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35 Cards in this Set
- Front
- Back
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Where is the major sleep center?
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In the HYPOTHALAMUS.
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How does the hypothalamus promote wakefulness and rapid eye movement sleep?
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The hypothalamus secretes HYPOCREATINS (orexins) that promote wakefulness and rapid eye movement sleep.
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What stages does the normal sleep cycle involve?
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1. NONRAPID EYE MOVEMENT (NREM) - non-vivid dreaming, contributes to body restoration.
2. RAPID EYE MOVEMENT (REM) - vivid, full-color dreaming occur, important for cognitive restoration. Loss of REM sleep can cause changes in mood and cause confusion. |
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What are the stages of NREM sleep and how long is a typical sleep cycle?
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NREM progresses through 4 stages during a typical 90-minute sleep cycle.
75 -80 % of sleep time is spent in NREM sleep. The amount of time spent in each stage varies over the life span. |
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What is the sleep quality between different cycles?
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The quality of sleep from stage 1 through stage 4 becomes increasingly deep.
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To what stages is the lighter sleep characteristic?
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Stages 1 and 2. Person is easily arousable.
STAGE 1: lasts a few minutes. Decreased physiological activity begins with gradual fall in vital signs and metabolism. Awakened, person feels as though daydreaming has occured. STAGE 2: lasts 10 -20 minutes. Body functions continue to slow. Period of sound sleep. Relaxation progresses. |
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What happens during 3rd and 4th sleep cycles?
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Stages 3 and 4 involve deeper, slow-wave sleep.
STAGE 3: lasts 15 -30 minutes, vital signs decline but remain regular. Muscles are completely relaxed. Sleeper is difficult to arouse and rarely moves. With each successice sycle, stages 3 and 4 shorten, and the period of REM lengthens. STAGE 4: lasts 15 -30 minutes. Vital signs are significantly lower than during waking hours. Very difficult to arouse sleeper. Sleepwalking and bed-wetting sometimes occur. Body releases human growth hormon for the repair and renewal of epithelial cells such as brain cells. Especially important in children (experience more stage 4 sleep)l |
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When does the REM take place?
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Rapid eye movement is the phase at the end of each sleep cycle. Occurs 90 minutes after sleep has begun. Very difficult to arouse sleeper. Duration increases with each cycle - averages about 20 min. Intense dreaming occurs as a result of heightened brain activity, but loss of skeletal muslce tone occurs. Highest during infancy and early childhood.
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How does the sleep cycle begin?
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Begins with presleep period- person is gradually developing speepiness. About 10 -30 min.
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What is NOCTURIA?
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Urination during the night.
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INSOMNIA and transient insomina?
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Not being able to get to sleep or fall back to sleep after waking up. Most common sleep related complain. Can happen due to stress, aging. Treat symptoms by helping the clinet relax.
Transient insomnia occurs as a result of situational stresses such as family, work, school. |
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What is sleep apnea?
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Disorder characterized by the lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep.
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Central sleep apnea (CSA)
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Central sleep apnea (CSA) involves dysfunctions in the brain's respiratory control center. The impulse to breathe temporarily fails, and nasal airflow and chest wall movement cease. Common in people with brain stem injury, muscular dystrophy and encephalitis. Mild and intermittent snoring.
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Obstructive sleep apnea (OSA)
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Obstructive sleep apnea (OSA) - occurs when muscles or structures of the oral cavity or thorax relax during sleep. The upper airway becomes partially or completely blocked, diminished nasal airflow (hypopnea) or stopping it (apnea) for as long as 30 seconds. Attems to breathe result in loud snoring. Most common. Obesity, smoking, alcohol and a family history increase the risk.
Clients with OSA are at risk for cardiac dysrhythmias,heart failure, pulmonary hypertension, angina attacks, stroke and hypertension. Contributes to high BP nad increased risk for heart attact and stroke. |
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What is NARCOLEPSY?
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Dysfunction of mechanism that regulate the sleep and wake states. A person has problem of falling asleep uncontrollably at inappropriate times.REM sleep occurs within 15 minutes of falling asleep. Symptoms include cataplexy (sudden muscle weekness during intense emotions), vivid dreams that are difficult to distinguish fro reality and sleep paralysis, or the feeling of being unable to move ot ralk just before waking or falling asleep.
