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60 Cards in this Set
- Front
- Back
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A state of unconsciousness from which a patient can be aroused by appropriate stimulus?
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-SLEEP: needed to maintain psychiatric equilibrium, physical well-being & strengthening of the immune system to ward off disease.
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STAGE I:
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-transition phase b/w wakefulness & sleep
-lasts only a few mins -some people experience it as wakefulness or drowsiness -2%-5% of sleep is stage I |
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What happens during STAGE II of NREM sleep?
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-people experience a Drifting or Floating sensation.
-if awakened during this stage, will often deny being asleep, "I was just resting my eyes" |
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Which Stage(s) of sleep does a person experience Light sleep periods & are easily aroused?
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-Stage I & Stage II
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What Stage of sleep does a person experience a Transition from the Lighter to Deeper sleep?
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-Stage III
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What happens during STAGE IV of NREM sleep?
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-Delta sleep=deep sleep
-dreamless -very restful -10% - 15% of sleep time in healthy young adults -decrease in B/P, R R & BMR |
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What happens during REM sleep?
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-accounts for 20% - 50% of normal sleep
-Peaks around 5:00 AM |
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What is REM sleep characterized by?
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-Rapid eye mvmt
-increase HR -Irregular breathing -secretion of stomach acids, muscular activity -Dreaming -time for our subconscious minds to release anxiety & tension -Important for reestablishment of Psychological equilibrium -helps in remembering |
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What is the time period in which a healthy young adult cycles through NREM & REM sleep?
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-90 minutes
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What is the order in which a person goes through the SLEEP CYCLE?
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Stage I > Stage II > Stage III > Stagve IV > Stage III > Stage II > REM
stage IV=deep sleep (T, R, B/P at lowest) |
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Defined as the inability to sleep, not a disease but a sx?
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-INSOMNIA: most common sleep d/o
-usually mild & short lived |
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What are the common causes of INSOMNIA?
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-changes in lifestyle or environment(hospitalization, lights, noise, traffic, restlessness, snoring sleeping partner, room temp, job shift change, school, birth)
-pain, illness, anxiety -large amt of caffine, alcohol -large "rich" meals before bedtime |
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CHRONIC INSOMNIA:
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-requires at least 1 mth of sleep disturbances to be dx as a sleep d/o
-develop fatigue or drowsiness that interfers w/ daytime functioning & employment responsibilities |
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SHORT-TERM INSOMNIA:
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-lasting < than 3 wks
-assoc. w/ travel across time zones, illness, anxiety ie. job-related, financial stress, examinations, emotional relationships |
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3 types of INSOMNIA:
1. INITIAL: 2. INTERMITTENT: 3. TERMINAL: |
1. inability to fall asleep when desired
2. difficulty staying asleep 3. early awakening w/ inability to fall back asleep |
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TRANSIENT INSOMNIA:
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-Sleep disturbance lasting only a few nights
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A drug that produces sleep:
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-HYPNOTIC
-more intense effect on CNS -effects depends on the dosage & condition of pt ie. Small dose of drug may act as a sedative & a large dose of a drug may act as a Hypnotic |
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SEDATIVE drug:
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-relaxes the pt but is not necessarily accompanied by sleep
-reduces anxiety, nervousness, excitability, irritability -also called: antianxiety &/ or anxiolytics |
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SEDATIVE-HYPNOTIC AGENTS?
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-increase total sleeping time, (stage II & stage IV)
-decrease # of REM cycles & total time in REM sleep (needed to maintain a mental balance during daytime activities) -may cause REM rebound (can occur w/in only 3 to 4 days of use) |
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What is the ACTION of SEDATIVE-HYPNOTIC agents?
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-sedatives produce relaxation & rest
-hypnotic= produce sleep -same drug may serve both function, depending on drug dose |
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What are the classes of Sedative-Hypnotics?
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-Barbiturates
-Benzodiazepines -Nonbarbiturates/Nonbenzodiazepines -Miscellaneous agents |
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What are the USES for sedative-hypnotic agents?
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-temporary tx of insomnia
-decrease anxiety & increase relaxation and/or sleep before diagnostic or operative procedures -Anticonvulsive agents |
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Nursing Assessment for Sedative-Hypnotic Therapy includes:
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-V/S: B/P, P & R decreases (monitor): before initiating med
- Check Allergies -Drug Interactions -pt's level of alertness, orientation & ability to perform motor functions - activities done before bed -ask about stressors -note sleep distruption patterns -caffeine sources in dietary hx -determine "actual need" -pt w/ hx of sleep apnea, heavy snoring or R difficulties are at higher risk for R depres if sedative-hypnotics are taken -older adults may react Paradoxically(opposite effects) -monitor for therapeutic & adverse/toxic effects -alcohol:causes sedation but disrutps sleep patterns & cause early-am awaking |
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What Patient Education/ Health Promotion should be taught by the Nurse?
