Exam 2- Sleep

Question 1

sleep

Answer 1

state where individuals lack conscious awareness of environmental surroundings but can easily aroused

provided healing & restoration

Question 2

adequate sleep

Answer 2

amount of sleep one needs to be fully awake and alert the next day

Question 3

insufficient sleep

Answer 3

obtaining less than the recommended amount of sleep

Question 4

fragmented sleep

Answer 4

frequent arousals or actual awakenings that interrupt sleep continuity

Question 5

nonrestorative sleep

Answer 5

sleep that is of adequate duration, but does not result in the individual feeling refreshed and alert the next day

Question 6

circadian rhythms

Answer 6

managed by the suprachiasmatic nucleus in the hypothalamus

synchronized through light detectors in the retina

light is the strongest cue

Question 7

sleep regulation

Answer 7

reticular activating system (RAS)
- facilitates reflex and voluntary movements
- controls cortical activities related to state of alertness

bulbar synchronizing region
- hypothesis that the release of serotonin from specialized cells in the raphe nuclei sleep system of the pons and medulla produce sleep

Question 8

stages of sleep

Answer 8

Non-rapid eye movement- 75% of night

stage 1- lightest lvl of sleep, gradual fall of vital signs; easily aroused
stage 2- sound sleep; arousal relatively easy
stage 3 & 4- deepest sleep; difficult to arouse

REM 25% of nightly sleep time
- vivid full color dreaming occurs
- pulse, respiratory rate, blood pressure, metabolic rate & body temp increases; skeletal mm tone and deep tendon reflexes are depressed

Question 9

sleep cycle

Answer 9

occurs when a person passes through 4 stages of of NREM

• the pattern is then reversed
• return from stages IV–III—II
• enter REM instead of re-entering stage 1
• the person re-enters NREM sleep at stage II and then moves to stage III and IV

Question 10

insomnia

Answer 10

difficulty falling asleep
difficulty staying asleep
waking up too early
complaints of waking up feeling unrefreshed

Question 11

acute insomnia

Answer 11

difficulty falling asleep or remaining asleep for at least 3 nights/ wk for less than a month

Question 11

acute insomnia

Answer 11

difficulty falling asleep or remaining asleep for at least 3 nights/ wk for less than a month

Question 12

chronic insomnia

Answer 12

fatigue, poor concentration, interference with social/ family activities
daytime symptoms that persist for 1 month or longer

Question 13

insomnia can be caused by

Answer 13

nightmare
medications
irregular
exercising near bedtime
jet lag
mental health issues
stressful life event
alcohol to induce sleep

Question 14

obstructive sleep apnea

Answer 14

partial or complete upper airway obstruction during sleep
-Apneic period may include hypoxemia and hypercapnia

clinical manifestations
- frequent arousals during sleep
- insomnia
- excessive daytime sleepiness
- witnessed apneic episodes
- snoring
- morning HA
- irritability

Question 15

obstructive sleep apnea

Answer 15

Apnea is cessation of spontaneous respirations for longer than 10 seconds.

Hypopnea is shallow respirations (30% to 50% reduction in airflow).

Airflow obstruction in OSA occurs because of (1) narrowing of the air passages with relaxation of muscle tone during sleep and/or (2) the tongue and the soft palate falling backward to partially or completely obstruct the pharynx

Each obstruction may last 10 to 90 seconds.

Apnea and arousal cycles occur repeatedly. Apneic episodes occur most often during REM sleep when airway muscle tone is lowest.
Smokers are more likely to have OSA.

OSA is more common in men than in women until after menopause, when the prevalence of the disorder is the same in both genders.

Women with OSA have higher mortality rates. OSA patients with excessive daytime sleepiness have increased mortality.

Question 16

obstructive sleep apnea can result in

Answer 16

hypertension
cardiac changes
poor concentration/memory
impotence
depression

Question 17

mild sleep apnea management

Answer 17

sleeping on one side
elevating head of bed
avoid sedatives and alcohol 3-4 hr b4 bed
wt loss
oral appliance

Question 18

severe sleep apnea

Answer 18

more than 15 apnea/ hypopnea events
- CPAP
- poor compliance
-BiPAP
- surgery

Question 19

narcolepsy

Answer 19

brain unable to regulate sleep- wake cycles normally

causes uncontrollable urges to sleep, often go into REM within 15 min of falling asleep

type 1- with cataplexy (sudden loss of skeletal mm tone.. mm wkness)

type 2- without cataplexy

Question 20

narcolepsy nursing interprofessional management

Answer 20

• teach proper sleep hygiene
• take naps throughout the day
• avoid heavy meals and alcohol
• ensure pt safety

Question 21

parasomnias

Answer 21

unusual and undesirable behaviors that occur while falling asleep

-night terrors
- nightmares
- bruxism
- enuresis

Question 22

circadian rhythm disorder

Answer 22

• occurs when the circadian time-keeping system loses synchrony with environment

jet lag disorder, shift work sleep disorder
symptoms=
insomnia, excessive sleepiness

Question 23

periodic limb mvmt disorder

Answer 23

involuntary continual mvmt of the limbs that affects people during sleep
- causes poor sleep quality

Question 24

gerontologic considerations for sleep

Answer 24

old age is associated with overall shorter total sleep time
- decreased sleep efficiency
- more awakenings
- insomnia symptoms
- awakening during the night increases risk for falls
– medications used by older adults can contribute to sleep problems
- avoid long acting benzos

Question 25

screening tools to asses sleep distrubances

Answer 25

the Epworth sleepiness scale
the pittsburg sleep quality index
sleep disturbance questionnaire

Question 26

key findings of physical assessments

Answer 26

energy level
facial characteristics
behavior characteristics
physical data suggestive of sleep problems

Question 27

sleep disturbances in the hospital

Answer 27

• hospitalization associated with decreased sleep time
• environmental sleep-disturbances
• psychoactive meds
• acute and critical illness

Question 28

nursing rituals to promote sleep

Answer 28

Prepare a restful environment.
Promote bedtime rituals.
Offer appropriate bedtime snacks and beverages.
Promote relaxation and comfort.
Respect normal sleep–wake patterns.
Schedule nursing care to avoid disturbances.
Use medications to produce sleep.
Teach about rest and sleep.