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IM1-Exam 7 Flashcards

1
Q

Sleep is _____ process

A

Physiological

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2
Q

What is sleep associated with

A

Recumbency and & Immobility

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3
Q

What is Recumbency?

A

“to be laying down”

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4
Q

When sleeping you __1__ conscious awareness but are __2__ awakened?

A

1.Lack
2. Easily

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5
Q

True or false: Sleep is not essential for healthy functioning and survival?

A

False- It is essential for healthy functioning and survival

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6
Q

What is sleep?

A

Sleep is the state in which an individual lacks conscious awareness of environmental surroundings but can be easily aroused

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7
Q

What is insufficent sleep?

A

Obtaining the less than recommended amount of sleep. (most adults require 7-8 hours in a 24 hour period)

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8
Q

What is the recommended amount of sleep for an adult?

A

Most adults require 7-8 hours in a 24 hour period

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9
Q

What is fragmented sleep?

A

Frequent arousal or actual awakenings that interrupt sleep

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10
Q

What is nonrestorative sleep?

A

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

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11
Q

Sleep disturbances are the result of ______?

A

Conditions of poor sleep quality

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12
Q

Sleep disorders are the result of _____?

A

Abnormalities unique to sleep.

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13
Q

What are some examples of sleep disorders?

A
  1. Insomnia
  2. Narcolepsy
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14
Q

True or false: Daytime sleepiness can interfere with daily living?

A

True

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15
Q

What controls a person’s sleep-wake cycle? (general anwser)

A

The brain.

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16
Q

More specifically what part of a persons brain plays a role in a person’s sleep wake cycle?

A
  1. The RAS (Reticular Activating system)
  2. Orexin (Hypocretin)- Neuropeptide that comes out of the hypothalamus.
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17
Q

What is orexin (hypocretin)?

A

Neuropeptide that comes out of the hypothalamus that helps regulate sleep/wake cycle.

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18
Q

What are some things we should know about the RAS (Reticular activating system).

A
  1. Sensory stimuli within cerebral cortex
  2. Regulates sleep-wake cycle
  3. 4 functions
    -Motor
    • Sensory
    • Visceral
    • Consciousness
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19
Q

What part of our body manages our Circadian Rhythm?

A
  1. Suprachiasmatic nucleus (SCN) in hypothalamus
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20
Q

Our Circadian Rhythm is synchronized through ______ in retina

A

Light detectors

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21
Q

What is the strongest cue for our circadian rhthym.

A

Light

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22
Q

What are somethings we should know about our circadian rhythm?

A
  1. Managed by the suprachiasmatic nucleus (SCN) in hypothalamus
  2. Synchronized through light detectors in retina
  3. Light is the strongest time que
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23
Q

True or false: Patients in ICU can suffer from ICU psychosis

A

True

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24
Q

How many phases of sleep are there

A

3

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25
Q

What does NREM stand for?

A

Non rapid eye movement

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26
Q

What phase is the majority of our sleep spent in?

A

NREM

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27
Q

What are the phases of sleep?

A
  1. Sleep Latency
  2. NREM (3 stages)
  3. REM (rapid eye movemet
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28
Q

What is sleep latency?

A

This is the time it takes for a person to fall asleep.

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29
Q

When does sleep latency start?

A
  1. Starts when eyes are closed for sleep
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30
Q

When does sleep latency end?

A

Ends when non-rem sleep is entered

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31
Q

True or false: The time spent in “sleep latency” is usually 10-40 minutes sometimes longer?

A

True

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32
Q

What percentage of sleep is spent in the NREM stage?

A

75%-80% of sleep time

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33
Q

What are the stages of NREM?

A

Stage 1: Slow eye movement
Stage 2: HR and temperature decrease
Stage 3: Deep or slow wave sleep (SWS) delta, waves, parasomnias

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34
Q

True or false: The older we get the more deep sleep we get?

A

False- The older we get the less deep sleep we get.

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35
Q

What is happening in stage 1 in NREM sleep?

A
  1. Slow eye movements
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36
Q

What is happening in stage 2 NREM sleep?

A

HR and temp decrease

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37
Q

What is happening in stage 3 NREM sleep?

A

Deep or slow wave sleep (SWS); delta waves, parasomnias

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38
Q

What is parasomnias?

A

Unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages, or during arousal from sleep

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39
Q

What causes parasomnias?

A

CNS activation

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40
Q

What are some actions that can happen as a result of parasomnias?

