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63 Cards in this Set

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K.T.

Biorhythm (p. 1114)
Rhythmic biological clock. In humans, biorhythms are controlled within the body and synchronized with environmental factors such as light and darkness, gravity and electromagnetic stimuli.
K.T.

Central apnea (p. 1119)
is thought to involve a defect in the respiratory center of the brain. All actions involved in breathing, such as chest movement and airflow, cease. Clients who have brain stem injuries and muscular dystrophy, for instance, often have central sleep apnea.
K.T.

Circadian synchronization (p. 1114)
when a person’s biological clock coincides with sleepwake patterns. The person is awake when the physiologic and psychological patterns are most active and is asleep when these patterns are most inactive.
K.T.

Insomnia (p. 1119)
the inability to obtain an adequate amount or quality of sleep.
K.T.

Insomnia: 3 Types
1) Initial insomnia – difficulty falling asleep
2) Intermittent/maintenance insomnia – difficulty staying asleep
3) Terminal insomnia – early morning or premature waking
K.T.

Mixed apnea (p.1119)
a combination of central apnea, described above, and obstructive apnea, which occurs when the structures of the pharynx and oral cavity block the flow of air.
K.T.

Polysomnography (p. 1121)
– An objective means of measuring sleep through which activity during sleep can be assessed. It is performed in a sleep lab.
K.T.

Basic Tests ued in Polysomnography:
• An EEG (electroencephalogram), in which electrodes are placed on the scalp to record brain waves
• An EMG (electromyogram), in which electrodes are placed on the chin to record muscle activity
• An EOG (electro-occulogram), in which an electrode is placed on the outer canthus of each eye to record eye movement.
K.T.

Other things that may be tested during Polysomnography:
Respiratory efforts and airflow, ECG (electrocardiogram), leg movement, and oxygen saturation may also be monitored. Oxygen saturation and ECG assessment is of particular importance is sleep apnea is suspected.
K.T.

Rest (p. 1114)
implies calmness, relaxation without emotional stress, and freedom from anxiety. It does not always imply inactivity.
K.T.

Sleep (p. 1114)
A basic human need.
Historically considered a state of unconsciousness; more recently considered an altered state of consciousness in which perception of and reaction to environment is decreased.
Characterized by minimal physical activity, variable levels of consciousness, changes in body’s physiologic processes, and decreased response to external stimuli.
K.T.

Sleep apnea (p. 1119)
Periodic cessation of breathing during sleep.
Often suspected with loud snoring, frequent nocturnal waking, excessive daytime sleepiness, insomnia, morning headaches, intellectual deterioration, irritability or other personality changes, and physiological changes such as cardiac arrhythmia or hypertension.
K.T.

