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69 Cards in this Set

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When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is:
1. headache
2. early wakening
3. impaired reasoning
4. excessive daytime sleepiness
4-excessive daytime sleepiness (EDS) is the most common c/o people with obstructive sleep apnea (OSA). Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities b/c of sleepiness.
One priority nursing intervention to promote sleep for a hospitalized client is to:
1. turn television on low to late-night programming.
2. avoid awakening client for nenessential tasks.
3. give prescribed sleeping medicaitons at dinner.
4. have client follow hospital routines.
2-in a hospital or extended care setting it is difficult to provide clients w.the time needed to rest and sleep. however, the nurse plans care to avoid awakeining clients for nonessential tasks. the nurse can help by sceduling assessments, treatments, procedures and routines for times when clients are awake. for example, if a client's physical condition has been stable, the nurse should avoid awakening the client to check VS.
The use of nonprescription sleeping medications is not advisable b/c these medications can:
1. lead to further sleep disruption even when they initially seemed to be effective.
2. be expensive and difficult to obtain
3. cause severe depression and anxiety.
4. casue headaches and nausea
1-the use of nonprescription sleeping meds is not advisable. clients should learn the risks of such drugs. over the long term, these drugs can lead to further sleep disruption evne when they intially seemed to be effective. older adults should be caustioned about using over-the-counter antihistamines b/c of their long duration of action that can casue confusion, constipation, urinary retention, and increased risk of falls.
If a client is using herbal compounds such a valerian for sleep, the nurse should caution the client that these compounds may:
1. interfere w/prescribed mediations
2. cause diarrhea and anxiety
3. not be used indefinitely
4. produce severe insomnia
1-clients should be cautioned about the dosage and use of herbal compounds b/c the FDA does not regulate them. Herbal compounds may create interations w/prescribed medication, and concurrent use should be avoided.
The nurse understands that the most vivid dreaming occurs during:
1. REM sleep
2. Stage 1 NREM sleep
3. Stage 4 NREM sleep
4. transition period from NREM to REM sleep
1-although dreams occur during both nonrapid eye movement (NREM) and rapid eye movement (REM) sleep, the dreams of REM sleep are more vivid and elaborate and are believed to be funtionally important to learning, memory processing, and adaptation to stress.
A client taking a beta-andrenergic blocker for hypertension can experience interference w/sleep patterns such as:
1. nocturia
2. increased daytime sleepiness
3. increases awakening from slee
4. increased difficulty falling asleep
2-beta-adrenergic agents can cause nightmares, insomnia, and awakenings form sleep.
The care plan for improving sleep in an older person may inclue:
1. a nap during the day to make up for lost sleep
2. exercise in the evening to increase fatigue
3. allowing the client to sleep as late as possible
4. decreasing fluids 2 to 4 hours before sleep
4-limiting alchol, caffeine, and nicotine and decreasing fluids 2-4 hours before sleep may promote sleep for older adults.
Currently the American academy of Pediatrics recommends that helathy infants be placed in a side-lying or supine position during sleep to decrease the incidence of:
1. falls
2. vomiting
3. cradel cap
4. sudden infant death syndrome (SIDA)
4-currently, the American Academy of Pediatrics recommends that apparently healthy infants be placed in the side-lying or supine position during sleep b/c of an association between the prone position and the occurrence of sudden infant death syndrome (SIDS)
Narcolepsy can be best explained as:
1. a sudden muscle wakness during exercise
2. stopping breathing for short intervals during sleep
3. frequent awakenings during the night
4. an overwhelming wave of sleepiness and falling asleep
4-narcolepsy is a dysfuntion of mechanisms that regulate the sleep and wake states. excessive daytime sleepiness is the most common complaint associated w/this disorder. During the day a person may suddenly feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur w/in 15 minutes of falling asleep.
A nursing measure to promote sleep in shcool-age children is to:
1. make sure the room is dardk and quiet
2. encourage evening exercise
3. encourage televison viewing
4. encourage quiet activities prior to bed time.
4-the amount of sleep needed during the school years is individualized b/c of varying states fo activity and levels of health. a 6yo averages 11-12 hrs of sleep nightly, whereas an 11yo sleeps about 9-10 hours. the 6 or 7yo can usually be persuaded to go to bed by encouraging quiet activities.