A
  1. sleepwalking
  2. Sleep terrors
  3. Nightmares
  4. Sleep paralysis
  5. sleep hallucinations
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41
Q

What percentage of sleep is spent in the REM stage?

A

20 to 25%

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42
Q

How often does REM sleep occur?

A

3 to 4 times a night

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43
Q

In what stage of sleep is skeletal muscle tone greatly reduced?

A

REM sleep

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44
Q

In what stage of sleep do we experience most of our vivid dreams?

A

REM

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45
Q

During what stage of sleep is the brain very active but mentally restful?

A

REM sleep

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46
Q

Middle-aged people experience what changes to their sleep?

A
  1. More stage shifts- decreased NREM3 and REM
  2. Resistant to sleep deprivation
  3. Increased awaking’s
  4. Changes in sleep efficiency
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47
Q

Older adults experience what changes to their sleep?

A
  1. Phase changes- go to bed earlier and arise earlier
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48
Q

What effects can sleep deprivation have on the neuro system

A
  1. Cognitive impairment
  2. Behavioral changes (e.g., irritability, moodiness)
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49
Q

What effects can sleep deprivation have on your immune system?

A
  1. Impaired function
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50
Q

What effects can sleep deprivation have on your respiratory system?

A
  1. Asthma exacerbated during sleep
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51
Q

What effects can sleep deprivation have on your cardiovascular system?

A
  1. Heart disease (hypertension, dysrhythmias)
  2. Increased BP in people with hypertension
  3. Stroke
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52
Q

What effects can sleep deprivation have on your gastrointestinal system?

A
  1. Risk for obesity
  2. Gastroesophageal reflux disease (GERD)
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53
Q

What effects can sleep deprivation have on your endocrine system?

A
  1. Increased risk for type 2 diabetes
  2. Increased insulin resistance
  3. Decreased growth hormone
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54
Q

Hospitalization are associated with decreased sleep time due to what factors?

A
  1. Enviromental sleep-disruptive factors (light & noises)
  2. Psychoactive medications (drugs)
  3. Acute and critical illness
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55
Q

What are symptoms of insomnia?

A
  1. Difficulty falling asleep
  2. Difficulty staying asleep
  3. Waking up too early
  4. Complaints of waking up feeling unrefreshed.
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56
Q

What is acute insomnia?

A

Difficulty falling asleep or remaining asleep for at least 3 nights/week for less than a month

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57
Q

What is chronic insomnia?

A
  1. Difficulty falling asleep or remaining asleep for at least 3 nights/week for less than a month
  2. Daytime symptoms that persist for 1 month or longer
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58
Q

Insomnia is aggravated by what?

A

inadequate sleep hygiene

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59
Q

What are some inadequate sleep hygiene factors?

A
  1. Stimulants
  2. Medications
  3. Using alcohol to induce sleep
  4. Irregular sleep schedules
  5. Nightmare
  6. Exercising near bedtime
  7. Jet lag
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60
Q

True or false: Alcohol reduces REM sleep?

A

True– causes interrupted sleep?

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61
Q

Why should you not exercise near bedtime?

A

Should not exercise two hours prior to bedtime because it will raise your metabolism and make it harder for you to fall asleep.

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62
Q

True or false: The cause of chronic insomnia is often unknown?

A

True

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63
Q

What could be some likely causes of chronic insomnia?

A
  1. Stressful life event
  2. Psychiatric illness or medical condition
  3. Medications or substance abuse
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64
Q

What are the clinical manifestations of insomnia?

A
  1. Difficulty falling asleep (long sleep latency)
  2. Frequent awakening (fragmented sleep)
  3. Prolonged nighttime awakenings
  4. Feeling unrefreshed on awakening (nonrestorative sleep)
  5. Fatigue, trouble with concentration
  6. Forgetfulness, confusion
  7. Anxiety
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65
Q

How is insomnia typically diagnosed?

A
  1. Self report
  2. Actigraphy
  3. Polysomnography (PSG)
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66
Q

What is the 1st thing we will ask a patient do when they think they have insomnia?

A

Keep a sleep journal for two weeks of when they went to bed, what time they woke up, if they woke up during the night, if they woke up feeling refreshed.

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67
Q

What is an actigraphy?

A

Watch like device, worn on the wrist, that can determine sleep and wake over a 14 day period.

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68
Q

What is a polysommongraphy?

A

Sleep study– records breathing patterns, thoracic movements, pulse ox, heart rate, sleep waves

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69
Q

What are things we can do for our patients with insomnia?

