LEC: Midterm Flashcards
There are two types of nursing care plans:
traditional and
standardized.
The ??? care plan is written for each client. The form varies from agency to agency according to the needs of the client and the department.
traditional care plan
nursing care plan:
Most forms have three columns:
one for nursing diagnoses, a second for expected outcomes, and a third for nursing interventions.
??? care plans were developed to save documentation time. These plans may be based on an institution’s standards of practice, thereby helping to provide a high quality of nursing care.
Standardized care plans
To think like a nurse, ??? and ??? must be defined and understood.
critical thinking and clinical reasoning
is the process of intentional higher level thinking to define a client’s problem, examine the evidence-based practice in caring for the client, and make choices in the delivery of
care.
Critical thinking
is the cognitive process that uses thinking strategies to gather and analyze client information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client’s physiological and psychosocial outcomes.
Clinical reasoning
According to Scheffer and Rubenfeld (2010), critical thinking
is a metaphorical bridge between
information and action.
The ten ??? components are confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection.
affective
The seven ??? are analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge.
skills
is thinking that results in the development of new ideas and products.
Creativity
is the application of a set of questions to a particular situation or idea to determine essential information and ideas and discard unimportant information and ideas.
Critical analysis
is a technique one can use to look beneath the surface, recognize and
examine assumptions, search for inconsistencies, examine multiple
points of view, and differentiate what one knows from what one
merely believes.
Socratic questioning
generalizations are formed from a set of facts or observations.
inductive reasoning
by contrast, is reasoning from general premise to the specific conclusion.
Deductive reasoning
is a systematic, rational method of planning and providing individualized nursing care.
The nursing process
is a mental activity in which a problem is identified that represents an unsteady state.
Problem solving
One way to solve problems is through ???, in which a
number of approaches are tried until a solution is found
trial and error
is a problem-solving approach that relies on a nurse’s inner sense.
Intuition
in nursing, it is a decision-making process to ascertain the right nursing action to be implemented at the appropriate time in the client’s care.
Clinical judgment
is a formalized, logical, systematic approach to problem solving
The research process
Critical thinking requires that individuals think for themselves. People acquire many beliefs as children, not necessarily based on reason but in order to have an explanation they comprehend
independence
Critical thinkers are fair-minded and make impartial judgments.
They assess all viewpoints with the same standards and do not base
their judgments on personal or group bias or prejudice
fair-mindedness
Critical thinkers are open to the possibility that their personal biases
or social pressures and customs could unduly affect their think
ing. They actively try to examine their own biases and bring them
to awareness each time they think or make a decision.
Insight into Egocentricity
means having an awareness of the limits of one’s own knowledge. Critical thinkers are willing to admit what they do not know; they are willing to seek new information and to rethink their conclusions in light of new knowledge.
Intellectual humility Intellectual humility
With an attitude of courage, a nurse is willing to consider and examine fairly his or her own ideas or views, especially those to which the nurse may have a strongly negative reaction. This type of courage comes from recognizing that beliefs are sometimes false or misleading. Values and beliefs are not always acquired rationally
Intellectual Courage to Challenge
the Status Quo and Rituals
requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others. Critical thinkers question their own knowledge and beliefs as quickly and thoroughly as they challenge those of another.
Intellectual integrity
Because critical thinking is a lifelong endeavor, nurses who are critical thinkers show ??? in finding effective solutions to client and nursing problems. This determination enables them to
clarify concepts and sort out related issues, in spite of difficulties and frustrations.
perseverance
Critical thinkers believe that well-reasoned thinking will lead to trustworthy conclusions. Therefore, they cultivate an attitude of ??? in the reasoning process and examine emotion-laden arguments using the standards for evaluating thought, by asking questions such as these
confidence
The mind of a critical thinker is filled with questions: Why do we
believe this? What causes that? Does it have to be this way? Could something else work? What would happen if we did it another way?
Who says that is so?
curiosity
are the thinking processes based
on the knowledge of aspects of client care.
