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Care of Older Adults > Chapter 12 Sleep > Flashcards

Chapter 12 Sleep Flashcards

0
Q

Stage 2 sleep cycle

A

Decreases with age
High voltage activity on EEG
Comprises 15% of sleep elders

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1
Q

Stage 1 sleep cycle

A

Lightest level
Easy to awaken
Comprises 5% of sleep in young

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2
Q

Stage 3 sleep cycle

A

Decreases and may cease with age

High Voltage activity on EEG

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3
Q

Stage 4 sleep cycle

A

Decreases with age
High voltage on EEG
15% of sleep in elders

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4
Q

REM sleep

A

Rapid Eye Movement
Vivid dreams happen here
First trip to REM is the shortest
In an 8 hour night, 2 hours are spent in REM sleep

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5
Q

What does sleep deprivation do to the body?

A
  • Decline in physical and mental activity
  • Nothing works as well
  • Immune system suffers
  • Do not deal with everyday problems as well
  • Dementia and Depression symptoms
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6
Q

Problems older adults have with sleeping

A
  • Need just as much sleep as younger adults
  • Sleep is lighter and fragmented
  • Frequent waking
  • More time spent getting to sleep
  • Increased daytime solomence
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7
Q

What is the importance of the pineal gland?

A

The pineal gland produces melatonin, which puts you to sleep.

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8
Q

Comorbid Insomnia is associated with

A

-Psychiatric disorders
-Medications (10-15% of all cases of insomnia)
==SSRI, Anti-HTN, Levedopa, Anticholinergics, Sympathomimetic amines (epinephrine, norepinephrine, dopamine), Diuretics, Opiates, Cough and cold meds, Thyroid preps, Phenytoin, Cortisone

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9
Q

Interventions for alterations in sleep patterns

A
  • Weight loss
  • Avoidance of alcohol and sedatives
  • Smoking cessation
  • Avoiding supine positioning during sleep
  • CPAP (continuous positive airway pressure) for known sleep apnea
  • Limit day-time napping to 30 minutes or less
  • No exercise within 4 hours of sleep
  • Snacks: light and easily digestible
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10
Q

Restless leg syndrome

A
  • Uncontrollable need to move legs, often accompanies by discomfort
  • Rule out and treat contributing medical condition
  • Medication review (Antidepressants and Neuroleptic meds)
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11
Q

Pharmacologic treatment of Restless Leg Syndrome

A

Dopamine Receptor Agonists: pramipexole, ropinirole

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12
Q

Non-pharmacologic treatment for Restless Leg Syndrome

A
  • Mild to Mod. physical activity, hot baths, mental exercise prior to sleep
  • Avoid caffeine
  • Elevate legs
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13
Q

Rapid Eye Movement Sleep Behavior Disorder (RBSD)

A
  • Elaborate enactment of dreams
  • Potential for violence
  • May be precursor to Parkinson’s disease
  • Assessment and treatment focuses on: Neurological assessment, Removal of aggravating meds, Safety measures in sleep environment
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14
Q

Circadian Rhythm Sleep Disorders (CRSD)

A
  • Relatively normal sleep at abnormal times
  • Irregular sleep-wake patterns
  • Most commonly found in individuals with dementia
  • Serious safety risk at night for cognitively impaired individuals that wander
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15
Q

Interventions for Circadian Rhythm Sleep Disorders (CRSD)

A
  • Increase light exposure during day and avoid bright light at night.
  • Structured activity during day and quiet sleep environment at night.
16
Q

Sleep apnea

A

-Sleep is fragmented and incomplete
-Repetitive cessation (>10 seconds) of respiration during sleep
=Hypopnea: transient reduction in airflow with diminished O2 sat for greater than 10 seconds during sleep
=Obstructive Sleep Apnea (90% of cases, 25% of adults older than 65)

17
Q

S/Sx seen in the day as a result of sleep apnea

A
  • Daytime sleepiness
  • Cardiopulmonary function altered (right sided heart failure, HTN, arrhythmia, death)
  • Increase in accidents, decreased performance, depression, decreased quality of life
18
Q

Risk factors of sleep apnea

A

Increasing age, Enlarged neck circumference, Male, Anatomical abnormalities, Family Hx, Obesity, Snoring, ETOH or Sedative use, Smoking, Cardiac disorders, HTN, Nocturia, Cognitive dysfunction, Upper airway obstruction/resistance