A
  1. Education
  2. Track sleep
  3. Sleep hygiene
  4. Cognitive-behavioral therapy for insomnia (CBT-I)
  5. Complementary and alternative therapies
  6. Drug therapy
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70
Q

What are some sleep hygiene techniques we can teach our patients?

A
  1. Do not go to bed unless you are sleepy
  2. If you are not asleep after 20 minutes, get out of bed and do non-stimulating activities. Return to bed only when you are sleepy.
  3. Adopt a regular pattern in terms of bedtime and awakening.
  4. Begin rituals that help you relax each night before bed.
    Refer to slide 32 for more examples
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71
Q

What are some causes on insomnia?

A
  1. Psychiatric
  2. Medical illness, medications
  3. Stress: finances, employment, school, life
  4. Substances: Caffeine, alcohol, nicotine
  5. Exercise
  6. Age, gender
  7. Other factors: travel
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72
Q

True or false: Tx for insomnia should begin with the most invasive method?

A

False

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73
Q

Cognitive behavior therapy and counseling can be treatments for insomnia?

A

Yes

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74
Q

What are some drugs used to treat insomnia?

A
  1. Benzodiazepines
  2. Benzodiazepine-receptor-like agents
  3. Melatonin-receptor agonists
  4. Antidepressants
  5. Antihistamines
  6. Alternative therapies
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75
Q

What should we know about sedative-hypnotic drugs

A

1.Depress the CNS function
2. primarily used to tx anxiety and insomnia
3. Antianxiety agents or anxiolytics
4. distinction between antianxiety effects and hypnotic effects depends on dosage

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76
Q

What are some things we should know about benzodiazepines?

A
  1. used to tx anxiety and insomnia
  2. Used to induce general anesthesia
  3. Used to manage seizure disorders, muscle spasms, panic disorder, and alcohol withdrawal
  4. potential for abuse
  5. Can produce physical dependence
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77
Q

What benzodiazepines are used specifically for sleep?

A
  1. Temazepam (Restoril)
  2. Triazolam (halcion)
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78
Q

What are two common types of benzodiazepines not usually used in sleep? DOUBLE CHECK I THINK THIS IS WRONG

A
  1. Diazepam (valium)
  2. Lorazepam (Ativan)
  3. Alprazolam (Xanax)
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79
Q

What are the pharmacologic effects of benzodiazpines?

A
  1. CNS: reduce anxiety and promote sleep
  2. Cardiovascular system: oral vs. intravenous
  3. Respiratory system: weak respiratory depressants
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80
Q

What are the therapeutic uses of benzodiazepine?

A
  1. Anxiety
  2. Insomnia
  3. Seizure disorders, muscle spasm
  4. ETOH withdrawal, perioperative application
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81
Q

What are some adverse effects of benzodiazepines

A
  1. CNS depression
  2. Amnesia
  3. Sleep driving
  4. Paradoxical effects
  5. Respiratory depression
  6. Abuse
82
Q

What types of toxicity can benzodiazepine have?

A
  1. Acute toxicity
  2. Oral overdose
    -drowsiness, lethargy, and confusion
  3. Intravenous toxicity
    -Life-threatening reactions, profound, hypotension, respiratory arrest, and cardiac arrest
83
Q

What are some general tx measurements in benzodiazepine toxicity?

A

Oral
1. Gastric lavage, activated charcoal, and dialysis

84
Q

What is the antidot for Benzodiazepine?

A

Flumazenil (romazicon)
1. Competitive benzodiazepine receptor agonist
2. Reverses sedative effects if benzodiazepine but may not reverse respiratory depression
3. Monitor for seizure when benzodiazepine stopped
4. Effects fade an hour after administration: monitor for sedation.

85
Q

What should we know about zolpidem (ambien)

A
  1. It is a benzodiazepine-receptor like agent
  2. Sedative-hypnotic
  3. Short-term management of insomnia
  4. Side effects: daytime drowsiness and dizziness

MAJOR SIDE AFFECT– CRAZY DECSION MAKING

86
Q

What should we know about zaleplon (sonata)

A
  1. Benzodiazepine-receptor-like agent
  2. Approved for short-term management of insomnia
  3. Most common side effects: headache, nasea, drowsiness, dizziness, myalgia and abdominal pain
87
Q

What should we know about Eszopiclone (Lunesta)?

