chapter 34 Rest and sleep Flashcards
describe physiology of sleep
Reticular Activating System (RAS)-facilitates reflex and voluntary movements related to state of alertness.
Wakefulness: RAS activated with stimuli from the cerebral cortex and periphery sensory organs and cells (pain, pressure, noise).
what are the neurotransmitters involved in the sleep process?
Excitation: norepinephrine, acetylcholine, dopamine, serotonin, histamine.
Inhibition: Gamma-aminobutyric acid (GABA)
Circadian Rhythms: 24 hour cycles that involve an individual’s sleep-wake cycle.
fluctuations in a person’s HR, BP, body temperature, mood, hormones, metabolism, and performance depends on?
circadian rhythms
What are the two stages of sleep?
Non-rapid eye movement (NREM)
Rapid eye movement (REM)
what are the different stages of NREM?
stage I
stage II
stage III
stage IV
describe the characteristics of NREM sleep stage I
falling to sleep, light sleep, arouse with relative ease
transitional stage between wakefulness and sleep
relaxed but still somewhat aware of the surroundings
involuntary muscle jerking may occur and waken the person
what are the characteristics of NREM sleep stage II
the “baseline” of sleep, 90 minute cycle
aroused with relative ease
What are some characteristics of NREM sleep stage III
depth of sleep increases; deep-sleep (delta sleep) or slow wave sleep
arousal starts to be more difficult
what are the characteristics of NREM sleep stage IV?
The arousal threshold (intensity of stimulus required to awaken) is greatest (delta sleep)
arousal is difficult
physiologic changes in the body:
slow brain waves, decrease HR, BP, RR, low body temperature, muscles are relaxed, slow metabolism
wakefulness occurs when —is activated with stimuli from the cerebral cortex and peripheral sensory organs
Reticular activating system (RAS)
The arousal threshold is usually greatest in which of the following stages of NREM sleep?
Stage IV
describe the phenomenon, termed REM rebound.
when a person who is deprived of REM sleep for several nights spends more time in REM on successive nights.
what are some characteristics of REM Sleep?
Eyes dart back and forth quickly
small muscle twitching
large muscle immobility (resembles paralysis)
irregular RR, rapid or irregular HR, increase or fluctuates BP, increase gastric secretions, increase metabolism, increase body temperature
enters and reenters NREM stage 2 sleep
arousal is difficult
reports of dreaming
Which of the body systems dominates during NREM sleep?
Parasympathetic Nervous system
what is “sleep architecture” ?
alternating between REM and NREM
what happens during a normal sleep cycle
passes consecutively through the 4 stages of NREM sleep
pattern is then reversed, return from 4 to 3 to 2
enter REM sleep
Than reenters NREM sleep stage 2 to 3 to 4
if awakened from sleep at any time, start at NREM stage I
4-5 cycles each night
each cycle lasts about 90-100 minutes
identify factors affecting sleep
developmental considerations motivation culture lifestyle and habits environmental factors psychological stress illness medications
what is the average hours of sleep adequate for the older adults?
5 to 7 hours
what are some patterns of sleep of the older adults
need more time to fall asleep
awake earlier and more frequently during the night (REM shorten)
less able to cope with changes in usual sleep patterns
nap during the day
illnesses, psychological factors, drug therapy
stage IV sleep is absent or considerable decreased.
environmental factors
describe nursing implications that address older adults sleep cycle
A comprehensive assessment and individualized interventions
emphasize concern for a safe environment (restful environment)
use sedatives with extreme caution
encourage patient in this group to discuss sleep concerns with physicians
promote bedtime rituals (eg. reading, listening to radio, watching TV, praying)
offer bedtime appropriate snacks and beverages (carbohydrates: toast, crackers, glass of fruit juice)
promoting relaxation( backrub, warm bath, washing face)
promoting comfort (eg. caring presence and touch, back massage, extra blanket, administering an analgesic)
respect normal sleep-wake patterns
scheduling nursing care to avoid unnecessary disturbances
identify appropriate interview questions for sleep assessment
use open-ended questions
The nature of the problem, its cause, SxS
when it began and how often it occurs
how it affects everyday living
how the patient is coping with the problem and the success of any Tx attempted