*exam 3 Chapter 42 Potter Perry Fundamentals Of Nursing

Front 1

Circadian rhythm

Back 1

Physical, mental, and behavioral changes that follow a roughly 24-hour cycle. Affects patterns of brain wave activity hormone production, cell regeneration, sensory acuity, mood, and other biological activities.

Front 2

What part of the brain controls the circadian rhythm?

Back 2

The suprachiasmatic nucleus (SCN): a group of cells located in the hypothalamus

Front 3

Biological clock

Back 3

drives circadian rhythm. Synchronizes sleep and wake cycles. Highly individual and genetically linked.

Front 4

Two phases of sleep

Back 4

NREM (nonrapid eye movement) and REM (rapid eye movement)

Front 5

Stages of sleep

Back 5

1 through 4 and REM

Front 6

Describe the typical adult sleep cycle including stages and timeframe

Back 6

Presleep sleepiness, Stage 1 (few minutes), Stage 2 (10-20 min), Stage 3 (15-30 min), Stage 4 (15-30 min), Stage 3 (15-30 min), Stage 2 (10-20 min), REM (20 minutes) - typical time to reach REM sleep is 90 minutes.

Front 7

Sleep stage 1

Back 7

Lightest level of sleep, lasts a few minutes, gradual fall in vitals and metabolism, easily aroused

Front 8

Sleep stage 2

Back 8

Sound sleep, 10-20 minutes, relaxation progresses, easy arousal

Front 9

Sleep stage 3

Back 9

Deeper Sleep, 15-20 minutes, difficult arousal, muscles relaxed, vitals decline

Front 10

Sleep stage 4

Back 10

Deepest sleep, 15-30 minutes, very difficult arousal, significant decrease in vital signs, considerable portion of night spent in this stage.

Front 11

REM sleep

Back 11

Vivid dreams, Begins about 90 min after onset of sleep. Typified by rapid eye movement, fluctuating heart and respiratory rates, increased BP. Loss of skeletal muscle tone, increased gastric secretions, very difficult arousal, duration increases with each sleep cycle. (20 min average length - may be as long as 60 min during last cycle).

Front 12

Describe how many sleep cycles adults typically move through per night and how the sleep cycles change throughout the night.

Back 12

4-5 complete cycles. With each successive cycle, stages 3 and 4 shorten and REM lengthens. The REM stages lasts up to 60 minutes in the last sleep cycle.

Front 13

What percentage of a typical adult's sleep is spent in NREM stages?

Back 13

75%-80%

Front 14

Newborns spend more time in ____ whereas older adults sleep cycles tend to be _______.

Back 14

Newborns spend more time in deep sleep. Older adults sleep is more fragmented with less time in deep sleep.

Front 15

Functions of sleep

Back 15

Contributes to physical and psychological restoration, body and brain tissue restoration, preserves cardiac function, preserves energy. Dreams involve learning, memory processing, and stress adaptation.

Front 16

Sleep requirements - neonates

Back 16

16 hrs average, sleep almost constantly the first week. Sleep cycle: 40-50 mins wakes after 1-2 sleep cycles. 50% is REM which stimulates brain centers and is critical for normal development.

Front 17

Sleep requirements - infants

Back 17

8-10 hrs of night time sleep by 3 months. Naps during the day. 15 hrs sleep total per day. 30% of sleep is REM. May awaken during the night.

Front 18

Sleep requirements - toddlers

Back 18

By age 2 - most sleep through the night, Still nap during the day. 12 hrs of sleep per day. May give up naps around age 3. Percentage of REM time falls with age. Bedtime routine may become a struggle.

Front 19

Sleep requirements - Preschoolers

Back 19

12 hrs per night. 20% REM. By age 5, naps are rare. Problems with sleep may include trouble settling down, bedtime fears, waking during the night, nightmares, partial wakening, crying, sleep-waking, bed-wetting.

Front 20

Sleep requirements - school-aged children

Back 20

required sleep varies 9-12 hours

Front 21

Sleep requirements - adolescents

Back 21

Experience changes in circadian rhythms. Secretion of melatonin changes to later in the night. May require 9-10 hours but actually get about 7.5. May result in poor school performance and behavior or mood problems.