A

1.Benzodiazepine-receptor-like agent
2. Approved from treating insomnia
3. No limitation on how long it can be used
4. Generally well tolerated
5. Adverse effect: bitter aftertaste, headache, somnolence, dizziness, and dry mouth
6. Low potential for abuse

88
Q

What should we know about the antidepressant trazodone (oleptro)?

A
  1. Atypical antidepressant with strong sedative actions
  2. Can decrease sleep latency and prolong sleep duration
  3. Does not cause tolerance or physical dependence
89
Q

What should we know about the antidepressant doxepin and amitriptyline?

A
  1. Old tricyclic antidepressant with strong sedative actions
  2. Used to tx patients who have trouble staying alseep
90
Q

What should we know about diphenhydramine (Benadryl)- antihistamine?

A
  1. May be added to night time cold/pain preparations
91
Q

What should we know about Doxylamine (unisom)- antihistamine

A
  1. Can be purchased without a prescription
  2. Less effective
  3. Tolerance develops quickly (1 to 2 weeks)
  4. Adverse effects: daytime drowsiness and anticholinergic effects
  5. Not intended for long term use.
92
Q

What are some complementary and alternative therapies used to treat insomnia?

A
  1. Melatonin: effective related to jetlag and shift work
  2. Valerian root, chamomile, passionflower, lemon blam, lavender, have very mild sedative effects, proof of benefits in insomnia is lacking.
  3. White noise and relaxation strategies.
93
Q

What should our nursing assessment include when assessing patients sleep?

A
  1. Sleep history
  2. Assess diet, caffeine, and alcohol intake
  3. ask about sleep aids
  4. Sleep diary for 2 weeks
  5. Medical history: factors that affect sleep
94
Q

What would the nursing diagnosis include with sleep related issues?

A
  1. Sleep deprivation
  2. Disturbed sleep pattern
  3. Readiness for enhanced sleep
95
Q

What should the nursing implementation for sleep include?

A

1.Assume primary role in teaching sleep hygiene
2. Teach patient about sleep medications

96
Q

What are some key points to teach about regarding sleep hygiene?

A
  1. Decrease caffeine intake
  2. Bedtime routine
  3. Decreased blue light before bedtime
  4. Reduce light and noise
97
Q

Sleep apnea occurs when the _____ gets closed

98
Q

What are some symptoms of sleep apnea?

A
  1. Loud snoring
  2. Excessive day time sleepiness
  3. Frequent episodes of obstructed breathing during sleep
  4. Morning headaches
  5. Unrefreshing sleep
  6. Increased irritability
99
Q

What are some non-surgical treatments for sleep apnea?

A
  1. Change sleep position
  2. Decrease weight
  3. CPAP
  4. Drug therapy for underlying cause
100
Q

What are some surgical treatments for sleep apnea?

A
  1. Adenoidectomy
  2. Uvulectomy
  3. Remodeling posterior oropharynx
  4. Bariatric surgery to decrease weight
101
Q

Complications of respiratory and sleep problems can result in

A
  1. Hypertension
  2. Cardiac changes
  3. Poor concentration/memory
  4. Impotence
  5. Depression
102
Q

What are some respiratory and sleep problems?

A
  1. sleep apnea
  2. Snoring and hypoventilation
  3. Obesity hypoventilation syndrome
  4. Reduced CW compliance
  5. Increased work of breathing
  6. Decrease in total lung capacity and functional residual capacity
  7. Also called obstructive sleep apnea hypopnea syndrome (OSAHS)
  8. partial or complete upper airway obstruction during sleep
  9. Apneic period may include hypoxemia and hypercapnia
103
Q

What is sleep apena?

A
  1. Apnea is cessation of spontaneous respirations for longer than 10 seconds.
  2. Each obstruction may last from 10-90 seconds.
  3. Apnea and arousal cycles occur repeatedly, as many as 200 to 400 times during 6 to 8 hours of sleep.
104
Q

What are some more symptoms of sleep apnea?

A
  1. Frequent arousal during sleep
  2. Insomnia
  3. Excessive daytime sleepiness
  4. Witness apneic episodes
  5. loud snoring
  6. Morning headache
  7. Irritability
105
Q

What are some risk factors of sleep apnea?

A
  1. Obesity (BMI > 28 kg/m2)
  2. Age > 65 years
  3. Neck circumference > 17 inches
  4. Craniofacial abnormalities that affect the upper airway, and acromegaly
  5. Smokers are more likely to have osa
  6. OSA is more common in men than women after menopause, when the prevalence of the disorder is the same in both genders. Women with OSA have high mortality rates.
106
Q

What lab/diagnostic testing can be done to determine if a patient has sleep apnea?

