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nursing 20030 > rest and sleep > Flashcards

rest and sleep Flashcards

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1
Q

describe rest

A

a state of mental, physical, and spiritual activity that leaves a person feeling refreshed

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2
Q

describe sleep

A

-rest that is accompanied by altered consciousness and relative inactivity
-emotionally and physically restorative
-impaired sleep = impaired well being

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3
Q

describe reticular activating system (RAS) and the bulbar synchronizing region

A

-in the brain stem
-responsible for alertness
-receive stimuli from environment
-helps wake up

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4
Q

describe hypothalamus

A

-sensitive to chanes in environment
-circadian rhythm (internal 24hr biological clock - more than sleep wake cycle, includes VS, hormones and cognitive function)

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5
Q

do neurotransmitters and hormones fluctuate

A

yep

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6
Q

what are neurotransmitters used for

A

excitation or inhibition of CNS

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7
Q

describe melatonin

A

released when eyes sense change in light -> begins generally at 9pm

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8
Q

describe the function of sleep

A

-poorly understood
-thought to be important for physiologic, emotional, and cognitive functioning (body tissue restoration, sorting and sicarding of neurophysiologic data, character reinforcement and adaptation)

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9
Q

describe non rapid eye movement sleep

A

-~75% of sleep time
-PNS is in control
-divided into four stages (I and II are light sleep, stage III and IV are deep sleep/delta sleep/slow wave sleep)

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10
Q

describe raoid eye movement sleep

A

-remaining 25% of sleep
-fluctuation or increase in vital signs
-increase in cerebral blood flood and oxygen consumption
-relaxation of of skeltal muscles
-REM rebound (REM tried to catch up with lost REM sleep)
-most difficult to wake somebody up
-stage increase in length of time closer to the morning

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11
Q

stages if sleeo are understood and evaluated through…

A

polysomnogram
-EEG, EOG, EMG
-challenging for pt

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12
Q

describe stage I of sleep

A

-transitional state between wakefulness and sleep
-hypnic jerk
-lasts only minutes
-muscle relaxation starts
-HR and RR slow a little

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13
Q

describe hypnic jerk

A

-involuntary contractions of muscle
-increased liklihood if a person has increased excercise, stress, or caffeine

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14
Q

describe stage II sleep

A

-asleep, but a light stage, easily awakened
-make up about half of sleep time
-more frequently in early night

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15
Q

describe stage III (slow wave/delta) sleep

A

-seeper sleep, more difficult to waken
-increased relaxation -> snoring, sleep walking, bed wetting

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16
Q

describe stage IV (slow wave/delta) sleep

A

-deepest stage, brain activity slows
-realistic dreams

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17
Q

how long is the average sleep cycle

A

90 mins, go through about 4-5 a night

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18
Q

sleep thorughout the lifespan

infancy

A

-newborns sleep approximately 16hrs per 24hr period
-sleeps through the night between 2-4 months of age
-REM constitutes much of sleep cycle
-ABCs of safe sleep (alone, back, crib)

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19
Q

sleep thorughout the lifespan

toddlers and preschoolers

A

-11-14 hrs in 24hr period
-transition from crib to bed
-establish bedtime routine
-probs still taking a nap

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20
Q

sleep thorughout the lifespan

school aged children

A

-9-12hrs in 24hr period
-increased need for sleep r/t growth spurts

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21
Q

sleep thorughout the lifespan

adolescents

A

8-10hrs/24hr recommended but rarely achieved

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22
Q

sleep thorughout the lifespan

adults

A

7-9hrs/24hrs
-decrease in nonREM stage IV sleep starts in middle age and is absent by older adulthood
-increased time to fall asleep and stay asleep as we age

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23
Q

name some impacts of insufficient sleep

A

-obesity
-anxiety
-depression
-GI compaints
-type 2 diabetes
-HTN
-stroke
-substance abuse
-MVA
-impaired decision making
-impaired task performance

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24
Q

name some factors that affect sleep

A

-motivation
-culture
-lifestyle/habits
-environment
-stress/anxiety
-illness
-medications

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25
Q

factors that affect sleep

motivation

A

desire to be awake may override physiological need

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26
Q

factors that affect sleep

culture

A

relationships, routines, security

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27
Q

factors that affect sleep

lifestyle/habits

A

-exercise, substance intake
-diet (complex carbs and protein help sleep)
-shift work (decreased clinical judgement and decision making

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28
Q

factors that affect sleep

environment

A

-distractions
-away from home environment
-temp and light (60 to 67 degrees is ideal for adults)

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29
Q

factors that affect sleep

stress/anxiety

A

everything gets worse at night

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30
Q

factors that affect sleep

illness

A

tons of shit
-pain, discomfort, fear, nausea
-GERD
-epilepsy
-enchephalitis and dementia

31
Q

factors that affect sleep

meds

A

a lot can affect sleep including
-antidepressants
-diuretics
-asthma steroids

32
Q

namr some different sleep disorders

A

-insomnia
-sleep related breathing disorders
-central disorders of hyper somnolence
-circadian rhythm sleep-wake disorders
-parasomnias
-sleep related movement disorders

33
Q

describe insomnia

A

-most common sleep disorder (most common in ppl over 60 and women > men)
-can be acute or chronic
-poor sleep qyuality, quanitity, or initiation
-have the time to sleep, but cant
-often have daytime sleepiness

34
Q

describe treatment of insomnia

A

-nonpharmacologic first: cognitive behavioral therapy (CBT)
-pharmacologic

35
Q

describe nonpharmacologic therapy for insomnia (CBT)

A

-helps with maladaptive sleep techniques
-relaxation techniques
-sleep resitrictions (no naps) and strict morning wake up (same time everyday)
-sleep hygiene measures (habits)

36
Q

describe pharmacologic therapies for insomnia

A

-should be used short term
-caution needs to be taken
-taken a little bit before bed

37
Q

name a sleep related breathing disorder

A

obstructive sleep apnea

38
Q

what is obstructive sleep apnea and what are the symptoms

A

-frequent (100s) mini arousals during sleep, decreased SWS and REM 10 sec-2min apneic episodes
-this causes HR and BP to increase -> sympathetic nervous system take over and awakens the pt

-Sx: excessive sleepiness, fatigue, depressed mood, difficulty concentrating, poor memory

39
Q

what is the tx of OSA

A

-CPAP
-surgery
-weight loss
-position changes

40
Q

why do 46-83% of ppl with OSA not use CPAP?