Cognitive processes
include reflective thinking and awareness of the skills
learned by the nurse in caring for the client
Metacognitive
processes
After assessing the data and determining what is relevant to the client’s condition and concerns, the nurse ??? and ???
identifies interventions and sets priorities for the most urgent needs
is a technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. Also known as mind mapping, concept maps are context dependent and can be used to develop analytical skills.
Concept mapping
is the ability to recognize subtle changes in a client’s condition over time.
Clinical reasoning-in-transition
is the identification of factors that improve client’s care.
Reflection
The nursing process is ??? centered
client
is involved in every phase of the nursing process.
Decision making
The nursing process is ??? and ???
interpersonal and collaborative
Collecting, organizing, validating,
and documenting client data
assessing
To establish a database about the client’s response to health concerns or illness and the ability to manage health care needs
assessing
Analyzing and synthesizing data
diagnosing
To identify client strengths and health problems that can be prevented or resolved by collaborative and independent nursing interventions. To develop a list of nursing and collaborative problems
diagnosing
Determining how to prevent,
reduce, or resolve the identified
priority client problems; how to
support client strengths; and how
to implement nursing interventions
in an organized, individualized, and
goal-directed manner
planning
To develop an individualized care plan that specifies client goals/desired outcomes, and related nursing interventions
planning
Carrying out (or delegating) and
documenting the planned nursing
interventions
implementing
to assist the client to meet desired goals/ outcomes; promote wellness; prevent illness and disease; restore health; and facilitate coping with altered functioning
implementing
Measuring the degree to which
goals/outcomes have been achieved and identifying factors that positively or negatively influence goal achievement
evaluating
To determine whether to continue,
modify, or terminate the plan of care
evaluating
is the systematic and continuous collection, organization, validation, and documentation of data (information)
Assessing
is the process of gathering information about a cli
ent’s health status.
Data collection
Data collection must be both ??? and ??? to prevent the omission of significant data and reflect a client’s changing health status.
systematic and continuous
contains all the information about a client; it includes the nursing health history, physical assessment,
primary care provider’s history and physical examination, results of
laboratory and diagnostic tests, and material contributed by other
health personnel.
A database
also referred to as symptoms or covert data, are apparent only to the person affected and can be described or verified only by that person.
Subjective data
also referred to as signs or overt data, are detectable by an observer or can be measured or tested against an accepted standard
Objective data
??? data is information that does not change over time such as race or blood type. ??? data can change quickly, frequently, or rarely and include such data as blood pressure, level of pain, and age
Constant;
Variable
Sources of data are ??? or ???
primary or secondary.
The best source of data is usually the ???, unless the client is too ill,
young, or confused to communicate clearly
client
Performed within specified
time after admission to a health
care agency
To establish a complete database
for problem identification, reference, and future comparison
Initial assessment
Ongoing process integrated
with nursing care
To determine the status of a
specific problem identified in an
earlier assessment
Problem-focused assessment
During any physiological or
psychological crisis of the
client
To identify life-threatening
problems
To identify new or overlooked
problems
emergency assessment
Several months after initial
assessment
To compare the client’s current
status to baseline data previously
obtained
time-lapsed assessment
include information documented by various health care professionals. It also contain data regarding the client’s occupation, religion, and marital status.
Client records
The principal methods used to collect data are
observing, interviewing, and examining
??? occurs whenever the nurse is in contact with the client or support persons. ??? is used mainly while taking the nursing health history. ??? is the major method used in the physical health assessment.
Observing
Interviewing
Examining
is to gather data by using the senses. It is a conscious, deliberate skill that is developed through effort and with an organized approach.
To observe
Observing has two aspects:
(a) noticing the data and
(b) selecting, organizing, and interpreting the data.
is a planned communication or a conversation with a purpose, for example, to get or give information, identify problems of
interview
In a ??? interview the nurse asks the client specific questions
to collect information related to the client’s problem
focused
The ??? interview is highly structured and elicits specific information.
directive
??? interview, or ??? interview, the nurse allows the client to control the purpose, subject matter, and pacing
nondirective;
rapport building
is an understanding between two or more people.