A

Polysomnography AKA sleep study

107
Q

What are treatments for mild sleep apnea?

A
  1. Sleeping on one’s side
  2. Elevating head of bed
  3. Avoiding sedatives and alcohol 3 to 4 hours before sleep
  4. weight loss
  5. Oral appliance
108
Q

What are some treatments for severe sleep apnea?

A

severe (>15 apnea/hypopnea events/hr)
1. CPAP- possible compliance issues
2. BiPAP
3. Surgery
-uvulopalatopharyngoplasty (UPPP or UP3)
- genioglossal advancement and hyoid myotomy (GAHM)

109
Q

What should we include in our patient teaching for a patient with sleep apnea?

A
  1. if a patient on CPAP or BIPAP remind them to always take with them if overnight trips are planned
  2. Explain the benefit of loosing weight
  3. Explain the benefits of sleeping on side
  4. Explain the need to avoid sedatives or alcohol 3-4 hours prior to bedtime
  5. Stress reduction
  6. stress importance of exerise
  7. avoid smoking
  8. Self imagine distrubance
110
Q

What should we include in our patient teaching for a patient with sleep apnea??

A
  1. if a patient on CPAP or BIPAP remind them to always take with them if overnight trips are planned
  2. Explain the benefit of loosing weight
  3. Explain the benefits of sleeping on side
  4. Explain the need to avoid sedatives or alcohol 3-4 hours prior to bedtime
  5. Stress reduction
  6. stress importance of exercise
  7. avoid smoking
  8. Self imagine disturbance
111
Q

Discharge planning for patients with sleep apnea should include?

A
  1. Case manager- need for equipment
  2. Nutritional consult
  3. Spiritual consult
112
Q

Nursing diagnosis for a patient with possible sleep apnea includes?

A
  1. anxiety
  2. insomnia
  3. imbalanced nutrition more than body requires
  4. knowledge deficit
113
Q

What is narcolepsy?

A

Brain unable to regulate sleep-wake cycles normally, causes uncontrollable urges to sleep, often go directly into REM sleeo

114
Q

What is the cause of narcolepsy?

A

Unknown cause
1. associated w/destruction of neurons that produce orexin

115
Q

What is Orexin?

A
  1. Neuropeptide that regulates sleep/wake cycles
116
Q

True or false: Low levels of Orexin lead to difficulty staying awake?

117
Q

When in a person’s life is narcolepsy usually diagnosed?

A

Adolescents to early in the 3rd decade

118
Q

What are the two types of narcolepsy?

A
  1. Type 1: With cataplexy
  2. Type 2: without cataplexy
119
Q

What is cataplexy?

A

Is a brief and sudden loss of skeletal muscle tone that can manifest as muscle weakness or complete postural collapse and falling

120
Q

Nursing and interprofessional management include what in regards to narcolpsy?

A
  1. Teach about sleep and sleep hygiene
  2. Take naps ( advise 3 or more short (15min nap) throughout the day
  3. Avoid heavy meals and alcohol
  4. Ensure patient safety
  5. Lifestyle changes (discourage driving, swimming)
121
Q

What are two wake-promotion drugs used to treat narcolepsy?

A
  1. Modafinil (Provigil)
  2. Armodafinil (Nuvigil)
122
Q

In terms of sleep what are some gerontologic considerations?

A

Older age is associated with
1. Overall shorter total sleep time
2. Decreased sleep efficiency
3. More awakenings
4. Insomnia symptoms
5. Awakenings during the night increase risk for falls
6. medications used by older adults can contribute to sleep problems
7. Avoid long-acting benzodiazepiens

123
Q

In terms of sleep what are some gerontologic considerations?

A

Older age is associated with
1. Overall shorter total sleep time
2. Decreased sleep efficiency
3. More awakenings
4. Insomnia symptoms
5. Awakenings during the night increase risk for falls
6. medications used by older adults can contribute to sleep problems
7. Avoid long-acting benzodiazepines

124
Q

What are some nurse fatigue: facts?

A
  1. Inadequate sleep
  2. Extended work hours
  3. Increased risk for errors
125
Q

Mobility can be….

A
  1. Nonverbal gestures
  2. Self-defense
  3. ADL’s
  4. Recreational
  5. Satisfaction of basic needs
  6. Expression of emotion
126
Q

What are some factors affecting mobility and activity?

