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Sleep and Comfort > Sleep and Comfort > Flashcards

Sleep and Comfort Flashcards

1
Q

Rest

A

when individuals are at rest, they are in a state of mental, physical, and spiritual activity that leaves them feeling refreshed, rejuvenated, and ready to resume the activities of the day. (i.e. Meditating).

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2
Q

Sleep

A

cyclical, physiological and behavioural process that alternates with longer periods of wakefulness. Up and conscious. (Sleeping unconsciously)

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3
Q

Ultradian process

A

occurs within the sleep state and is characterized by the alteration of two sleep stages:

Nonrapid eye movement (NREM)
Rapid eye movement (REM) sleep

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4
Q

Homeostatic Process

A

dependent on sleep-wake cycle (in the body)

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5
Q

Circadian Process

A

Process C) – functions to maintain a state of wakefulness. Body’s ability to know when it is morning, night, when to wake and sleep, etc.)

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6
Q

Circadian Rhythms

A

biological functions of most living organisms. Rhythm you establish in your body for sleep and wake. (factors that affect circadian rhythms and daily sleep – wake cycles include light, temperature, social activities, travel and work routines.

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6
Q

Sleep Regulation

A

involves a sequence of physiological and behavioural states maintained by highly integrated central nervous system (CNS) activity, which is associated with changes in the autonomic nervous system, endocrine, cardiovascular, respiratory, gastrointestinal, renal and musculoskeletal systems

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7
Q

The body’s major sleep centre is the hypothalamus. – it secretes hypocretins (orexins) that promote wakefulness. The anterior pituitary gland also secretes hormones (growth hormone and prolactin) that promote sleep.

A
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8
Q

Stage 1 – Rapid Eye Movement (NREM) – easily interrupted

A

Lightest level of sleep

Muscle tone is present

This stage only lasts a few minutes
2-5% total sleep time

When awakened from this stage, a person feels as though they had been day dreaming

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9
Q

Stage 2 – Non-rapid Eye Movement (NREM) – Deeper sleep

A

A period of sound sleep

Relaxation progresses

Body functions continue to slow

Muscle tone remains present

Eye movements are absent

45-55% total sleep time

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10
Q

Stage 3 – Non-rapid Eye Movement (NREM) – Deepest Sleep (Delta Waves)

A

The deepest period of sleep

Muscles become relaxed

Vital signs are lower than during
wake hours

Sleepwalking, bedwetting occurs at this state

10% of total sleep time

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11
Q

Stage 2 – Non-rapid Eye Movement (NREM) – Deeper sleep

A

Adults return to stage 2 before progressing into REM sleep

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12
Q

Stage 4 – Rapid Eye Movement (REM)

A

Rapid eye movements are present

Respirations are irregular and shallow

Variable heart rate and blood pressure occur

Dreaming occurs in this stage (dreams occur before you wake)

Usually begins about 90 minutes after sleep has begun

Difficult to arouse

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13
Q

Dreams

A

Defined as mental activity that occurs while individuals are asleep.

Occur during both NREM and REM sleep

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14
Q

Insomnia

A

report problems falling asleep, staying asleep and nonrestorative sleep with daytime consequences including fatigue and difficulty concentrating.

It is more common in women

Often associated with poor sleep hygiene and behviours, including anxiety and depression.

Treatment may include nonpharmacological therapies (relaxation therapy, cognitive-behavioural therapy, etc.

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15
Q

Sleep Apnea

A

Sleep Apnea – disorder in which people stop breathing for a period of at least 10 seconds while asleep.

Two types of sleep apnea:

Obstructive Sleep Apnea – relaxation of the soft tissues in the back of the throat. Upper airways become partially or completely blocked, so diminishing nasal airflow and stopping it. Episodes are terminated by gasps, snorting or brief periods of awakening. Symptoms is that they snore.

Excessive daytime sleepiness (EDS) – often report taking daytime naps and experience a disruption in their daily activities because of sleepiness.

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16
Q

Sleep Deprivation

A

Insufficeint sleep during a specific time period. Common is lifestyle factors or work related factors.

Sleep deprivation may be observed as a reduction in sleep time so that sleep time does not meet the needs of the individual, prolonged wakefulness and sleep disruption related to pathophysiological process.

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17
Q

Parasomnia

A

undesirable sleep problems that occur while falling asleep; between sleep phases or during transitions from sleep to wakefulness. Include those associated with NREM and REM and those of other causes or unspecified causes. Fancy sleep disorders

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18
Q

Narcolepsy (Type 1 and 2)

A

is a rare, complex neurological sleep disorder for which there is no known cure.

