workers
and have difficulty falling asleep.
Emotional stress
Stress is considered to be the major cause of short-term sleep
difficulties.
A person preoccupied with Personal Problems eg School, on job
related pressure, family or marriage problems may be unable to relax
sufficiently to get to sleep.
Stimulants and Alcohol:
Caffeine · Containing Beverages act as Stimulant of Central nervous
system (CNS).
Drinking beverages containing caffeine the afternoon or evening may
interfere with sleep.
Even though alcohol induces Sleep, it disturbs REM sleep causing
irritability.
Diet:
Certain foods induces sleep.
Ex; the L-Tryptophan present in the milk induces sleep.
Smoking:
Nicotine has a Stimulating effect on the body and Smokers often
than non-smokers.
Motivation:
Motivation can increase alertness in some situation.
Ex ; During the time of Examination.
browsing internet in the late night.
Medication
Beta-blockers have been known to cause insomnia.
Narcotics: Such as morphine, are known to suppress REM sleep and
to cause frequent awakening and drowsiness.
Most Hypnoties suppresses REM sleep

Exercise:
Defination:
Exercise is physical activity for conditioning the body, improving and
maintaining fitness.
Benefits of Physical Exercise:
Improved Cardiopulmonary function.
Reduced blood Pressure.
Increased muscle tone and strength.
Greater physical endurance.
increased weight loss.
Reduced blood glucose level
Decreased low-density blood lipids.
Improved physical appearance.
increased bone density
Regularity of bowl elimination
Promotion of sleep.
Reduced tension and depression.
Classification of Exercise:
Exercise
Based on muscle Based on source of energy
Isotonic Active
Isometric PASSIVE
Isokinetic

Based on muscle Contraction:

ISOTONIC EXERCISE
It cause muscle contraction and active movement. Eg; walking,
aerobics, moving arms and legs.
ISOMETRIC EXERCISE
Tightening or tensing of muscles without Shortening (there is no
movement] this increases muscle tension but do not change the
length of muscle fibers Eg; Contraction of glutal muscle.
ISOKINETC EXERCISE
It involves muscle Contractions with resistance
Resistance is provided by an external Source.
Eg; movement of leg against resistance.

Based on Source of Energy

Active Exercise:-
It is therapeutic activity that the client performs independently.
Passive Exercise:-
It is a therapeutic activity that the client performs with assistance is
provided when client cannot move one or more parts of the body.

Range of motion exercises:

The movement of a joint to the extent possible without causing pain.
Purposes:
Promote and maintain joint mobility.
Prevent contractures and shortening of muscles and tendons.
Increase circulation to extremities.
Facilitate comfort for the patient.
Contraindiction To ROM :-
All illness disorder where increased use of energy or increased
circulation is hazardous.
E.g, myocordial infection, Swollen, inflamed joints.

Patient Preparation
Explain the slep and advantages of Rom exercises.
Remove all restrictive clothing linen, splint and dressing.
Drape appropriately.
Rise the bed to comfortable height.
Position the patient comfortably preferably spine position.
Body Mechanics
Definition:
Body Mechanics is the term used to describe the efficient,
coordinated, and safe used of the back move objects and carry out
the activities of daily livings (ADL's)
Purposes:
To maintain good balance.
To reduce the energy requirement.
To avoid excessive fatigue.
To avoid Strains of tear.
To avoid skeletal injuries.
To avoid injury to the patient
To avoid injury to assisting staff members.
Principles of Body Mechanics:
To wider the base of support and greater the stability.
The lower the centre of gravity, the greater the stability.
The equilibrium the centre of gravity, the greater the stability.
The lower the centre of gravity, the greater the stability.
The equilibrium of an object is maintained as long as the line of
gravity passes through it's base of support.
Facing the direction of movement prevents abnormal twisting of the
spine.
Dividing balance activity between arms and legs reduces the risk of
back injury.
Principles of Body mechanics:-
it is easier to pull push, or roll an object is lift it.
Movements should be smooth and coordinated rather than Jerky.
When friction is reduced between the object to be moved & the
surface on which it is moved less force is required to move it.
Less energy or force is required to keep an object moving than it is to
start and stop it.
Use the arm and leg muscles as much as possible the back muscles as
little as possible.