A
  1. Developmental
  2. Nutrition
  3. Lifestyle
  4. Stress
  5. Environment
  6. Diseases and abnormalities
127
Q

What are some diseases and abnormalities that can affect mobility?

A
  1. Bones, Muscles and nervous system
  2. Pain
  3. Trama
  4. Respiratory system
  5. Circulatory
  6. Psychological/social
128
Q

What is immobility?

A
  1. A person’s inability to move about freely?
129
Q

What is paraplegia?

A

Refers to paralysis to the lower part of the body

130
Q

What is hemiplegia?

A

Paralysis or restrictive movement to one part of the body (stroke)

131
Q

What is quadriplegia?

A

AKA Tetraplegia paralyzed from the neck down.

132
Q

What is bedrest?

A

Restricts patients to bed for therapeutic reasons?

133
Q

What are some benefits of a patient being on bedrest?

A
  1. Sometimes prescribed for selected patients
  2. Reduces physical activity and o2 demand of the body
  3. Reduces pain
  4. Allow ill or debilitated patients to rest
  5. Allows exhausted patients to rest
  6. Duration depends on illness or injury and prior state of health.
134
Q

What are some physical causes of immobility?

A
  1. Bone fracture
  2. Surgical procedure
  3. Major sprain or strain
  4. Illness/disease
  5. Cancer
  6. Aging process
135
Q

What are some psychosocial causes of immobility?

A
  1. Stress/depression
  2. Decreased motivation
  3. Hospitalization
  4. Long term care facility residents
  5. Voluntary sedentary lifestyle
136
Q

Prolonged immobility leads to…

A
  1. Reduced functional capacity
  2. Altered metabolism
  3. Numerous physiological changes
137
Q

Immobility can affect what parts of body/system?

A
  1. Musculoskeletal
  2. Lungs
  3. Heart and vessels
  4. Metabolism
  5. Integument
  6. Gastrointestinal
  7. Genitourinary
  8. Psychological
138
Q

What effects can immobility have on the musculoskeletal system?

A
  1. Brittle bones
  2. Contractures
  3. Muscle weakness and atrophy
  4. Foot drop
139
Q

What effects can immobility have on the nervous system?

A
  1. Lack of stimulation
  2. Feelings of anxiety and isolation
  3. Confusion
  4. Depression
140
Q

What effects can immobility have on the digestive system?

A
  1. Decreased appetite and low fluid intake
  2. constipation and/or bowel obstruction
  3. Incontinence
  4. Electrolyte imbalances
141
Q

What effects can immobility have on the integumentary system?

A
  1. Decreased blow flow
  2. Pressure ulcers
  3. Infections
  4. Skin breakdown and pressure ulcers
142
Q

What effects can immobility have on the cardiovascular system?

A
  1. Blood clots
  2. Reduced blood flow
143
Q

What effects can immobility have of the respiratory system?

A
  1. Pneumonia
  2. Decreased respiratory effort
  3. Decreased oxygenation of bl0od
144
Q

What effects can immobility have on the urinary system?

A
  1. Reduced kidney function
  2. Incontinence
  3. Urinary tract infections
  4. Urinary retention
145
Q

What are some musculoskeletal assessments we can do for immobile patients?

A
  1. Activity intolerance
  2. anthropometric measurements
  3. Nutrition

-Muscle loss, bone loss and joint stiffness can occur
- the longer you remain still the worse the activity intolerance will be
- For every week on bedrest a person will lose 10% of there muscle mass
- Protein is going to be a crucial part of a immobile patient

146
Q

What two types of cells are part of bone resorption?

A
  1. Osteoclasts
  2. Osteoblasts
147
Q

What is an osteoclasts?

A
  1. Dissolve bone and calcium get released into the bloodstream (clast means to break)
148
Q

What is an osteoblast?

A

Trys to reabsorb and deposit calcium back into bone (blast means to grow)

149
Q

True or false: Immobile patients have decreased bone mass because the osteoclast come in, tear down and dissolve the bone?

150
Q

What are characteristics of osteoporosis?

A

Pores in bone or a bone with lots of dead speace

151
Q

What are characteristics of osteoporosis?

A

Pores in bone or a bone with lots of dead space

152
Q

What are some risk factors of osteoporosis?

A
  1. gender (females more affected than males especially after menopause)
  2. Insufficient exercise or too much exercise
  3. Poor diet (low in Ca and protien)
  4. Smoking
153
Q

True or false: Bone density is strongly linked to estrogen?