Rapport
A ??? question is a question the client can answer without direction or pressure from the nurse, is open ended, and is used in nondirective interviews. Examples are “How do you feel about that?” “What do you think led to the operation?”
neutral
??? question, by contrast, is usually closed, used in a directive in
terview, and thus directs the client’s answer. Examples are “You’re
stressed about surgery tomorrow, aren’t you?” “You will take your
medicine, won’t you?”
leading
STAGES OF AN INTERVIEW
An interview has three major stages:
the ??? or introduction, the ??? or development, and the
???
opening;
body;
closing
The ??? or head-to-toe approach begins the examination at the head; progresses to the neck, thorax, abdomen, and extremities; and ends at the toes
cephalocaudal
or physical assessment is a systematic data collection method that uses observation (i.e., the senses of sight, hearing, smell, and touch) to detect health problems.
The physical examination
A ???, also called a review of systems, is a brief review of essential functioning of various body parts or systems.
screening examination
Conceptual Models/Frameworks
Most schools of nursing and health care agencies have developed
their own structured assessment format. Many of these are based on
selected nursing models or frameworks..
examples are
Gordon’s functional health pattern framework, Orem’s
self-care model, and Roy’s adaptation model.
is the act of “double-checking” or verifying data to confirm that it is accurate and factual
Validation
are subjective or objective data that can be directly observed by the nurse; that is, what the client says or what the nurse can see, hear, feel, smell, or measure.
Cues
are the nurse’s interpretation or conclusions made based on the cues (e.g., a nurse observes the cues that an incision is red, hot, and swollen; the nurse makes the inference that the incision is infected).
Inferences
To complete the assessment phase, the nurse ???
records client data
Data are recorded in a ??? manner and not interpreted by the nurse
factual
is the second phase of the nursing process. In this phase, nurses use critical thinking skills to interpret assessment data and identify client strengths and problems
Diagnosing
The term ??? refers to the reasoning process, whereas the term ??? is a statement or conclusion regarding the nature of a phenomenon.
diagnosing;
diagnosis
The standardized NANDA names for the diagnoses are called ???; and the client’s problem statement, consisting of the diagnostic label plus ??? (causal relationship between a problem and its related or risk factors), is called a ???
diagnostic labels;
etiology;
nursing diagnosis
The official NANDA definition of a ??? is:
“. . . a clinical judgment concerning a human response to health con
ditions/life processes, or a vulnerability for that response, by an individual, family, group, or community”
nursing diagnosis
“refers to the actuality or potentiality
of the problem/syndrome or the categorization of the diagnosis as a
health promotion diagnosis
Status of the nursing diagnosis
An ??? diagnosis is a client problem that is present at the time
of the nursing assessment.
actual
A ??? diagnosis relates to clients’ preparedness to implement behaviors to improve their health condition
health promotion
A ??? diagnosis is a clinical judgment that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene.
risk nursing
??? diagnosis is assigned by a nurse’s clinical judgment to describe a cluster of nursing diagnoses that have similar
interventions
syndrome
A nursing diagnosis has three components:
(1) the problem and its definition,
(2) the etiology, and
(3) the defining characteristics.
The ???, or ???, describes the client’s health problem or response for which nursing therapy is given.
problem statement;
diagnostic label
are words that have been added to some NANDA labels to give additional meaning to the diagnostic statement
Qualifiers
(inadequate in amount, quality, or degree; not sufficient;
incomplete)
Deficient
(made worse, weakened, damaged, reduced, deteriorated)
Impaired
(lesser in size, amount, or degree)
Decreased
(not producing the desired effect)
Ineffective
(to make vulnerable to threat)
Compromised
The ??? component of a nursing diagnosis identifies one or
more probable causes of the health problem, gives direction to the
required nursing therapy, and enables the nurse to individualize the client’s care.
etiology
are the cluster of signs and symptoms that indicate the presence of a particular diagnostic label.