Sleep apnea (p. 1119): 3 types:
obstructive, central and mixed apnea.
2. Discuss the physiology of sleep (p. 1114/Kozier)
What part of the brain is thought to control the cyclic nature of sleep?
the lower part of the brain
2. How is the physiology of sleep broken down?
into three elements:
1. circadian rhythms,
2. stages of sleep and
3. sleep cycles.
2. Discuss the physiology of sleep relative to Circadian Rhythms:
refer to the body’s ability to synchronize the biologic clock with sleep wake patterns. By doing this, the person is awake when the body’s physiologic and psychological rhythms are mostly active and asleep when these rhythms are most inactive.
2. Discuss the physiology of sleep relative to stages of sleep:
Stages of sleep include NREM (non-REM) sleep and REM (Rapid Eye Movement) sleep.
2. Describe what happens during NREM sleep:
Deep restful sleep, it brings a decrease in some physiologic functions.
Consists of four Stages: I, II, III, and IV. Stages I and II are the early, lighter stages of sleep and III and IV are the deeper stages of sleep.
Physiological changes during NREM:
• Arterial blood pressure falls
• Pulse rate decreases
• Peripheral blood vessels dilate
• Cardiac output decreases
• Skeletal muscles relax
• Basal metabolic rate decreases 10% to 30%
• Growth hormone levels peak
• Intercranial pressure decreases
2. Describe what happens during REM sleep:
Not as restful as NREM sleep; most dreams occur during this stage. During this period of sleep the brain is highly active. Other physiologic changes:
• Muscle tone is depressed
• Gastric secretions increase
• Heart and respiratory rates become irregular
2. Discuss the physiology of sleep relative to sleep cycles:
During a sleep cycle, people pass through both NREM and REM sleep. Average person experiences 4 to 6 cycles during a 7 to 8 hour sleep period. Duration of the NREM and REM stages vary throughout the sleep period. In early sleep, when the person is tired, NREM stages, especially Stages III and IV, are longer and REM stages shorter. As the sleep period progresses and the person becomes less tired, NREM Stages III and IV become shorter and REM periods become longer.
3. Identify and discuss Stage 1 of NREM sleep including physiological changes:
The stage of very light sleep.
Person feels drowsy and relaxed, the eyes roll from side to side, and the heart and respiratory rates drop slightly. Sleeper can be easily awakened.
Lasts only a few minutes.
3. Identify and discuss Stage II of NREM sleep including physiological changes:
Stage of light sleep during which body processes continue to slow down. Eyes are generally still, heart and respiratory rates decrease slightly, and body temperature falls.
Lasts only about 10 to 15 minutes, but accounts for 40% to 45% of total sleep.
3. Identify and discuss Stage III of NREM sleep including physiological changes:
Heart and respiratory rates slow further due to domination of parasympathetic nervous system.
Sleeper becomes more difficult to wake and is not disturbed by sensory stimuli. Skeletal muscles are relaxed, reflexes are diminished, and snoring may occur.
3. Identify and discuss Stage IV of NREM sleep including physiological changes:
Stage of deep sleep called delta sleep. Heart and respiration rates drop 20% to 30% below waking hours.
Sleeper is very relaxed, rarely moves and is difficult to rouse.
Thought to restore the body physically. During this stage the eyes roll and some dreaming occurs.
4. Discuss the characteristics and functions of REM sleep. (p. 1115/Kozier)
Usually recurs @ every 90 minutes and lasts about 5 to 30 minutes.
Not as restful as NREM sleep; period when most dreams occur. Dreams are often remembered, and consolidated in the memory.
Brain is highly active and its metabolism may increase by 20%. Sleeper may be difficult to rouse or may wake spontaneously, muscle tone is depressed, gastric secretions increase, and heart and respiratory rates are often increased.
4. When does REM sleep occur relative to a sequence of NREM stages?
REM sleep occurs after the sleeper has passed through the following stages of NREM sleep in the following order:
I – II – III – IV – III – II – REM
In the early cycles of sleep the sleeper spends more time in Stages III and IV of NREM. As the cycles progress and the sleeper is less tired, the length of Stages III and IV decrease and the length of REM increases and dreams lengthen. If the sleeper is very tired, REM cycles are often short during the early portion of sleep. Before sleep ends, periods of near wakefulness occur and Stages I and II of NREM sleep predominate.
5. Compare the loss of REM sleep with that of the loss of NREM sleep stages II and IV. (p. 1115/Kozier)
NREM sleep is restful, rejuvenating sleep. Stage II consists of light sleep, while Stage IV is deep sleep thought to restore the body physically. REM is less restful sleep during which the brain is highly active.
Therefore, the loss of Stage IV sleep would seem to have the greatest impact on the body.
Stage II is the stage of sleep accounting for 40% - 45% of total sleep.
