rest and sleep Flashcards
describe rest
a state of mental, physical, and spiritual activity that leaves a person feeling refreshed
describe sleep
-rest that is accompanied by altered consciousness and relative inactivity
-emotionally and physically restorative
-impaired sleep = impaired well being
describe reticular activating system (RAS) and the bulbar synchronizing region
-in the brain stem
-responsible for alertness
-receive stimuli from environment
-helps wake up
describe hypothalamus
-sensitive to chanes in environment
-circadian rhythm (internal 24hr biological clock - more than sleep wake cycle, includes VS, hormones and cognitive function)
do neurotransmitters and hormones fluctuate
yep
what are neurotransmitters used for
excitation or inhibition of CNS
describe melatonin
released when eyes sense change in light -> begins generally at 9pm
describe the function of sleep
-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)
describe non rapid eye movement sleep
-~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)
describe raoid eye movement sleep
-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
stages if sleeo are understood and evaluated through…
polysomnogram
-EEG, EOG, EMG
-challenging for pt
describe stage I of sleep
-transitional state between wakefulness and sleep
-hypnic jerk
-lasts only minutes
-muscle relaxation starts
-HR and RR slow a little
describe hypnic jerk
-involuntary contractions of muscle
-increased liklihood if a person has increased excercise, stress, or caffeine
describe stage II sleep
-asleep, but a light stage, easily awakened
-make up about half of sleep time
-more frequently in early night
describe stage III (slow wave/delta) sleep
-seeper sleep, more difficult to waken
-increased relaxation -> snoring, sleep walking, bed wetting
describe stage IV (slow wave/delta) sleep
-deepest stage, brain activity slows
-realistic dreams
how long is the average sleep cycle
90 mins, go through about 4-5 a night
sleep thorughout the lifespan
infancy
-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)
sleep thorughout the lifespan
toddlers and preschoolers
-11-14 hrs in 24hr period
-transition from crib to bed
-establish bedtime routine
-probs still taking a nap
sleep thorughout the lifespan
school aged children
-9-12hrs in 24hr period
-increased need for sleep r/t growth spurts
sleep thorughout the lifespan
adolescents
8-10hrs/24hr recommended but rarely achieved
sleep thorughout the lifespan
adults
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
name some impacts of insufficient sleep
-obesity
-anxiety
-depression
-GI compaints
-type 2 diabetes
-HTN
-stroke
-substance abuse
-MVA
-impaired decision making
-impaired task performance
name some factors that affect sleep
-motivation
-culture
-lifestyle/habits
-environment
-stress/anxiety
-illness
-medications
factors that affect sleep
motivation
desire to be awake may override physiological need
factors that affect sleep
culture
relationships, routines, security
factors that affect sleep
lifestyle/habits
-exercise, substance intake
-diet (complex carbs and protein help sleep)
-shift work (decreased clinical judgement and decision making
factors that affect sleep
environment
-distractions
-away from home environment
-temp and light (60 to 67 degrees is ideal for adults)
factors that affect sleep
stress/anxiety
everything gets worse at night
factors that affect sleep
illness
tons of shit
-pain, discomfort, fear, nausea
-GERD
-epilepsy
-enchephalitis and dementia
factors that affect sleep
meds
a lot can affect sleep including
-antidepressants
-diuretics
-asthma steroids
namr some different sleep disorders
-insomnia
-sleep related breathing disorders
-central disorders of hyper somnolence
-circadian rhythm sleep-wake disorders
-parasomnias
-sleep related movement disorders
describe insomnia
-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
describe treatment of insomnia
-nonpharmacologic first: cognitive behavioral therapy (CBT)
-pharmacologic
describe nonpharmacologic therapy for insomnia (CBT)
-helps with maladaptive sleep techniques
-relaxation techniques
-sleep resitrictions (no naps) and strict morning wake up (same time everyday)
-sleep hygiene measures (habits)
describe pharmacologic therapies for insomnia
-should be used short term
-caution needs to be taken
-taken a little bit before bed
name a sleep related breathing disorder
obstructive sleep apnea
what is obstructive sleep apnea and what are the symptoms
-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
what is the tx of OSA
-CPAP
-surgery
-weight loss
-position changes
why do 46-83% of ppl with OSA not use CPAP?
clautrophobic and uncomfy
what risks are associated with OSA
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)
describe hypersomnia
-excessive (daytime) sleep
-naps do not relieve symptoms
-awaken disoriented, irritated, slowed thoughts and speech
describe narcolepsy
-excessive daytime sleepiness and frequent overwhelming urges to sleep
-most also experience cataplexy (involuntary loss of skeletal muscle tone)
name some circadian rhythm sleep-wake disorders
-shift work disorder
-jet lag
describe shift work disorder
25-33% of shift workers experience problems with sleep
what are some treatments used for circadian rhythm sleep wake disorders
-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
what are parasomnias
-wakeful behavior while asleep
-priority: safety and injury prevention
name some parasomnias
-somnambulism
-REM behavior disorder (RBD)
-sleep terrors
-nightmares
-bruxism
-enuresis
-sleep related eating disorder
parasomnias
somnambulism
sleep walking
parasomnias
RBD
acting out dreams
parasomnias
sleep terrors
-occur in deepest sleep stage
-children, sit up screaming but not able to reason
parasomnias
nightmares
vivid and disturbing dreams
parasomnias
bruxism
teeth grinding
parasomnias
enuresis
bed wetting
parasomnias
sleep related eating disorder
consumes food but has no recollection
name a sleep related movement disorder
restless leg syndrome
aka willis-ekbom disease (WED)
describe restless leg syndrome
-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
describe subjective assessment of sleep and rest
-batin history
-may also collect info from a sleep diary
name some shit that might be included in a sleep diary
-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
describe objective assessment of sleep and rest
-signs of fatigue/sleepiness
-indicators of possibly problems
name some different assessment/screening tools for sleep and rest
-STOP- bang questionaire (to further assess risk for OSA)
-the pittsburgh sleep quality index
-the epworth sleepiness scale
describe some nursing diagnoses r/t rest and sleep
-insomia
-distrubed sleep pattern (difficulty falling, remaining asleep, altered sleep/wake cycles)
-sleep deprivation
-anxiety
-ineffective breathing pattern
-fatigue
-knowledge deficit
describe planning r/t rest and sleep
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
describe interventions for rest and sleep
-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
describe preparing a restful environment
-60-67 degrees
-dark or night light
-clean linen/blankets
-privacy
-sleep masks and ear plugs
describe promoting bedtime rituals
-HS care/warm bath/shower/face cloth
-bedtime stories
-prayer
-blankie/bear
what are some appropriate bedtime snacks and beverages
-trptophan and complec carbs
-milk and cookies, peanut butter crackers
describe promoting relaxation and comfort
-manage anxiety/stress
-manage pain, uncomfortable symptoms
describe scheduling nursing care to avoid disturbances
-cluster care
-provide care when patient is already awake
-manage alarms
describe using meds to produce sleep
-use nonpharmacologic first
-usually PRN
-be knowledgable about onset and duration when considering administration time
describe evaluation of sleep and rest
-improvement in sleep?
-resolution of problem?
-interventions effective?
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
B
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