Defining characteristics
relate primarily to the nurse’s independent functions, that is, the areas of health care that are unique to nursing and separate and distinct from medical management.
Nursing diagnoses
With regard to medical diagnoses, nurses are obligated to carry out
physician-prescribed therapies and treatments, that is, ??? functions
dependent
A ??? problem is a type of potential problem that nurses manage using both independent and physician-prescribed interventions.
collaborative
are present when a particular disease or treatment is present; that is, each disease or treatment has specific complications that are always associated with it.
Collaborative problems
A ??? or ??? is a generally accepted measure, rule, model, or pattern.
standard or norm
The basic two-part statement includes the following:
problem
etiology
The basic three-part nursing diagnosis statement is called the ??? format and includes the following:
PES
- Problem (P):
- Etiology (E):
- Signs and symptoms (S):
Some diagnostic statements, such as health promotion diagnoses and
syndrome nursing diagnoses, consist of a ?
NANDA label only
A ??? is a classification system or set of categories arranged based on a single principle or set of principles.
taxonomy
A ??? is “any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes”
nursing intervention
begins with the first client contact and continues until the nurse–client relationship ends, usually when the client is discharged from the health care agency
Planning
The nurse who performs the admission assessment usually develops the
initial comprehensive plan of care
All nurses who work with the client do ??? planning. As nurses obtain new information and evaluate the client’s responses to care, they can individualize the initial care plan further.
ongoing
the process of anticipating and planning for needs after discharge, is a crucial part of a comprehensive health care plan and should be addressed in each client’s care plan.
Discharge planning
An ??? nursing care plan is
a strategy for action that exists in the nurse’s mind.
informal
A ??? nursing care plan is a written or computerized guide that organizes information about the client’s care.
formal
A ??? care plan is a formal plan that specifies the nursing care for groups of clients with common needs
standardized
An ??? care plan is tailored to meet the unique needs of a specific client—needs that are not addressed by the standardized plan.
individualized
Like standards of care and standardized care plans, ???
are predeveloped to indicate the actions commonly required for a
particular group of clients.
protocols
??? and ??? are developed to govern the handling of frequently occurring situations.
Policies and procedures
A ??? is a written document about policies, rules, regulations, or orders regarding client care.
standing order
A ??? is the evidence-based principle given as the reason
for selecting a particular nursing intervention
rationale
A ??? care plan is a standardized plan that outlines the care required for clients with common, predictable—usually medical— conditions.
multidisciplinary
is the process of establishing a preferential sequence for addressing nursing diagnoses and interventions
Priority setting
On a care plan, the ??? describe, in terms of observable client responses, what the nurse hopes to achieve by implementing the nursing interventions.
goals/
desired outcomes
are stated in neutral terms, and each outcome includes a five-point scale (a measure) that is used to rate the client’s status on each indicator.
Indicators
??? interventions are those activities that nurses are licensed to initiate on the basis of their knowledge and skills
Independent
??? interventions are activities carried out under the orders or supervision of a licensed physician or other health care provider authorized to write orders to nurses.
Dependent
??? interventions are actions the nurse carries out in collaboration with other health team members, such as physical therapists, social workers, dietitians, and primary care providers.
Collaborative
A taxonomy of nursing outcome statements, the ???, has been developed to describe measurable states, behaviors, or perceptions that respond to nursing
Nursing Outcomes Classification (NOC)
consists of doing and documenting the activities that are the specific nursing actions needed to carry out the interventions.
implementing
The ??? skills (intellectual skills) include problem solving, decision making, critical thinking, clinical reasoning, and creativity.
cognitive
??? skills are all of the activities, verbal and non-verbal, people use when interacting directly with one another. The effectiveness of a nursing action often depends largely on the nurse’s ability to communicate with others.