Given that the body spends less time in REM sleep when it is tired, and allows more time for REM when it is less tired, it would seem that the body could better handle loss of REM sleep than loss of Stage II or Iv NREM sleep.
6. Discuss the functions of sleep. (p. 1115/Kozier)
Sleep has a physiologic effect on the nervous system and other body structure. It restores levels of activity and normal balance among parts of the nervous system. It is necessary for protein synthesis, which allows repair processes to occur.
The role of sleep is psychological well-being is best noticed by deterioration in mental function related to sleep loss. People with inadequate sleep tend to be emotionally irritable, have poor concentration and experience difficulty making decisions.
7. Identify normal sleep patterns and requirements in Newborns:
(p. 1116/Kozier)
Newborns sleep 16 – 18 hours a day, usually divided into 7 sleep periods. Most of their sleep time is spent in Stages III and IV or NREM sleep. Nearly 50% of sleep is REM.
7. Identify normal sleep patterns and requirements in INFANTS:
(p. 1116/Kozier)
sleep as much as 22 hours a day or as little as 12 hours. About 10% to 30% of sleep is REM. By 4 months most infants sleep through the night and establish a pattern of daytime naps. About _ of the infant’s sleep time is spent in light sleep.
7. Identify normal sleep patterns and requirements for toddlers:
Sleep requirements decrease to 10 – 12 hours per day. About 20% to 30% is REM. Most still need an afternoon nap.
Normal sleep wake cycle is usually established by age 2 or 3 years old. May begin to exhibit resistance about going to bed. Maintaining a consistent approach with respect to bedtime will promote good sleep habits.
7. Identify normal sleep patterns and requirements Preschoolers:
require 11 – 12 hours of sleep per night. Need fluctuates in relation to activity levels and growth spurts.
4 – 5 year old may become restless and irritable if sleep requirements are not met. Preschoolers wake frequently during the night. REM sleep is still 20% to 30% higher than adults, however, Stage I sleep is lower.
7. Identify normal sleep patterns and requirements School age children:
Between 8 and 12 hours each night without daytime naps. The REM sleep of children this age is reduced to about 20%.
7. Identify normal sleep patterns and requirements Adolescents:
8 to 10 hours of sleep each night to prevent fatigue and susceptibility to infection. A change in sleep patterns is common in adolescence. Children who were once early risers begin to sleep late mornings and occasionally take afternoon naps. The need for the daytime sleep is not fully understood, but is possibly a result of physical maturity and reduced nocturnal sleep. Sleep at this age is about 20% REM.
7. Identify normal sleep patterns and requirements Young adults:
Are thought to require 7 to 8 hours of sleep each night, but may do well on less.
7. Identify normal sleep patterns and requirements Middle age adults
maintain patterns established at a younger age. This age group usually requires about 6 to 8 hours of sleep each night. About 20% of this is REM sleep. The number of arousals begins to increase and the amount of Stage IV sleep begins to decrease at this age.
7. Identify normal sleep patterns and requirements for elders:
6 hours per night. About 20% to 25% of this is REM. Stage IV sleep is markedly decreased and sometimes absent. The 1st REM period is longer. Because of the decrease or complete lack of Stage IV sleep, elders have less restorative sleep.
8. Discuss how age can affect sleep: (p. 1117/Kozier)
The age of a person greatly influences their sleep patterns and needs. Infants and children sleep for longer periods of time, but with more REM cycles. Young adults need less sleep to function well. Middle adults begin to experience a decrease in Stage IV sleep and an increase in arousals. Older adults sleep less, have much decreased Stage IV sleep and awaken more often.
8. Discuss how Illness can affect sleep: (p. 1117/Kozier)
Causes a person to require more sleep than normal. Sleep/ wake patterns are also altered. Respiratory conditions can disturb sleep. Shortness of breath, nasal congestion, and nasal drainage can lead to difficulty sleeping.
People with gastric or duodenal ulcers may have disturbed sleep due to pain, often resulting from increased gastric secretions during REM
Certain endocrine disturbances can affect sleep. Hyperthyroidism lengthens pre-sleep time, making it hard to fall asleep. Hypothyroidism decreases Stage IV sleep. Women with low levels of estrogen often report excessive fatigue. They may have their sleep disturbed by hot flashes or night sweats associated with decreased estrogen levels.
Elevated body temperatures can reduce Stage III and IV NREM and REM sleep.
The need to urinate during the night can disrupt sleep. Once the person is awake, it may be difficult to get back to sleep.
8. Discuss how Environment can affect sleep: (p. 1117/Kozier)
can promote or hinder sleep
8. Discuss how Fatigue can affect sleep: (p. 1117/Kozier)