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19
Q

Hypersomnia

A

Hypersomnia’s include Idiopathic hypersomnia,Hypersomnia due to a medical disorder, Hypersomnia due to a medication or substance,Hypersomnia associated with a psychiatric disorder.

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20
Q

Sleepwalking

A

hard to diagnose. Observed by someone else.

Don’t shake someone awake when they are sleepwalking.

Guide them back to bed.

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21
Q

Newborns

A

during the first few weeks of life, newborns sleeps about 16 hours a day. Sleeping almost constantly during the first week.

Sleep cycle is generally 40-50 minutes , with waking occurring after one to two sleep cycles.

Active sleep (REM sleep) or quiet sleep (NREM sleep equivalent)

22
Q

Infants

A

amount of time the newborn spends in active sleep (REM sleep equivalent) diminished. Sleep-wake periods begin to develop into a day/night cycle.

Infants sleeping pattern is characterized by nocturnal sleep period of 10-12 hours’ duration.

23
Q

Toddlers

A

Toddlers (sleep most at night) – most children usually require 12-14 hours of sleep each day, which generally includes a nap in the afternoon.

24
Q

Preschoolers

A

sleeps about 13 hours a night (20 of which is REM sleep)

25
Q

School aged children

A

most need 9-10 hours each night. Early waking.

26
Q

Adolescents

A

Need a lot of sleep) - insufficient sleep is common among adolescents. Physiological processes that regulate sleep and wakefulness are also thought to influence the sleep habits of adolescents. Excessive daytime sleepiness is common in adolescence.

27
Q

Young Adults

A

Young Adults – average 6-8.5 hours of sleep per night.

28
Q

Middle Age

A

(less deep sleep) – total time spent sleeping at night begins to decline. The amount of time inNREM Stage 3 begins tofall.

29
Q

Older people

A

approximately 50% of older persons report difficulty sleeping. Aging is associated with changes in sleep architecture. Aging is associated withchanges to sleeppatterns and increaseddifficulty sleeping.

30
Q

Things that affect sleep

A

Medications - Many medications and other substances disrupt sleep, or cause sleepiness

Lifestyle - Daily routines influence sleep patterns

Usual Sleep Patterns - Not following regular sleep patterns will affect sleepiness

Emotional Stress - Stress causes difficulty falling asleep, frequent waking, or even oversleeping

Environment - Ventilation, properties and position of bed, lighting, noise, etc. all affect sleep.

Exercise and Fatigue - Moderate fatigue promotes the highest sleep quality.

Food and Caloric Intake - Good eating habits are important for restful sleep.

31
Q

Acute Care - sleep goals

A

Nurses in acute care settings should minimize disruptions to sleep, as normal routines are often affected by admission. –

Goal: get them as comfortable as possible.

Medicate pain before bed and medication for sleep.

Look at positioning and bath before bed.

32
Q

Continuing Care

A

Nurses in residential settings also need to reduce barriers to sleep, but also, focus more to promote comfort.

Goal: setting routine. Focus more on routine and getting things are predicable, regular and stable as possible. Consistency is key. Less use as “as needed” pain medication.

Long-term care: get them what they need to make the comfortable. If they want feather pillows, give them feather pillows.

33
Q

Actions to promote sleep

A

Environmental Controls: room temperature, lighting, noise, comfortable bed help, ventilation

Promote Bedtime Routines: establishing bedtime routines help patients relax and prepare to sleep.

Promote Safety: removal of fall hazards, as well as use of dim lighting at night can be helpful.

Promote Comfort: Encourage appropriate nightwear and bedding, as well as using the bathroom before bed.

Rest and Sleep Periods- in care settingsassessments, treatments, procedures, and routines should be scheduled for times when patients are awake. In high needs areas, try to complete as many tasks in one visit as possible.

Stress Reduction-encourage patients to get up anddo some calming activities for a little while and then try tosleep again after calming down.You may offer a back rub to help as well as ordered medications.

Bedtime Snacks- some people enjoy bedtime snacks where in others it may causegastrointestinal upset and may make it more difficult to fall asleep.Instruct patients to avoid caffeine before bed.

Pharmacological Approaches-Melatonin is ahormone thatplays a role inthe circadian system and promotes sleep. Use of herbal remedies can interact with other medications and non-prescription sleep aids cancause dependence.

34
Q

Positions

A

Clotting can be an issue, swelling, redness and pain.

Repositioning patients, putting them in a position that increases there risk

Alignment during lifting, bending, etc.

35
Q

Supported Fowler’s Position

A

Head of the bed is elevated 45-60 degrees

Patient knees are slightly elevated without pressure to restrict circulation in lower legs

semi sitting to improve breathing and circulation

36
Q

Supine Position

A

The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.

supported by pillows

37
Q

Prone Position

A

Lying chest down

38
Q

Side-Lying Position

A

Resting on the side with the major portion of boy weight on the dependent hip and shoulder

reduces pressure on lungs and joints

39
Q

Providing Comfort / Pain Management

A

Relaxation and Guided Imagery

Massage

Hot and Cold Therapies

Distraction

40
Q

Pain Management

A

Pain management should be person centred.