Front 22

Sleep requirements - young adults

Back 22

6-8.5 hours 20% is REM. May begin to experience sleep problems due to stress, social activities, insomnia. Pregnancy may increase need for sleep.

Front 23

Sleep requirements - middle adults

Back 23

Total time spent sleeping declines. Stage 4 sleep falls and continues to decline with advancing age. Anxiety, depression, and or physical illness may cause sleep disturbances. Menopausal symptoms may lead to insomnia.

Front 24

Sleep requirements - older adults

Back 24

Increasing complaints of sleeping difficulties. 50% of adults 65 and older have sleep problems. REM sleep shortens. Decrease in stage 3 and stage 4 NREM with a possible total loss of stage 4 or deep sleep. Frequent awakenings and difficulty falling asleep. Chronic illenss may result in loss of sleep - changes caused by changes in CNS that affect sleep regulation. Sensory impairment reduces sensitivity to time cues that maintain circadian rhythms.

Front 25

Insomnia

Back 25

Chronic difficulty falling asleep, frequent wakings, short sleep. Most common sleep-related complaint.

Front 26

Effects/characteristics of Insomnia

Back 26

Results in excessive day time sleepiness. More common in women. Often signals underlying physical or psychological disorders or situational stress. Also associated with poor sleep hygiene (practices/habits associated with good health). Increased risk for anxiety, depression. Treatment begins with improved sleep hygiene.

Front 27

Sleep Apnea

Back 27

Lack of airflow (apnea) or diminished airflow (hypopnea) through the nose and mouth for periods of 10 seconds or longer. May be central, obstructive, or mixed. Most common is Obstructive (OSA).

Front 28

Effects/characteristics of sleep apnea

Back 28

Causes loud snoring. Affects 10-15% of middle-aged adults. Risk factors include smoking, obesity, alcohol, family history. Results in excessive daytime sleepiness. Causes a decline in arterial oxygen saturation. Increased risk of cardiac dysrhythmias, right sided heart failure, pulmonary hypertension, angina attacks, stroke, hypertension.

Front 29

Polysomnography

Back 29

Testing for sleep apnea. A number of physiologic variables are measured and recorded during sleep. These include - Brain electrical activity, eye and jaw muscle movement, leg muscle movement, airflow, respiratory efford (chest and abdomincal excursion), EKG, oxygen saturation

Front 30

Treatment for sleep apnea

Back 30

CPAP, VPAP, or BIPAP - Continuous, Variable, or Bi-pressure Positive Airway Pressure

Front 31

Narcolepsy

Back 31

Dysfunction of the mechanism that regulates sleep and wake states

Front 32

Effects/characteristics of narcolepsy

Back 32

Excessive daytime sleepiness, REM sleep occurs within 15 min of falling asleep. Treated with medications, exercise, diet modifications, deep breathing, scheduled naps.

Front 33

Parasomnias

Back 33

a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Includes - Sleepwalking, night terrors, nightmares, bed wetting (nocturnal enuresis), tooth griding, body rocking.

Front 34

Effects/characteristics of parasomnias

Back 34

More common in children. Sleep hygiene becomes very important. Safety is key.

Front 35

Examples of chronic diseases that poor sleep is believed to contribute to -

Back 35

Heart disease, diabetes, immunity, obesity

Front 36

Assesment for sleep issues includes

Back 36

Asking about usual sleep patterns, physical and psychological illness, current life events, emotional and mental status, bedtime routines, bedtime environments, behaviors of sleep deprivation

Front 37

Nursing diagnoses related to sleep issues

Back 37

Anxiety, ineffective breathing pattern, acute confusion, compromised family coping, ineffective coping, insomnia, disturbed sensory perception, sleep deprivation.

Front 38

Nursing planning related to sleep issues

Back 38

Client will -
Control environmental sources disrupting sleep within 1 month
Identify factors in the immedicate home environment that disrupt sleep in 2 weeks
Report having a discussion with family members about environmental barriers to sleep within 2 weeks.
Report changes made in the bedroom to promote sleep within 2 weeks.
Report fewer than 2 awakenings per night within 4 weeks.