Can affect a person’s ability to fall asleep. It is believed that a moderately fatigued person usually has a restful sleep. The more tired a person is, the shorter the 1st REM period of sleep will be.
8. Discuss how Lifestyle can affect sleep: (p. 1117/Kozier)
A person who does shift work must arrange activities to be ready to sleep at the appropriate times. Moderate exercise is usually conducive to sleep, but excessive exercise can delay sleep. The person’s ability to relax before retiring to bed greatly influences their ability to fall asleep.
8. Discuss how Emotional stress can affect sleep: (p. 1117/Kozier)
Anxiety and depression frequently disturb sleep. Preoccupation with personal problems may prevent a person from relaxing sufficiently to fall asleep. Anxiety increases norepinepherine blood levels through stimulation of the sympathetic nervous system, which results in less Stage IV NREM and REM sleep and more Stage changes and awakenings.
8. Discuss how Alcohol and stimulants can affect sleep: (p. 1117/Kozier)
Caffeine containing beverages act as stimulants of the CNS, thus interfering with sleep. Alcohol consumption can also disrupt REM sleep. While making up for the loss of REM sleep, after some of the effects of the alcohol have worn off, people often experience nightmares.
8. Discuss how Diet can affect sleep: (p. 1117/Kozier)
Weight loss has been associated with reduced total sleep time as well as broken sleep and early waking. Weight gain seems to be associated with an increase in total sleep time, less broken sleep, and later awakening. Dietary L-Tryptophan, which is found on milk and cheese, may induce sleep.
8. Discuss how Smoking can affect sleep: (p. 1117/Kozier)
Nicotine has a stimulating effect on the body. Smokers often have more difficulty falling asleep than no-smokers. Smokers are easily aroused and often describe themselves as light sleepers.
Many former smokers report improvement in sleep after quitting.
8. Discuss how Motivation can affect sleep: (p. 1117/Kozier)
The desire to stay awake can often overcome a person’s fatigue. A tired person can probably stay alert while doing something that they find interesting, but would fall asleep if bored and unmotivated to stay awake.
8. Discuss how Medications can affect sleep: (p. 1117/Kozier)
• Hypnotics can interfere with Stages III and IV NREM and suppress REM
• Beta Blockers have been known to cause insomnia and nightmares
• Narcotics (Demerol, morphine) are known to suppress REM and cause frequent awakenings and drowsiness
• Tranquilizers interfere with REM sleep
• Amphetamines and antidepressants decrease REM sleep abnormally
A client withdrawing from any of these gets much more REM sleep that usual and, as a result, may experience upsetting nightmares.
8. Drugs that impact sleep:
box on 43-2 on p. 1118
9. Describe the following sleep disorder:
Insomnia
the inability to obtain an adequate amount or quality of sleep. There are three types:
1) Initial – difficulty falling asleep
2) Intermittent/maintenance – difficulty staying asleep because of frequent or prolonged waking
3) Terminal – early morning or premature waking
Insomnia can result from physical discomfort, but is more often a result of mental over stimulation due to anxiety. People habituated to drugs or who drink large quantities of alcohol are likely to have insomnia. Treatment frequently requires the client to develop new behavior patterns that induce sleep. The usefulness of sleep medications is questionable as they don’t deal with the cause of the problem and can lead to dependency.
9. Describe the following sleep disorder: Hypersomnia
Opposite of insomnia, is excessive sleep, particularly during the daytime. It may be caused by a medical condition such as: CNS damage as well as kidney, liver or metabolic disorders such as diabetic acidosis and hypothyroidism. In some instances, it may be used as a coping mechanism to avoid facing responsibilities.
9. Describe the following sleep disorder:
Narcolepsy
Sudden wave of overwhelming sleepiness that occurs during the day. It is referred to as a sleep attack. Its cause is unknown, but is believed to be lack of the chemical hypocretin in the CNS, which regulates sleep. Onset tends to occur between age 15 and 30. Generally it is treated with a drug called modafinil, which improves alertness without stimulating other body systems or interfering with nighttime sleep.
9. Describe the following sleep disorder: Sleep apnea
a periodic cessation of breathing during sleep. There are 3 types: obstructive, central and mixed apnea. In addition to affecting a person’s work or school performance, sleep apnea can cause a sharp rise in blood pressure and lead to cardiac arrest. Over time, apneic episodes can lead to cardiac arrhythmias, pulmonary hypertension, and subsequent left-sided heart failure.
9. Describe the following sleep disorder:
Parasomnia
a behavior that may interfere with sleep or that occurs during sleep.
• Bruxism – clenching and grinding of teeth, usually during Stage II NREM sleep
• Nocturnal enuresis
• Nocturnal erections
• Periodic limb movement disorder
• Sleep talking