Treaded with stimulants, antidepressants, wakefulness-promoting agents, avoiding shifts in sleep, alcohol, heavy meals or exchausting activities. |
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Factors affecting sleep.
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1. Drugs and substances
2. Lifestyle 3. Usual sleep patterns 4. Emotional stress 5. Environment 6. Exercise and fatigue 7. Food and caloric intake |
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Best source for sleep assessment?
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Usually the client's subjective reports. Visual analog scale is very effective (straight horizontal line 100 mm long with opposing statements "best night sleep" and "worst night sleep" - client marks their perceptions. Needs to be used repeatedly to show change over time.Numeric scale with a 0 to 10 sleep rating. Secondary - bed partners, parents of children.
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What is normal sleep pattern?
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Difficult to define because individuals vary in perception of adequate quantity and quality of sleep.
It is important to have clients describe THEIR usual sleep pattern to determine the significance of the changes caused by a sleep disorder. Find out the following answers - what time in bed, what time fall asleep, how often awaken and why, wake up time and hours of sleep. |
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How to promote client safety for clients prone to confusion or falls?
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A small night-light assists the client in orienting to the room environment before going to the bathroom. Beds set to the lowerst lessens the chance of a person falling. Clients need to void before going to sleep. Instruct clients to remove clutter and throw rugs from the path, if patient needs assistance in ambulation, place a small bell at the bedside to call family members. Sleepwalkers - do not startle sleepwalkers but instead gently awaken them and lead back to bed.
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What hormone controls circadian rhythms and promote sleep?
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Melatonin, a neurotransmitter produced in the brain helps control circadian rhythms and promote sleep.
It is popular nutritional supplement to aid sleep. |
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Medications to approach sleeping problems.
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Melatonin - popular nutritional supplement to aid sleep. Recommended dosage is 0.3 -1 mg taken 2 hours before bedtime. Valerian is effective in mild insomnia - produces mild sedation. Kava helps promote sleep in clients who have sleep problems related to anxiety. The use of nonprescription sleeping medications is not advisable - lead to further sleep disruption even when effective initially.
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What common symptom will the client most likely report with obstructive sleep apnea?
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Headache and excessive daytime sleepiness.
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What is circadian rhythm?
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Predictable 24-hour day-night cycle; disruptions can affect physical functioning - irritability, decreased appetite, impaired judgment.
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Polysomnogram.
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Client is monitores during sleep to look at oxygenation, heart and brain activity.
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Sleep deprication.
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Not getting enough sleep. Frequently happens in the hospital. Symptoms include decreased judgment, confusion, irritability, increased senitivity to pain.
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Nursing process - Assessment
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Assess sleep patterns, possible sleep problems.
May have client keep a record of when they go the sleep, when they wake up. Find out about health problems that may interfere with sleep. Assess bedtime routine, environemnt. What are client expectations. |
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Nursing process - Nursing diagnosis
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Insomina is a nursing diagnosis.
Sleep apnea nursing diagnosis may be ineffective breathing patters. |
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Nursing process - Planning
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Plan ways to enhance sleep for the client.
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Nursing process - Implementation
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Sleep hygiene = good habits promote good sleep.
Comfortable room temperature. Only use bedroom for sleep/ If you don't fall asleep within 30 minutes, get out of bed, do quiet activity. |
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Nursing process - Evaluation
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Does the patient feel like they are getting enough sleep?
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The nurse is gathering a sleep history from a client who is being evaluated for obstructive sleep apnea. What common symptom will the client most likely report?
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Headache.
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The nurse teaches a client taking Dilantin, an anticonculsant, that this group of medications causes which type of sleeping problems?
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Increased daytime sleepiness because they decrease REM sleep time.
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To validate the suspection that married male client has sleep apnea, the nurse first?
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Questions the wife if she is awakened by her husband's snoring.
The client would not know if he is experiencing sleep apnea. |
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When analgesics are ordered for a client with obsturctive sleep apnea (OSA) following surgery, the nurse is most concerned about?
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Opioids - the risk of respiratory distress is increased.Clients with OSA should start out with very low doses.
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Which medications are the safest to administer to adults needing assistance falling asleep?
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Benzodiazepines.
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