Interpersonal
??? skills are purposeful “hands-on” skills such as manipulating equipment, giving injections, bandaging, moving, lifting, and repositioning clients.
Technical
is a planned, ongoing, purposeful activity in which clients and health care professionals determine (a) the client’s progress toward achievement of goals/ outcomes and (b) the effectiveness of the nursing care plan.
evaluating
An ??? consists of two parts: a conclusion and supporting data
evaluation statement
A ??? is an ongoing, systematic process designed to evaluate and promote excellence in the health care provided to clients.
quality assurance (QA) program
focuses on the setting in which care
is given.
Structure evaluation
??? evaluation focuses on how the care was given.
Process
???evaluation focuses on demonstrable changes in the
client’s health status as a result of nursing care
Outcome
A ??? is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
sentinel event
??? is a process for identifying the factors that bring about deviations in practices that lead to the event.
Root cause analysis
Unlike quality assurance, ??? follows
client care rather than organizational structure, focuses on process rather than individuals, and uses a systematic approach with the intention of improving the quality of care rather than ensuring the quality of care.
quality improvement (QI)
An ??? refers to the examination or review of records.
audit
A ??? audit is the evaluation of a client’s record after discharge from an agency.
retrospective
means “relating to past events
Retrospective
A ??? audit is the evaluation of a client’s health care while the client is still receiving care from the agency.
concurrent
A ??? is an informal oral consideration of a subject by two or more health care personnel to identify a problem or establish strategies to resolve a problem.
discussion
A ??? is oral, written, or computer-based communication intended to convey information to others.
report
A ???, also called a chart or client record, is a formal, legal document that provides evidence of a client’s care and can be written or computer based.
record
The process of making an entry on a client record is called
recording, charting, or documenting.
The traditional client record is a ???. Each person or department makes notations in a separate section or sections of the client’s chart.
source-oriented record
??? charting is a traditional part of the source-oriented record. It consists of written notes that include routine care, normal findings, and client problems.
Narrative
established by Lawrence Weed in the 1960s, the data are arranged according to the problems the client has rather than the source of the information.
problem-oriented medical record (POMR), or problem
oriented record (POR),
A ??? in the POMR is a chart entry made by all health professionals involved in a client’s care; they all use the same type of sheet for notes.
progress note
SOAP is an acronym for
subjective data, objective data, assessment, and planning.
Over the years, the SOAP format has been modified. The acronyms
SOAPIE and SOAPIER refer to formats that add ?
interventions, evaluation, and revision
The PIE documentation model groups information into three categories. PIE is an acronym for ???of nursing care.
problems, interventions, and evaluation
The ??? uses specific assessment criteria in a particular format, such as human needs or functional health patterns.
flow sheet
is intended to make the client and client concerns and strengths the focus of care.
Focus charting
is a documentation system in which
only abnormal or significant findings or exceptions to norms are recorded.
Charting by exception (CBE)
A goal that is not met is called a
variance
communication, which is defined as a process in which information about patient/client/resident care is
communicated in a consistent manner including an opportunity to
ask and respond to questions
“handoff”
The handoff communication or ???report is given to all nurses on the next shift
change-of-shift
Measures practiced by health care personnel to prevent spread, transmission and acquisition of infection between clients, from health care providers to clients & from clients to health care provider
infection control
A hospital- acquired infection, also known as ??? infection. It
is an infection that is acquired in a hospital or other health care facility
nosocomial
INFECTION CONTROL IS BASED ON
standard & additional precaution
Set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, and mucus.
standard precaution
it is also known as hand hygiene is the act of cleaning hands for the purpose of removing soil, dirt & microorganisms.
HANDWASHING
Specialized clothing or equipment won by an employee for protection
against infectious materials
PERSONAL PROTECTIVE EQUIPMENT
It is a process intended to kill all microorganisms and is the highest level of microbial kill that is possible.
