Sleep Difficulties and Pain Management for Mr. Arthur Charleston: A Comprehensive Nursing Approach

QUESTION

Arthur Charleston is a 72-year-old Aboriginal Wiradjuri man. Birth date 7/04/1950. MRN 1020304.

Mr Charleston presented to the Emergency Department today following a fall at his home. Mr Charleston has a contusion above his left eye and shows some disorientation to person, place and time; he currently has a GCS of 14. Pupils are equal and reactive to light and motor function is equal on both sides in his legs and arms. Mr Charleston has a history of Type 2 Diabetes Mellitus, Hypertension, IHD, and COPD. He wears glasses for reading and hearing aids. Mr Charleston lives on his own and smokes 20 cigarettes a day. Mr Charleston consumes 6 cans of full-strength beer per day, and he states that he eats very little and enjoys take away meals most days. He is allergic to shell fish and Penicillin. Vital signs 170/80, HR 92, RR 20, SpO2 99%, Temp 36.5, BGL 12.4 mmol, Weight: 110kg Height: 190cm.

Mr Charleston is not able to sleep properly while in hospital.

a) Identify three (3) factors that could be causing difficulties with his sleep. Refer to the case study for these answers.

b) After identifying possible factors, what nursing interventions could you implement to assist Mr Charleston with his sleeping and comfort?

References must be included.

During your ongoing assessment of Mr Charleston, you observe that he is in increased pain.

c) Which assessment for pain are you going to use to gain more information about the pain? And why? Please justify your answer to show your understanding of why you are using this pain assessment.

d) What interventions could you as an EN provide to assist Mr Charleston with his pain? Consider non-pharmacological and pharmacological interventions.

References must be included.

ANSWER

Sleep Difficulties and Pain Management for Mr. Arthur Charleston: A Comprehensive Nursing Approach

Introduction

This essay addresses the case of Mr. Arthur Charleston, a 72-year-old Aboriginal Wiradjuri man who presented to the Emergency Department following a fall. Mr. Charleston has a history of multiple comorbidities, including Type 2 Diabetes Mellitus, Hypertension, IHD, and COPD. He also consumes alcohol regularly, smokes heavily, and has a limited appetite. The essay will identify factors contributing to Mr. Charleston’s sleep difficulties and increased pain and propose nursing interventions to address these issues.

Factors Contributing to Sleep Difficulties

Physical Discomfort: Mr. Charleston’s contusion above his left eye and pain from his fall could be causing physical discomfort, making it challenging for him to find a comfortable position to sleep.

Disorientation and Cognitive Impairment: Mr. Charleston’s disorientation to person, place, and time, along with a GCS of 14, suggests cognitive impairment. Cognitive changes can disrupt sleep patterns and lead to restlessness.

Environmental Factors: Being in an unfamiliar environment, such as the hospital, can lead to sleep disturbances due to noise, interruptions, and changes in routines.

Nursing Interventions for Sleep and Comfort

Pain Management: Administer prescribed analgesics to manage Mr. Charleston’s pain effectively, ensuring he is comfortable and can rest better.

Environmental Modifications: Create a comfortable and calming environment in the hospital room, minimizing noise and disturbances, and allowing for better sleep.

Establishing Routine: Maintain Mr. Charleston’s usual bedtime routine, incorporating any personal rituals or habits that promote relaxation and improve sleep quality.

Cognitive Support: Provide cognitive stimulation during the day, such as conversation and activities, to reduce disorientation and promote mental alertness, thereby improving sleep at night.

Positioning and Comfort Measures: Assist Mr. Charleston in finding a comfortable position to rest, ensuring that he has adequate pillows and support to relieve physical discomfort.

Assessment for Pain

To gain more information about Mr. Charleston’s pain, the appropriate pain assessment tool to use would be the Numeric Rating Scale (NRS). The NRS is a simple and reliable tool that allows patients to rate their pain intensity on a scale from 0 to 10, with 0 indicating no pain and 10 representing the worst pain imaginable. The NRS is suitable for patients with cognitive impairment, as it requires minimal cognitive effort.

Justification for using the NRS: Mr. Charleston’s cognitive impairment makes it challenging to use complex pain assessment tools. The NRS is easy to understand, and the patient can communicate his pain intensity effectively using numbers, ensuring an accurate assessment.

Interventions for Pain Management

Non-Pharmacological Interventions:
Positioning and Comfort: Assist Mr. Charleston in finding a comfortable position, using pillows and support to alleviate pain.
Heat or Cold Therapy: Apply heat or cold packs to the affected area as per Mr. Charleston’s preference to reduce localized pain.
Distraction Techniques: Engage Mr. Charleston in enjoyable activities or conversations to divert his attention from the pain and promote relaxation.

Pharmacological Interventions:
Administer Analgesics: Provide prescribed analgesics, such as paracetamol or opioids, as per the pain assessment and physician’s orders to manage Mr. Charleston’s pain effectively.

Conclusion

Comprehensive nursing care for Mr. Arthur Charleston requires addressing his sleep difficulties and pain management. By identifying the factors contributing to his sleep disturbances and implementing appropriate nursing interventions, such as pain management strategies and environmental modifications, Mr. Charleston can experience improved sleep and comfort during his hospitalization. Using the Numeric Rating Scale as a pain assessment tool ensures effective pain evaluation, enabling appropriate non-pharmacological and pharmacological interventions to provide him with optimal pain relief. A patient-centered approach, combined with vigilant monitoring, will contribute to Mr. Charleston’s well-being and overall healthcare experience.