Chapter 34 - Rest and Sleep

Question 1

Reticular Activating System

Answer 1

• Extends through the medulla, pons, midbrain, and into the hypothalamus. RAS facilitates reflex and voluntary movements related to a state of alertness
• Wakefulness occurs when RAS is activated with stimuli from the cerebral cortex and periphery sensory organs and cells (pain, pressure, noise)

Question 2

Circadian Rhythm

Answer 2

24-hour cycles that involve an individual’s sleep-wake cycle

-HR, BP, body temperature, mood, hormones, metabolism, performance depend in part on circadian rhythms.

Question 3

NREM Sleep

Answer 3

Stage I - Falling to sleep, light sleep, arouse with relative ease
Stage II - The “baseline” of sleep, ~ 90 minute cycle, still be aroused with relative ease
Stage III - Depth of sleep increases, arousal starts to be more difficult
Stage IV - Greatest depth of sleep (delta sleep), arousal is difficult, slow brain waves, ↓ HR, ↓ BP, ↓ RR, muscles are relaxed, slow metabolism, low body temperature

Question 4

REM Sleep

Answer 4

Eyes dart back and forth quickly
Small muscle twitching
-Large muscle immobility (resembles paralysis)
-Irregular RR
-Rapid or irregular HR
-BP ↑ or fluctuates
 -↑ gastric secretions, ↑ metabolism, body temperature
-Enters and reenters NREM stage 2 sleep
-Arousal is difficult
-Reports of dreaming during REM sleep

Question 5

Sleep Cycle

Answer 5

• Passes consecutively through the 4 stages of NREM sleep
• Pattern is then reversed, return from 4 to 3 to 2 then enter REM sleep
• Then reenter NREM sleep stage 2 to 3 to 4
• Start at NREM stage 1 if awaken
• 4-5 cycles each night (each cycle 90-100 minutes)

Question 6

Single Normal Sleep Cycle

Answer 6

• Wakefulness
• NREM Stage 1
• NREM Stage 2
• NREM Stage 3
• NREM Stage 4
• NREM Stage 3
• NREM Stage 2
• REM
• NREM Stage 2

Question 7

Factors Affecting Sleep

Answer 7

• Developmental Considerations
• Motivation
• Culture
• Lifestyle and Habits
• Environmental factors
• Psychological Stress
• Illness
• Medications

Question 8

Dyssomnia

Answer 8

• Insomnia- characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep
• Hypersomnia- characterized by excessive sleep, particularly during the day
• Narcolepsy - Characterized by an uncontrollable desire to sleep. Can literally sleep standing up. Dangerous if driving, swimming, welding
• Sleep apnea - The absence of breathing (apnea) or diminished breathing efforts (hypopnea) during sleep between snoring intervals
• Obstructive sleep apnea - Blockage of the airway, usually when the soft tissue (hypopharynx) in the rear of the throat collapses and closes during sleep
• Central sleep apnea - The brain fails to signal the muscles to breathe.
• Restless Leg Syndrome - Common neurological disorder characterized by unpleasant sensations of the legs and an urge to move them for relief
• Sleep deprivation - A decrease in amount, consistency, or quality of sleep. Consequences include loss of concentration, inattention and impaired information processing, safety risk, irritability and disintegration of personality

Question 9

Parasomnias

Answer 9

Patterns of waking behavior that appear during sleep
-Somnambulism (sleepwalking), sleep talking, teeth grinding (bruxism), night terrors, enuresis (urinating during sleep) and nocturnal erections
+Common in children, seldom in adulthood
+Promote safety and prevent injury
-Sleep-related eating disorder (weight gain, injuries, sleep disruption)

Question 10

Physiological Effects of Sleep Deprivation

Answer 10

• ↓ growth hormone level (maturation and growth)
• ↑ corticosteroid level (↑ BP, weaken bones, ↓ resistance to infections, ↓ wound healing,↑ risk of kidney stones and diabetes, mental disturbances such as irritability, slower reaction time, memory lapses or loss, slurred speech, temper tantrum in children, depression and hallucinations)
• ↓ leptin level (hormone that inhibits appetite) and ↑ grehlin level (hormone that stimulates appetite) lead to significant weight changes
• Impaired glucose-lowering effects of insulin despite normal insulin level
• Alter insulin secretion by pancreas
• May affect body’s ability to metabolize glucose which can lead to early-stage Diabetes Type 2
• ↓Thyroid Stimulating Hormone (potentially significant effects on growth, glucose and fat metabolism, immune function, and cognition)
• Memory loss
• Intellectual impairments
• Behavioral changes
• Depression
• ↓ self-esteem
• ↓ emotional health

Question 11

Nurse Assessment

Answer 11

• sleep history
• sleep diary: time, stressors, food, medications, physical activities, mental activities, environmental factors
• physical assessment: energy level, facial and behavioral characteristics, snoring nocturnal myoclonus

Question 12

Nursing Diagnosis

Answer 12

-Disturbed Sleep pattern as the problem
\+Physical discomfort, pain
\+Anxiety, stress, exercise
\+Drug dependency and withdrawal
-Disturbed Sleep pattern as the Etiology
\+Anxiety
\+Activity Intolerance
\+Risk for injury
\+Disturbed Thought process

Question 13

Nursing Implementations

Answer 13

• Prepare a restful environment
• Promote bedtime rituals
• Bedtime appropriate snacks and beverages
• Promote relaxation / comfort
• Respect normal sleep-wake patterns
• Schedule care to reduce disturbances
• Medications
• Teaching about rest and sleep

Question 14

Nursing Evaluation

Answer 14

Patient will be able to:

• Verbalizes feeling rested
• Identifies factors that interfere/disrupt sleep
• Knows techniques that promote sleep
• Increases concentration and function
• Eliminate behaviors related to sleep deprivation