STERILIZATION
Four main ways for sterilization:
(high pressure steam)
AUTOCLAVE
Four main ways for sterilization:
(in an oven)
DRY HEAT
Four main ways for sterilization:
(Formaldehyde solution)
CHEMICAL STERILANTS
Four main ways for sterilization:
(with the help of physical agents)
e.g. gamma rays
RADIATION
It is the reduction in number of microorganisms on an object or surface but not the complete destruction of kill microorganisms or spores.
decontamination
is less effective than sterilization because it does not kill bacterial endospores.
Disinfection
The hospital’s housekeeping department is responsible for the regular and routine cleaning of all surfaces and maintaining a high level of hygiene in the facility in collaboration with the function control committee
cleaning
It is the collection,
transport, processing or
disposal, managing &
monitoring of waste
material.
WASTE MANAGEMENT
Dust particles containing infections agents can remain suspended in the air for long periods of time.
E.g. T.B, Measles & Chicken Pox
AIR BORNE PRECAUTIONS
Propelled short distances through the air. Deposited on host’s conjunctiva, nasal mucosa or mouth.
E.g. Streptococcal pharyngitis, mumps, influenza,
rubella, pneumonia, sepsis
DROPLETPRECAUTIONS
Frequent mode of transmission for nosocomial infections. It can be through Direct contact and Indirect contact transmission.
CONTACTPRECAUTIONS
DONNING OF PPE KIT
Gown
Mask or respirator
Goggles or face shield
Gloves
DOFFING OF PPE KIT
Gloves
Goggles of face shield
Gown
Mask or respirator
Hand wash
Some microorganisms are normal ??? (the collective vegetation in a given area) in one part of the body, yet produce infection in another.
resident flora
An ??? is the growth of microorganisms in body tissue
where they are not usually found. Such a microorganism is called an
???
infection ;
infectious agent
is the freedom from disease-causing microorganisms.
Asepsis
includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, and transmission of microorganisms
Medical asepsis
A detectable alteration in nor
mal tissue function, however, is called ???.
disease
microorganisms’ ability to
produce disease
virulence
If the infectious agent can be transmitted to an individual by direct or indirect contact or as an airborne infection, the resulting condition is called a
communicable disease
is the ability to produce disease; thus, a pathogen is a microorganism that causes disease
Pathogenicity
An ??? pathogen causes disease only in a susceptible individual.
opportunistic
are by far the most
common infection-causing microorganisms
Bacteria
consist primarily of nucleic acid and therefore must enter
living cells in order to reproduce
Viruses
live on other living organisms.
Parasites
is the process by which strains of microorganisms
become resident flora.
Colonization
A ??? infection is limited to
the specific part of the body where the microorganisms remain.
local
If the microorganisms spread and damage different parts of the body, the infection is a ??? infection.
systemic
When a culture of the person’s blood reveals microorganisms, the condition is called ???
bacteremia
When bacteremia results in systemic infection, it is referred to as ???
septicemia
??? infections are the direct result of diagnostic or therapeutic procedures
Iatrogenic
It is a fragile, gelatinous tissue, appearing pink or red because of the many newly formed capillaries.
granulation tissue
An ??? is a substance that induces a state of sensitivity or immune responsiveness (immunity)
antigen
The ??? defenses, or cellular immunity, occur through
the T-cell system
cell-mediated;
(agents that inhibit the growth of some microorganisms)
antiseptics
(agents that destroy pathogens other than spores)
disinfectants
is a state of complete physical, mental and social well being.
Health
The various practices that help in maintaining good health are called
hygiene
The word hygiene comes from a Greek word ???that means ‘Goddess for health’ and deals with personal and community health.
hygiea
Refers to a patient’s routine of exercise, activity, leisure, and recreation, including activities of daily living (ADLs) that require energy expenditure.
activity exercise pattern
It involves the level of physical fitness, movement capabilities, and any functional limitations.
This pattern also considers factors that affect mobility and exercise, such as pain, discomfort, or any conditions that impact physical performance.
activity exercise pattern
is defined as any bodily movement produced by the contraction of skeletal muscles that increases energy expenditure.