A

clautrophobic and uncomfy

41
Q

what risks are associated with OSA

A

strongly linked to CV disease (HTN, ischemic heart disease, CVA) and to cognitive impairments (attention deficit, impaired concentration, memory problems)

judicious use of sedatives (hypnotics, ETOH)

42
Q

describe hypersomnia

A

-excessive (daytime) sleep
-naps do not relieve symptoms
-awaken disoriented, irritated, slowed thoughts and speech

43
Q

describe narcolepsy

A

-excessive daytime sleepiness and frequent overwhelming urges to sleep
-most also experience cataplexy (involuntary loss of skeletal muscle tone)

44
Q

name some circadian rhythm sleep-wake disorders

A

-shift work disorder
-jet lag

45
Q

describe shift work disorder

A

25-33% of shift workers experience problems with sleep

46
Q

what are some treatments used for circadian rhythm sleep wake disorders

A

-CBT (avoiding naps, maintaining regular sleep-wake times, avoiding stimulants within several hours of bedtime)
-shifting the sleep-wake cycle by an hour or 2 several weeks is ideal

47
Q

what are parasomnias

A

-wakeful behavior while asleep
-priority: safety and injury prevention

48
Q

name some parasomnias

A

-somnambulism
-REM behavior disorder (RBD)
-sleep terrors
-nightmares
-bruxism
-enuresis
-sleep related eating disorder

49
Q

parasomnias

somnambulism

A

sleep walking

50
Q

parasomnias

RBD

A

acting out dreams

51
Q

parasomnias

sleep terrors

A

-occur in deepest sleep stage
-children, sit up screaming but not able to reason

52
Q

parasomnias

nightmares

A

vivid and disturbing dreams

53
Q

parasomnias

bruxism

A

teeth grinding

54
Q

parasomnias

enuresis

A

bed wetting

55
Q

parasomnias

sleep related eating disorder

A

consumes food but has no recollection

56
Q

name a sleep related movement disorder

A

restless leg syndrome

aka willis-ekbom disease (WED)

57
Q

describe restless leg syndrome

A

-15% of the population (mostly middle aged and older adults)
-cannot lie still
-unpleasant, creeping, crawling, or tingling sensation
-no known cure
-massage, walking, stretching seems to help
-leads to chronic sleep loss

58
Q

describe subjective assessment of sleep and rest

A

-batin history
-may also collect info from a sleep diary

59
Q

name some shit that might be included in a sleep diary

A

-time patient retires
-time patient tried to fall asleep
-approximate time patient falls asleeo
-time of any awakenings during the night and resumption of sleep
-tiem of awakening in the morning
-presence of any stressors affecting sleep

60
Q

describe objective assessment of sleep and rest

A

-signs of fatigue/sleepiness
-indicators of possibly problems

61
Q

name some different assessment/screening tools for sleep and rest

A

-STOP- bang questionaire (to further assess risk for OSA)
-the pittsburgh sleep quality index
-the epworth sleepiness scale

62
Q

describe some nursing diagnoses r/t rest and sleep

A

-insomia
-distrubed sleep pattern (difficulty falling, remaining asleep, altered sleep/wake cycles)
-sleep deprivation
-anxiety
-ineffective breathing pattern
-fatigue
-knowledge deficit

63
Q

describe planning r/t rest and sleep

A

patient centered goal that is established by the RN that is realistic and attainable
-stating rationales
-verbalizing new behaviors to try (or to avoid)
-recognition of resources

64
Q

describe interventions for rest and sleep

A

-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 disturbences
-use meds to produce sleep
-teach about rest and sleep

65
Q

describe preparing a restful environment

A

-60-67 degrees
-dark or night light
-clean linen/blankets
-privacy
-sleep masks and ear plugs

66
Q

describe promoting bedtime rituals

A

-HS care/warm bath/shower/face cloth
-bedtime stories
-prayer
-blankie/bear

67
Q

what are some appropriate bedtime snacks and beverages

A

-trptophan and complec carbs
-milk and cookies, peanut butter crackers

68
Q

describe promoting relaxation and comfort

A

-manage anxiety/stress
-manage pain, uncomfortable symptoms

69
Q

describe scheduling nursing care to avoid disturbances

A

-cluster care
-provide care when patient is already awake
-manage alarms

70
Q

describe using meds to produce sleep

A

-use nonpharmacologic first
-usually PRN
-be knowledgable about onset and duration when considering administration time

71
Q

describe evaluation of sleep and rest

A

-improvement in sleep?
-resolution of problem?
-interventions effective?

72
Q

a nurse caring for pts in a busy hospital environment should implement which recommendation to promote sleep?

A) keep the room light dim during the day
B) keep room cool
C) keep door to the room open
D) offer a sleep aid med to pts on a regular basis

A

B

73
Q

a nurse caring for patients in a logn term care facility is implementing interventions to help promote sleep in older adults. which action is recommended?

A) increase physical acitivities during the day
B) encourage short periods of napping
C) increase fluids during the evening
D) dispense diuretics during afternoon hours

A

A

nursing 20030 (31 decks)

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