19
Q

Treatment for Sleep Apnea

A
  • Reducing morbidity and mortality
  • Increasing quality of life
  • Reduction of risk factors
  • Avoid sleeping in the supine position (use pillows or chair)
  • CPAP
  • Decongestants, nasal steroids, antihistamines, SSRI’s and Tricyclic antidepressants
  • Surgery: reconstruct upper airway, removal of tonsils, dental devices, pacemakers
20
Q

Pharmacological management for sleep disorders

A

-Used in combination with behavioral interventions
-Monitored closely for side effects
-Avoid sedatives, hypnotics, and certain OTC (antihistamines) drugs for their adverse effects on older adults
Meds to use: Benzodiazipine receptor agonists (zolpidem, eszopiclone, and zaleplon. Melatonin may cause less psychomotor and cognitive impairments

21
Q

Xerosis

A
  • Extremely dry, cracked skin
  • Most common skin disorder in elders
  • Primarily seen in extremities
  • Problem: Dry skin may be just dry skin, but can also be indicative of a serious health problem…DM, hypothyroidism, renal disease, dehydration
22
Q

Scabies

A
  • Parasitic disorder
  • Similar to lice
  • Curved linear ridges in skin
  • Itching is more intense
23
Q

Purpura

A
  • Thinning of dermis
  • Fragility of capillaries
  • Blood vessels rupture easily, with minimal trauma
24
Q

Herpes Zoster (Varicella Zoster)

A
  • Shingles
  • Similar to simplex
  • Grouped lesions along segment of skin (fluid filled vesicles; very, very painful)
  • Follows a spinal or cranial nerve (most commonly seen in the thoracic area)
  • Painful
  • Postherpetic neuralgia is possible
  • Secondary infection is possible
25
Q

Photoaging

A
  • Changes in appearance of skin resulting from chronic exposure to UV radiation from sun exposure.
  • Solar elastosis or exaggerated fine and coarse wrinkling of skin, sallowness, and telangiectasis
26
Q

Actinic Keratosis

A
  • Premalignant
  • Small macule or papule with dry, rough, adherent yellow or brown scale.
  • Base may be erythematous
  • Risk: yellowed, wrinkled, weather beaten skin
27
Q

Squamous Cell Carcinoma

A
  • Firm nodular lesion (crust or central area of ulceration)
  • Indurated (hard and fixed) margins
  • Fixed to underlying tissue with deep invasion
  • Risk: sun exposure, chronic irritation or injury (head, neck, lower lip)
  • Metastasis: 10% of cases (quick)
28
Q

Basal Cell Carcinoma

A 
Pearly papule
=Central crater
=Rolled and waxy borders
Rarely metastasizes
Risk: Sun exposure areas
29
Q

Melanoma

A
  • High mortality rate
  • Irregularly shaped pigmented papule or plaque
  • Multicolored: red, blue, black, and/or white
  • Grows out then up
  • Rapid invasion and metastasis
30
Q

Candidiasis (Candida albicans)

A
  • Fungal infection
  • Can be found in mouth, skin folds, perineal areas
  • Risk factors: Diabetes, Immunocompromised, Steroid therapy, Chemotherapy, Poor hygiene
31
Q

Pressure ulcers

A
  • Highest incidence reported in hospitalized or institutionalized older adults. Also high in vulnerable adults undergoing orthopedic procedures.
  • Most commonly found on bony prominences (sacrum, heels, greater trochanter, elbows, knees, scapula, pinna of ears also vulnerable)
32
Q

Risk factors for pressure ulcers

A

Comorbid illnesses
Protein malnutrition
Cognitive deficits
Reduced mobility

33
Q

Prevention of Pressure Ulcers

A 
-Thorough assessment of skin
=Braden scale
=Norton risk assessment scale
-Nutritional evaluation
-Laboratory studies
-Positioning
-Incontinence care
34
Q

Age-related foot changes

A
  • Skin becomes drier, less elastic, cooler
  • Subcutaneous tissue on dorsum and sides of foot things
  • Plantar fat pad shrinks and degenerates
  • Toenails become brittle, thicken, less resistant to fungal infections
  • Degenerative joint disease decreases ROM
35
Q

Greatest risk factor related to poor foot care:

A
  • Interference with walking and mobility

- Ultimately effects the client’s ability to remain independent

36
Q

Whose toenails do you NOT cut?

A

a Diabetics

37
Q

What do you assess for on feet?

A 
Color
Circulation
Pulses
Structures
Temperature
Dermatological aspects

Care of Older Adults (8 decks)

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