“Activity”
This includes both planned and routine movements, such as exercise, activities of daily living (ADLs), and mobility.
activity
is a planned, structured, and repetitive bodily movement performed to improve or maintain physical fitness.
It is a subset of physical activity that is deliberate and aimed at enhancing cardiovascular endurance, muscle strength, flexibility, and overall health.
Exercise
refers to a person’s capacity to perform physical activities without experiencing undue fatigue or adverse effects.
Activity tolerance
is a condition in which the body is in a decreased state of activity without physical emotional stress and freedom from anxiety.
Rest
is a state of rest accompanied by altered level of consciousness and relative inactivity, and perception to environment are decreased
Sleep
The cyclic nature of sleep is thought to be controlled by Centers located in the brain and by ???
Circadian Rhythms.
??? system (RAS) located at the brain stem and Cerebral Cortex plays an important role in sleep wake cycle.
Reticular activating
Sleep begins with the activation of the ??? of the anterior hypothalamus.
pre optic area
Sleep promoting neurons act over wake promoting neurons by releasing ???
Gamma Amino Butyric Acid (GABA).
The inhibition of wake promoting neurons results in intensifying sleep process.
Another key factor to sleep is exposure to ???
darkness
the Pineal gland in the brain begins to actively secrete the natural hormone ???, and the person feels less alert.
Melatonin
With the beginning of daylight, Melatonin is at its lowest level in the body and the stimulating hormone, ???, is at its highest causing wakefulness.
Cortisol
It is a sort of 24-hour internal biological clock. The term circadian is from the Latin “circa dies”, meaning “about a day.”
Circadian Rhythms
??? patterns, eye movements and muscle activity are used to identify stages of sleep.
Electroencephalogram (EEG)
The stages of sleep are classified into two stages:
Non Rapid Eye Movement (NREM) Sleep
Rapid Eye Movement Stage(rem) Sleep
First stage of sleep is known as
NREM sleep
About [percentage range] of sleep during a night is NREM sleep
75% to 80%
NREM stages
4
Stage lasts a few minutes.
It includes lightest level of sleep.
Gradual fall in vital signs and metabolism.
General slowing of EEG frequency
Eyes tend to roll slowly from side to side
Sensory stimuli such as noise easily arouses person.
Sleeper may deny he is sleeping.
stage 1: NREM
Stage lasts 10 to 20 minutes.
It is a period of sound sleep.
Relaxation progresses.
Further slowing of EEG
Absent eye ball movements
Body functions continue to slow.
Arousal remains relatively easy
stage 2: NREM
Stage lasts 15 to 30 minutes.
It involves initial stages of deep sleep.
Muscles are completely relaxed.
Large slow waves in EEG
Vital signs decline but remain regular.
Sleeper is difficult to arouse and rarely moves
stage 3: NREM
Stage lasts approximately 15 to 30 minutes.
It is the deepest stage of sleep.
If sleep loss has occurred, sleeper spends considerable portion of night in this stage.
Vital signs are significantly lower than during waking hours.
Further slowing of EEG
Sleepwalking and enuresis (bed-wetting) sometimes occur.
It is very difficult to arouse sleeper
Stage 4: NREM
Stage usually begins about 90 minutes after sleep has begun.
REM sleep
Dreaming occurs in this stage
REM stage
Stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates, increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions.
EEG pattern resembles that of awake state.
It is very difficult to arouse sleeper.
REM sleep
after REM sleep it goes back to?
stage 2 NREM
Normal Sleep Requirements:
Newborn:
Infants:
Toddlers:
Preschool:
School-Age:
Adolescents:
Adult:
Elders:
Newborn: 16-18 hours /day
Infants: 12-14 hours
Toddlers: 10-12 hours
Preschool: 11-12 hours
School-Age: 8- 12 hours
Adolescents: 8-10 hours
Adult: 6-8 hours
Elders: 6 hours
FACTORS AFFECTING SLEEP (10)
age
illness
environment
lifestyle
emotional stress
stimulants and alcohol
diet
smoking
motivation
medications
- ??? have been known to cause insomnia.