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-encourage standard bedtimes
-avoid late, heavy meals -limit caffeine(coffee, tea, drinks & chocolate) & alcohol intake (use decaffeinated or herbal products) -control sleep enviro -promote stress-reducing tech. (yoga, sex, wine, book, hot bath) -benefits of med compliance & nonpharmacologic interventions -protein foods & dairy products contain an amino acid that synthesizes serotonin, a NT that is found to increase sleep time & decrease the time required to fall asleep |
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What is the ACTION for BARBITURATES?
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-interferes w/ chemical transmission of impulses across the synaptic junction w/in the reticular formation of the brainstem
-potentiates inhibitory effect in nerve impulse transmission of a substance known as GABA -effect depends on dose, tolerance, route of admin, pt's condition -Suppress REM & stage III/IV sleep patterns when used for hypnosis -long-half live -Residual sedation, common: drowiness, hypotension, decreases motor coordination,anxiety, blurred vision ie. if given at 10pm, still going to see it at 6am |
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What are the USES for BARBITURATES?
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-anticonvulsant: phenobarbital
-general anesthetic (ultrashort-acting) -sedative & hypnotic effect (rare use) |
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*What should the baseline assessment include for BARBITURATES?
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-R Rate & depth
-LOC -state of arousal -behavior -motor function (ie. able to brush teeth, ambulate) |
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What are the Side Effects to expect w/ BARBITURATES?
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-morning "hangover"
-blurred vision -transient hypotension on arising -sedation -lethargy -impaired coordination |
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What are the side effects that should be report w/ BARBITURATES?
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-excessive use or abuse
-excessive CNS depression (can't wake up) -hypersensitivity- infrequent: (hives, rash, pruritus, high fever, inflammation of mucous membranes) -Excitement: Paradoxical Response -Blood Dyscrasias: rare, schedule labs (rbc, wbc, diff), -tolerance -dependence |
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BLOOD DYSCRASIAS:
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general term which is used to describe any abnormality in the blood or bone marrow's cellular components, such as low white blood cell count, low red blood cell count or low platelet count
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What are the Drug Interactions w/ BARBITURATE?
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-Increase the effects of barbiturates: alcohol, antihistamines, tranquilizers, analgesics,anesthetics, monoamine oxidase inhibitors
-Pt's taking phenytoin & barbiturates for seizure control shouuld have drug levels monitored to ensure adequate dosages -Reduce effectiveness of Warfarin (monitor PT), estrogens (b/c pills), corticosteroids, beta-adrenergic blockers, metronidazole, doxycycline, antidepressants, quinidine & chlorpromazine |
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BENZODIAZEPINES, are difficult to characterize as a class, but includes?
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-anticonvulsants
-antianxiety -sedative-hypnotic agents -muscle relaxants |
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What is the Action of BENZODIAZEPINES?
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-enhances the action og GABA in the CNS
-increase Stage II while decreasing stage III / IV, & to a lesser extent, REM sleep -helps w/ sleep & rest |
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GABA?
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-an inhibitory NT in CNS, initiating sleep & increasing total sleep time
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What are the USES of BENZODIAZEPINES?
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-most commonly used as Sedative-hypnotics
-preoperative sedative (Ativan) -Conscious sedation (Versed) - |
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What are the therapeutic outcomes for BENZODIAZEPINES?
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-to produce mild sedation
-preoperative sedation w/ amnesia -valium/librim: most commonly used today |
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What are examples of Benzopdiazepines drugs used for Insomnia?
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1. Dalmane (flurazepam):
2. Restoril 3. Halcion |
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Benzopdiazepines drug
DALAMANE: |
-flurazepam (generic name)
-long acting/ C-IV -used for short-term tx of insomnia (up to 4 wks) -morning hangover may be significant -rebound insomnia & REM sleep occur less freq. |
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Benzopdiazepines drug
RESTORIL |
-temazepam / C-IV
-intermediate acting -used to treat Insomnia -minimal if any morning hangover -rebound insomnia may occur |
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Benzopdiazepines drug:
HALCION |
-triazolam/ C-IV
-used to treat insomnia but tends to lose effectiveness w/in 2 wks -tapering therapy is recommeneded to reduce rebound insomnia -rapid onset of action -No am hangover |
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What benzodiazepines are used for Anxiety?
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-xanax
-Librium (alcohol withdrawal) -Versed (pre-op, sedation, amnesia) -Klonopin (seizures/anxiety) -Tranxene (anti-anxiety) -Valium (seizure/anxiety) -Paxipam -Ativan (status epilepticus=uncontrolled seizures) -Serax (alcohol w/drawal) |
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What is the Pre-Med assessment for BENZODIAZEPINES?
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>V/S , b/p: laying & sitting (causing orthostastic hypotension)
>increased risk of RESPIRATORY depression (ie. pt's w/ COPD, emphysema), - pt w/ impaired R function -when taken w/ other CNS depressants -Given IV >Monitor closely if Impaired liver & kidney function (at risk for toxicity) -Benz metabolizes in liver -physical dependence if used > 4 wks |
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**What 3 letters do Benzodiazepines drugs typically end in?
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-"LAM"
-"PAM" |
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What side effects are Expected w/ BENZODIAZEPINES?