• Somnambulism – sleepwalking. Occurs during Stages III and IV of NREM sleep. It is episodic and usually occurs 1 – 2 hours after falling asleep. Sleepwalkers tend not to notice danger and need to be protected.
9. Describe the following sleep disorder: Sleep deprivation
syndrome brought about by a prolonged disturbance in amount, quality, and consistency of sleep. It is not a sleep disorder, but the result of sleep disturbances. Two major types are REM deprivation and NREM deprivation. A combination of the 2 increases the severity of symptoms. (Chart of symptoms is found on p. 1120).
10. Identify the components of a sleep history. (p. 1120/Kozier)
includes:
• Usual sleeping patterns, specific sleeping and waking hours, hours of undisturbed sleep, quality or satisfaction with sleep, time and duration of naps.
• Bedtime rituals performed to help the person fall asleep (hot fluids, reading, positioning aids)
• Use of sleep medications or other drugs
• Sleep environment (level of light, temperature, noise)
• Recent changes in sleep pattern or difficulty in sleeping
11. Discuss the use of a sleep diary. (p. 1121/Kozier)
Maintained for at least one week. May include :
• Total of sleep hours per day
• Activities performed 2- 3 hours before bed (type, duration, and time)
• Bedtime rituals (ingestion of food, drink or medication before going to bed)
• Time of a) going to bed, b) trying to fall asleep, c) falling asleep (approximate), d) any instances of waking up and duration of these periods, and e) waking up in the morning
• Any worries that the client believes may affect sleep
• Factors that the client believes have a positive or negative effect on sleep
Keeping such a diary may become stressful for some clients and further affect their sleep. Partner may help in keeping the diary if possible, or discontinue the diary if it presents a problem. When completed, the nurse and the client can develop flowcharts and graphs to assist in organizing the data and identifying the specific problem.
12. Nursing process....
See addendum
13. Discuss nursing interventions to consider in creating a restful environment for promoting sleep. (p. 1123/Kozier)
• Close window curtains if street light shine in
• Close curtain between clients in a semi-private or larger room
• Reduce of eliminate overhead lighting; provide a night light
• Close door of client’s room
• Adhere to agency policy about times to turn off communal TV or radios
• Lower ring of nearby telephones
• Discontinue use of paging system after a certain hour
• Keep required staff conversation at a low level
• Wear rubber soled shoes
• Ensure all cart wheels are well oiled
• Perform only essential noisy acts during sleeping hours
14. Identify measures to promote comfort and relaxation. (p. 1124/Kozier)
• Provide loose fitting nightwear
• Assist client with hygiene routines
• Ensure bed linen is smooth, clean and dry
• Assist or encourage client to void before bedtime
• Offer to provide a back massage before sleep
• Position dependent clients appropriately to aid muscle relaxation and provide support devices to protect pressure areas
• Schedule medications, especially diuretics, to prevent nocturnal awakenings
• For client with pain, administer analgesics 30 minutes before sleep
• Listen to client’s concerns and address them as they arise
14. Identify measures to promote comfort and relaxation. More: (p. 1124/Kozier)
People, especially the elderly, are unable to sleep if they are cold. The following interventions can be used to keep the elderly warm during sleep:
• Warm bed with prewarmed bath blankets before client retires
• Use 100% cotton flannel sheets or apply thermal blankets between sheet and bedspread
• Encourage client to wear their own clothing such as flannel nightgown or pajamas, socks, long underwear, sleeping caps, and sweater
Encourage relaxation techniques, as emotional stress interferes with the ability to relax, rest and sleep.
15. Identify types of medications that maybe prescribed to promote sleep.
(p. 1126/Kozier)
• Chloral hydrate (Noctec)
• Ethchlorvynol Placidyl)
• Flurazepam (Dalmanc)
• Glutethimide (Doriden)
• Lorazepam (Ativan)
• Melatonin
• Temazepam (Restoril)
• Triazolam (Halcion)
• Zaleplon (Sonata)
• Zolpidem (Ambien)
15. Problems relative to giving sleep meds:
Sedative-hypnotic medications induce sleep by depressing the general central nervous system. This is an unnatural sleep, which alters REM and NREM sleep and may cause the client to suffer from daytime drowsiness and/or a morning hangover.
Abrupt cessations of sedative-hypnotics can lead to withdrawal symptoms such as restlessness, tremors, weakness, insomnia, increased heart rate, seizures, convulsions and even death. Long-term users need to taper withdrawal by about 25% to 30% weekly.
Anti-anxiety medications decrease anxiety and tension by decreasing the levels of arousal by facilitating the actions of the neurons in the central nervous system that suppress responsiveness to stimulations. These medications are contraindicated in pregnant or nursing women because they are associated with risk of congenital abnormalities.