Front 39

Rest

Back 39

A state of mental relaxation, free from anxiety and physically calm

Front 40

Urination during the night which affects sleep cycle

Back 40

Nocturia

Front 41

Involves the use of electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG), to monitor stages of sleep

Back 41

Polysomnogram

Front 42

Results in impaired waking function, poor work performance, accidents, and emotional problems

Back 42

Excessive daytime sleepiness (EDS)

Front 43

Most common sleep complaint, signaling an underlying physical or psychological disorder

Back 43

Insomnia

Front 44

More common in children, an example is SIDS

Back 44

Parasomnias

Front 45

Cyclical process that alternates with longer periods of wakefulness

Back 45

Sleep

Front 46

Rapid eye movement phase at the end of each sleep cycle

Back 46

REM

Front 47

Synchronizes sleep cycles

Back 47

Biological clock

Front 48

Influences the pattern of major biological and behavioral functions

Back 48

Circadian rhythm

Front 49

Sleep that progresses through four stages (light to deep)

Back 49

NREM

Front 50

More vivid and elaborate during REM sleep and are functionally important to learning

Back 50

Dreams

Front 51

Characterized by the lack of airflow through the nose and mouth for 10 seconds or longer during sleep

Back 51

Sleep apnea

Front 52

Practices that the client associates with sleep

Back 52

Sleep hygiene

Front 53

Inadequacies in either the quantity or quality of nighttime sleep

Back 53

Hypersomnolence

Front 54

Problem clients experience as a result of dyssomnia

Back 54

sleep deprivation

Front 55

Sudden muscle weakness during intense emotions at any time during the day.

Back 55

cataplexy

Front 56

Dysfunction of mechanisms that regulate the sleep and wake states (excessive daytime sleepiness)

Back 56

narcolepsy

Front 57

Neonates sleep for _____hours per day _____% is REM

Back 57

16 hrs, 50% REM

Front 58

Neonates sleep cycles are ____ minutes long and they usually wake after _____ cycles

Back 58

40-50 minutes, 1-2 cycles

Front 59

Infants sleep _____ hours at night. ____ hours total per day including naps with ___ % REM

Back 59

8-10 hrs at night, 15 hours total, 30% REM

Front 60

Toddlers sleep ____ hours total per day with 1-2 naps.

Back 60

12hrs

Front 61

Preschoolers sleep ____ hours at night, ____ % is REM

Back 61

12 hours, 20% REM

Front 62

School-aged kids: A typical 6-yr-old sleeps ____ hours per night. Typical 11-yr-old sleeps ____ hours per night

Back 62

11-12 hours at age 6, by age 11 that has dropped to about 9-10 hours per night

Front 63

Adolescents sleep an average of ___ hrs per night

Back 63

7.5 hours

Front 64

Young adults sleep an average of _____ hours per night

Back 64

6-8.5 hours

Front 65

Sleep patterns of middle adults -

Back 65

Sleep begins to decline. Time spent in stage 4 declines. Insomnia is common, especially in women going through menopause

Front 66

Sleep patterns of older adults

Back 66

More than 50% of adults over 65 experience sleep problems. Decrease in length of stages 3 and 4, with ultimately almost no time spent in stage 4.

Front 67

Components of a sleep history

Back 67

Description of sleeping problems, usual sleep pattern, physical and psychological illness, current life events, emotional and mental status, bedtime routines, bedtime environment, behaviors of sleep deprivation.

Front 68

Common nursing diagnoses related to sleep problems

Back 68

Anxiety, ineffective breathing pattern, acute confusion, compromised family coping, ineffective coping, insomnia, disturbed sensory perception, sleep deprivation.

Front 69

The 24 hour day-night cycle is known as

Back 69

Circadian rhythm

Front 70

What substance could a patient take to promote normal sleep patterns

Back 70

L-tryptophan (a natural protein found in milk, cheeses, and meats that aides in the production of melatonin)

Front 71

Irritability, hyperactivity, and decreased motivation are symptoms of

Back 71

sleep deprivation