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-drowsiness
-am "hangover" -blurred vision -transient hypotension on arising |
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What side effects should be Reported w/ BENZODIAZEPINES?
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-confusion -agitation
-hallucinations -amnesia -Excessive use or abuse -physical dependence can result from chronic use (> 4 wks) -Blood Dyscrasias: labs(wbc, rbc, diff) (monitor for development of a sore throat, fever, purpura, jaundice, or excessive & progressive weakness) -Hepatotoxicity (sx: anorexia, N/V, jaundice, hepatomegaly, splenomegaly & abnormal liver function test: elevated bilirubin, AST, ALT, GGT |
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What are the Drug Interactions w/ Benzodiazepines?
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-toxic effects can be increased if used w/ Alcohol, Tranquilizers, Antihistamines, analgesics, Narcotics & Anesthetics
-smoking increases the metabolism of Benzo (md will need to increase the dose of benz) |
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Benzodiazepine Drug:
-RAMAZICON (generic name, uses?) |
-flumazenil (Antidote)
-receptor antagonist -reverses CNS depression -Decreases in B/P |
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What is the ACTION for Nonbarbiturates & Nonbenzodiazepines?
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-variable effects on REM sleep
-tolerance development -rebound REM sleep (nightmares, bizarre dreams: see w/ Ambien or lunesta is d/c) -insomnia after discontinuation |
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What is the USES for Nonbarbiturates & Nonbenzodiazepines?
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-sedative & hypnotic effects
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What is the Therapeutic outcomes for Nonbarbiturates & Nonbenzodiazepines?
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-to produce a mild sedation
-for short term use to produce sleep |
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Nonbarbiturates & Nonbenzodiazepines Drug:
-NOCTEC (generic name, uses) |
>chloral hydrate C-IV
-does not suppress REM -Used for short-term therapy ~tachyphylaxis -tolerance to hypnotic action occurs rapidly (<10 days) -combo of chloral hydrate & alcohol causes a rapid LOC (Mickey-Finn, knockout dros) -it does not depress R or cough reflex -may cause N -admin w/ full glass of H2O -don't chew capsules |
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Tachyphylaxis:
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'A rapid decrease in the response to a drug after repeated doses over a short period of time
-may develop with an initial dose |
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Nonbarbituates/ Nonbenzodiazepines:
AMBIEN (generic name, uses) |
-zolpidem C-IV
-preserves(helps) deep sleep -rapid onset (7-27 mins) -duration: 3-5 hrs -minor effect on REM -use short-term -no muscle relaxation & no anticonvulsant effects -will get Rebound insomnia - tolerated in Older adults: start w/ 5 mg immediate release or 6.25 mg controlled release tab |
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Drug Class: Nonbarbituates/ Nonbenzodiazepines:
-BUSPAR: (generic name/uses): |
-buspirone
-action unclear -tx of General anxiety d/o (GAD) -less likely to affect cognitive (thinking) & motor performance -rarely interacts w/ other CNS depressants -Common side effects: dizziness, HA, drowsiness -may take several wks for optimal results |
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Antihistamines:
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used for short-term tx of mild insomnia
-tolerance develops only a few nights after use -increasing the dose causes a more restless & irregular sleep pattern |
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Drug Class: Nonbarbituates/ Nonbenzodiazepines:
BENADRYL (generic name/uses) |
-diphenhydramine
-antihistamine -common OTC sleep aid -good for intermitten sleep but not for long term use -used for mild insomnia (up to 1 wk) -tolerance develops, increased dosage causes more side effects w/ no more efficacy |
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Drug Class: Nonbarbituates/ Nonbenzodiazepines:
VISTARIL (generic name/uses) |
-hydroxyzine
-helps w/ rest & calmness -antihistamine |
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Nursing Assessment for MISCELLANEOUS sedative-hypnotic agents:
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-V/S: B/P(assess while pt is sitting & lying down before admin sedative-hypnotic)
-Lab results should be monitored for hepatic dysfunction or bld abnormalities |
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What are the side effects to expect w/ MISCELLANEOUS sedative-hypnotic agents:
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-morning hangovers
-blurred vision -transient hypotension on arising -restlessness, anxiety -paradoxical excitment in older adults & pt w/ severe pain (excitement, euphoria, restlessness & confusion) |
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What are the Drug Interactions w/ MISCELLANEOUS sedative-hypnotic agents?
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- tranquilizers, alcohol, narcotics, antihistamines, analgesics, anesthetics & other drugs that may effect the CNS will magnify the toxic effects of these miscell. agents
-fluvoxamine: inhibits metabolism of ramelteon, causing excessive sedation -drugs that decrease therapeutic effect: rifampin enhances the metabolism of ramelteon, reducing therapeutic effect -Disulfiram may prolong the effect of paraldehyde -for faster onset, do not admin w/ or stat after a meal -chloral hydrate may enhance the anticoagulant effects of warfarin (observe for petechiae, ecchymoses, nosebleeds, bleeding gyms, dark tarry stools, bright red or "coffee ground" emesis -observe PT & INR when taking warfarin |