- ???, such as morphine, are known to suppress REM sleep and to cause frequent awakenings and drowsiness.
- Most ??? suppresses REM sleep
Beta-blockers ;
Narcotics;
Hypnotics
Sleep disorders are mainly classified into 3 categories
DYSOMNIAS
PARASOMNIAS
DISORDERS DUE TO OTHER MEDICAL CONDITIONS
The sleep itself is pretty normal.
But the client sleeps too little, too much, or at the wrong time.
So, the problem is with the amount (quantity), or with its timing, and sometimes with the quality of sleep
dysomnias
Insomnia
Hypersomnia
Narcolepsy
Sleep Apnea
Insufficient Sleep/ Sleep Deprivation
dysomnias
is described as the inability to fall asleep or remain asleep.
Persons with this awaken not feeling rested.
is the most common sleep complaint.
Insomnia
lasts one to several nights and is often caused by personal stressors or worry.
Acute insomnia
If the insomnia persists for longer than a month, it is considered ???insomnia
Chronic
insomnia Treatment is (3)
development of new behavioral patterns that induces sleep
Create a sleeping environment that induces sleep
Create positive sleep thoughts
refers to conditions where the affected individual obtains sufficient sleep at night but still cannot stay awake during the day.
Hypersomnia
is a disorder of excessive daytime sleepiness caused by the lack of the chemical hypocretin in the area of the CNS that regulates sleep.
Narcolepsy
is characterized by frequent short breathing pauses during sleep.
Sleep Apnea
[sleep disorder] is most frequently diagnosed in men and postmenopausal women, it may occur during childhood.
Sleep Apnea
apnea that occurs when the structures of the pharynx or oral cavity block the flow of air.
Obstructive apnea
APNEA Due to defect in the respiratory centre of the brain.
CENTRAL APNEA
apnea is combination of obstructive and central apnea
Mixed
A prolonged disturbance in quality and quantity of sleep can lead to a syndrome called as ???
sleep deprivation
Something abnormal occurs during sleep itself, or during the times when the client is falling asleep or waking up
The quality, quantity, and timing of the sleep are essentially normal.
parasomnia
Usually occurring during stage II NREM sleep, characterized by clenching and grinding of the teeth. This clenching and grinding of the teeth can eventually erode dental crowns, cause teeth to come loose, and lead to deterioration of the temporomandibular (TMJ) joint, called TMJ syndrome
bruxism
Bed-wetting during sleep occurring in children over 3 years old. More males than females are affected. It often occurs 1 to 2 hours after falling asleep.
Enuresis
In this condition, the legs jerk twice or three times per minute during sleep. It is most common among older adults. Respond well to medications such as levodopa, pramipexole , ropinirole, and gabapentin
Periodic limb movement disorder (PLMD).
Talking during sleep occurs during NREM sleep before REM sleep. It rarely presents a problem to the person unless it becomes troublesome to others
Sleeptalking
occurs during stages III and IV of NREM sleep. It is episodic and usually occurs 1 to 2 hours after falling asleep. People with this tend not to notice dangers (e.g., stairs) and often need to be protected from injury
Sleepwalking (somnambulism)
avoid excessive physical exertion at least ?? hours before bedtime.
3
Nursing Interventions To Promote Sleep (4)
sleep-wake pattern
environment
diet
medications
Decrease fluids ??? hours before sleep
2 to 4
Avoid ??? and ??? foods. These foods can cause gastrointestinal upsets that disturb sleep
heavy and spicy
Use sleeping medications only as a ???
last resort
Minimize the usage of medicines as much as possible because many contain ??? that cause daytime drowsiness
antihistamines
Take analgesics ??? before bedtime to relieve aches and pains.
30 mins
Consult the health care provider about adjusting other medications that may cause ???
insomnia