154
Q

Changes in bone density with age is more pronounced in women or men?

155
Q

True or false: the further away from menopause the more likely a fracture can occur?

156
Q

What is range of motion:

A
  1. Maximum amount of movement available to a joint
157
Q

Joints not moved are at risk for what?

A

contractures- which can begin forming within 8 hours

158
Q

True or false: ROM exercises do not help improve joint mobility

A

False– it helps

159
Q

What is one of the easiest interventions to maintain or improve joint mobility?

A
  1. ROM excercise
160
Q

True or false: ROM exercises can be coordinated with other activities?

161
Q

What is active ROM or AROM

A

Done by the patient

162
Q

What is active assist ROM?

A

Done by patient but with help

163
Q

What is passive ROM

A

Done by nurse or other caregiver or CPM (continuous passive motion)

164
Q

How often should you try to do ROM exercises?

A

3 times a day
1. After bath
2. Mid day
3. Bedtime

165
Q

What are some good techniques for ROM exercises?

A
  1. Start gradually and move slowly using smooth motions
  2. Support the extremity
  3. Stretch the muscle only to the point of resistance/pain
  4. Encourage active ROM if possible
166
Q

What is contractures?

A

Shortening of the muscle

167
Q

What should your respiratory assessment on an immobile patient include?

A
  1. Lung sounds (general patient every 8 hours, cirtical every 4 hours.)
  2. O2 sats
  3. Respiratory rate
  4. Activity tolerance (SOB)
  5. Chest x-ray
  6. ABG
168
Q

True or false: If a patient is laying in bed with a high resp rate this is an indicator of a MAJOR problem

169
Q

What should our cardiac assessment include on an immobile patient?

A
  1. Blood pressure
  2. Pulse rate
  3. Heart sounds
  4. Activity tolerance (BP,HR, Chest pain)
  5. Calf pain
170
Q

Deep vein thrombosis is caused by?

A
  1. Decreased muscle activity leading too
  2. Pooling of blood leading too
  3. Clot formation
171
Q

What are some treatments o f DVT’S

A
  1. Ambulation
  2. TED hose
  3. SCD’s
172
Q

TED hoses are used on patients that….

A
  1. Are post surgical
  2. Non-walking
173
Q

True or false it is important that the ted hose do not bunch up at the top?

174
Q

What should we know about SCD’s?

A
  1. Sleeves around the legs
  2. Alternately inflate and deflate
  3. For patients post surgery/circulatory disorders
175
Q

What should be included in our metabolism assessment on immobile patients?

A

Assess for
1. Decreased appetite
2. Weight loss
3. Muscle loss
4. Weakness
5. Labs

176
Q

What should be included in our integument assessment of a immobile patient?

A
  1. Skin assessment ( color changes & integrity)
    2.Nutrition
  2. Incontinence
177
Q

What should be included in our gastrointestinal assessment?

A
  1. Bowel sounds
  2. Abdominal palpation
  3. Bowel habits (last BM)
  4. I & O

Gi tract will slow down so making sure that they have good active bowel sounds. If you dont hear bowel sounds in all four quadrants this could be an indicator of something more

178
Q

What should be included in our genitourinary assessment in immobile patients?

A
  1. I & O
  2. Palpate abdomen
  3. Incontinence
  4. Urine (color, smell, clarity?)
179
Q

What is the number one culprit of kidney stones?

A

Calcium- so if you have a patient who is laying still in bed there bones are being broken down and calcium is being entered into the blood stream which travels to the kidneys further increasing risk of kidney stones.

Keep in mind a person laying flat will have urine that settles in the renal pelvis/bladder. Urine then becomes concentrated and does not move the way it should. Adding the calcium will increase risk of kidney stones plus infection

180
Q

True or false: Standing urine travels down but laying down urine settles?

181
Q

What is urinary stasis?

A
  1. When the renal pelvis fills before urine enters the ureters because peristaltic contractions of ureters are insufficient to overcome gravity.
182
Q

Immobility–> decreased fluid intake–> dehydration–> concentrated urine–> leads too what?

A
  1. Increased risk for UTI and kidney stones
183
Q

What should our psychosocial assessment include in an immobile patient?

A

Assess
1. Mood
2. Orientation
3. Speech
4. Affect
5. Sleep

184
Q

What are some psychosocial effects of immobility?

A
  1. social isolation
  2. Loneliness
  3. Decreased coping
  4. Depression
  5. Anxiety
  6. Withdrawal
  7. Delerium
185
Q

What are some benefits of of mobility?