Teaching the patient about pain treatment and having an attitude of dignity and caring

In some cultures, there may not be a specific work for pain…just descriptors. Pain scale may not work in all cultures.

Monitor patients who receive opioids for depression. Monitor standing, ambulation, and transfer to chair if the patient has received an opioid

Eliminate environment conditions that worsen pain (noisy room, warm room, etc.)

Provide maximum rest periods for patient. Written schedule for caregivers to follow is ideal.

Turn patient over every two hours or remind patients to turn themselves.

Screen for pain during patient transfer or other activity that might provoke pain.

41
Q

When assessing a patient

A

Identify patient using two-person specific identifiers: Name and date of birth

Use hand-hygiene

Assess patient’s risk for pain

Ask patient if they are in pain (when did pain start, what pain feels like, etc.)

Examine site of patient’s pain or discomfort when possible. Inspect discoloration, swelling, drainage, etc.)

Assess behaviour (moaning, facial expressions, etc.)

After applying pain medication, within an hour of intervention, ask patient to describe level of relief

.

42
Q

Effleurage

A

massaging upward and outward from vertebral column and back again.

43
Q

Petrissage

A

muscles are kneaded, lifted, grasped, squeezed, rolled and released. Not over bony areas.

44
Q

Vibration

A
45
Q

Tapotement Massage

A
46
Q

Friction

A

ball of thumb - not over kidney or back of the knee.

47
Q

3-6 minutes for a back massage

Encourage patient to breath deeply and relax during massage.

Stimulate scalp and temples

Sacral area massage in circular motion

Support base of finger and work each finger in corkscrew-like motion.

Complete using effleurage strokes from fingertips to wrist.

Use effleurage along muscles of spine and upward and outward motion

Use petrissage on muscles of each shoulder toward font of patient.

A
48
Q

Andree returns to the health care clinic with her husband, David, for a follow-up visit. She tells you that since she started her sleep hygiene plan she feels more rested but is still having some problems sleeping because of her husband’s loud snoring. In addition to Andree’s report of David’s snoring, you note that he is overweight. On the basis of Andree’s report of David’s snoring, what additional assessment data should you gather from David?

A

a. Sleep History: Duration and quality of sleep, frequency of snoring, and any observed apnea episodes.
b. Daytime Symptoms: Reports of excessive daytime sleepiness, fatigue, or irritability.
c. Sleep Position: How he sleeps (e.g., back, side) and if it affects the snoring.
d. Medical History: Any history of sleep disorders, cardiovascular issues, or respiratory problems.
e. Lifestyle Factors: Alcohol consumption, smoking, and any medications that might affect sleep or respiratory function

49
Q

You enter the room of a patient recovering from abdominal surgery.

The physician has
ordered that the patient be positioned on their left side to promote drainage.

The patient is
currently lying supine. Explain how you will safely position the patient on their left side
using pillows for comfort and support

A

Left Lateral Position: The patient lies on their left side. Place pillows between the
patient’s knees to provide support and prevent pressure on the lower leg. Adjust the
patient’s arm in front of their body for comfort

50
Q

You are preparing to assess a patient who is experiencing back pain. The physician has
instructed you to place the patient in a supine position with a pillow under their knees to
relieve pressure on their lumbar spine. The patient is currently sitting in a chair. Describe
the steps you will take to position the patient correctly.

A

Supine Position: The patient lies flat on their back. Place a pillow under the
patient’s knees to reduce strain on the lower back. Ensure the patient’s arms are at
their sides or across their chest for comfort

51
Q

A patient with a respiratory condition needs to be positioned prone to help improve
oxygenation. They are currently in a supine position. Explain how you will safely turn the
patient to a prone position and ensure their comfort and safety.

A

Prone Position: The patient lies face down on their stomach. Carefully turn the
patient while ensuring their face is turned to one side to keep the airway open. Place
pillows under the chest and hips for support and comfort.

52
Q

You are caring for a patient with heart failure who requires a high semi-Fowler’s position to
aid in their breathing. The patient is currently lying supine. Describe how you will elevate
the head of the bed and position the patient appropriately.

A

High Semi-Fowler’s Position: The patient is positioned with the head of the bed
elevated to about 60-90 degrees. Ensure the patient’s feet are flat on the bed or
supported with a pillow to prevent sliding. The arms should be relaxed at their sides
or supported on armrests

Sleep and Comfort (1 decks)

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