A
  1. Strengthen muscles
    -especially those of the abdomen and legs
  2. Joint flexibility
    • especially that of the hips, knees and ankles
  3. Stimulates circulation
    • which helps prevent phlebitis and development of clots
  4. Prevents constipation
    • the movement of the abdominal muscle stimulates the intestinal tract
  5. Prevents osteoporosis
    • due to mineral loss from the bones when they do not bear weight
  6. Stimulates the appetite
  7. Prevents urinary incontinence and infections
    • when patient s are able to the bathroom on thier own, incontinence is reduced
  8. Relieves pressure
    • on the body and skin, helping to prevent pressure injuries
  9. Improves self-esteem
    • and the patients feelings of independence
  10. Decreases anxiety and depression
    • induced by hospitalization
186
Q

What is the best intervention to prevent immobility complications?

187
Q

What are restraints?

A

Any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move arms, legs, body or head freely.

188
Q

What would be some reasons we place non-violent restraints on a patient?

A
  1. Actions impede medical care
  2. Lack of awareness of potential harm to self/others
  3. Unable to follow commands and comply with safety instructions
  4. Attempts to pull out tubes, drains or other lines/devices medically necessary for tx
189
Q

What are some requirements that must happen in order to place a patient in restraints?

A
  1. Requires every 2 hours monitoring and documentation
  2. New order required every calendar day
  3. Wehn discontinuing, date & time must be documented
190
Q

What are some type of restraints?

A
  1. Extremity
  2. Mitten
  3. Posey
  4. Belt
191
Q

Covenant restraint policy states that prior to restraining alternatives such as________________ be attempted

A
  1. Reorientation (explain what’s going on, who they are, where they are)
  2. Limit setting (remind them of what they cant do)
  3. Increased observation and monitoring (using sitters)
  4. Change the patients physical environment (open window, move them out to the rn station)
  5. Review and modification of medication regimens
192
Q

What are some alternative measures for restraints?

A
  1. Orient family and patient to environment
  2. Offer diversionary activities
  3. Use calm simple statements
  4. promote relaxation techniques
  5. Attend to needs
  6. use of glasses/hearing aids
193
Q

True or false: You must have an order prior to applying a restraint unless it is an emergent situation?

A

True– asap let provider know

194
Q

True or false: You want to try and discontinue restraints ASAP?

195
Q

Restraint assessment should include?

A
  1. Vitals, hydration and circulation, skin integrity and patients level of distress
  2. Regularly assess the need for continued use of restrains
  3. Assess patients behavior
  4. Assess circulation, motion, sensation
  5. Make sure restraint fits properly
  6. Mental status- ask to move limbs/or if they feel tingling
196
Q

What are some risks of using restraints? (More emotional)

A
  1. Increase in injury or death
  2. Loss of self-esteem
  3. Humiliation
  4. Fear
  5. Anger
  6. Increased confusion and agitation
197
Q

What are some complications of restraints?

A
  1. Impaired skin integrity
  2. Lower extremity edema
  3. Altered nutrition
  4. Physical exhaustion
  5. Social isolation
  6. Immobility complications
  7. Death
198
Q

Intervention of application with restraints includes

A
  1. Restrict movement as little as necessary
  2. Make sure restraint fits properly
  3. Always tie (slip knot or bow tie) to bed from/mattress spring- NEVER TO A MOVING PART
  4. Always explain the need for restraint
  5. Never leave patient unattended without the restraint
  6. Pad bony prominences
199
Q

What are some interventions we can do prevent complications from restraints?

A
  1. ROM
  2. Reposition
  3. Nutrition/hydration/Toileting
  4. Release at the earliest possible time
200
Q

What should you document in regards to restraints?

A
  1. Any medical eval for restraint
  2. Description of the patient’s behavior and the intervention used
  3. Any alternative or less restrictive interventions attempted
  4. Patient’s conditions or symptom that warranted the use of the restraint
  5. Patients response to the intervention used and rationale for continued use of the intervention.
  6. the intervals for monitoring
  7. revisions to the plan of care
  8. Pts behavior and staff concerns regarding safety risks to the patient, staff and others that necessitated the use of the restraint
  9. injuries to the patient
  10. death associated with the use of restraint
  11. The identity of the provider who ordered the restraint
  12. Orders for restraint
  13. Notification of the use of restraint to the attending physician
  14. Consultations
  15. Pt/family teaching
  16. response to removing restraint

Module 1 (20 decks)

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