Circadian rhythm
a biorhythm pattern that is regularly repeated at 24-hour intervals.
insomnia
difficulty falling asleep, intermittent sleep, non-retorative sleeping; can be situational:
-increased w/age
-sleeper c/o difficulty falling asleep, sleeping too lightly, easily awoken, early-morning awakenings
-usually resolves w/in 2 wks
-can lead to symptoms of sleep deprivation
-person c/o inability to sleep @ night & is drowsy during day
narcolepsy
-dysfuntion of mechanisms that regulate sleep-wake cycle.
-CNS loses control of REM sleep
-excessive daytime sleepiness, distrubed nighttime sleep, cataplexy, sleep paralysis
-person suddenly falls asleep during the day, usually last 20-30 minutes, REM sleep
-treated w/stimulants & 20 minunte naps
-nerologic disorder
REM sleep
-non-rapid eye movement
-highly active brain function in an immoblilized body.
-EEG recordings are similare to wakefulness
-characterized by high brain activity, loss of muscle tone, dreaming, variable arousability, and potential physiological instability
-25% of sleep
-duration is about 20 minutes but increases w/each cycle of sleep
-research has found that REM sleep is essential for mental & emotional equilibrium. it also plays a role in learning, memory and adaptation.
-*most difficult to arise from
sleep
-we spend approximately 1/3 of our lives sleeping
-state of altered consciousness during which varying degrees of stimuli are required to produce wakefulness
-a cyclical, physiological process
-the sleeping person is unaware of external stimuli
Dyssomnias
primary disorders that have their own origin in different body systems and are subdivided into three major groups: intrinsic, extrinsic, and circadian rhythm disorders.
Intrinsic sleep disorder
-include disorders of intiating and maintaining sleep
-various forms of insomnia and disorders of excessive sleepiness such as narcolepsy and obstructive sleep apnea
Extrinsic sleep disorders
-develop from external factors, which if removed, lead to resolution of the sleep disorder.
Circadian rhythm disorders
arise form a misalignment between the timing of sleep and what is desired by the individual or is a societal norm.
Parasomnias
-undesirable behaviors that occur predominantly during sleep: arousal disorders, partial arousals, or disorders during transitions in the sleep cycle or form sleep to wakefulness.
Sleep apnea
-a disorder characterized by the lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep.
Three types of sleep apnea:
central
obstructive
mixed apnea
Most common type of sleep apnea?
obstructive sleep apnea
Sleep deprivation
-a problem many clients experience as a result of the dyssomnia.
Causes of sleep deprivation?
illness, emotional stress, medications, environmental disturbances, variablity in the timing of sleep due to shift work.
NREM sleep (stage 4)
Non-rapid eye movement sleep
-deepest stage of sleep
-very difficult to arouse sleeper
-if sleep loss has occurred, sleeper will spend considerable portion of night in this stage.
-VS are significantly lower than during waking hours
-stage lasts approximately 15-30 minutes
-sleepwalking and enuresis may occur
NREM sleep (stage 3)
-invlolves initial stages of deep sleep.
-sleeper is difficult to arouse and rarely moves.
-muscles are completely relaxed
-VS decline but remain regular
-stage lasts 15-30 minutes
NREM sleep (stage 2)
-period of sound sleep
-relaxation progresses
-arousal remains relatively easy
-stage lasts 10-20 minutes
-body functions continue to slow
NREM sleep (stage 1)
-includes lightest level of sleep
-stages lasts a few minutes
-decreased physiological activity begins with gradual fall in VS and metablolism
-person is easily aroused by sensory stimuli such as noise.
-awakened, person feels as though daydreaming has occurred
What is the physiology of sleep?
-Reticular activation system(RAS)
-Bulbar synchronizing region (BSR)
What is Reticular activating system (RAS)?
-located int he upper brain stem
-wakefulness occurs when the RAS receives added stimuli from the cerbral cortex and the peripheral sensory organs and cells of the body.
-pain, pressure, and noise produce wakefulness through initial stimulation of perpheral cells stimulating cerebrel cortex which stimulates the RAS.
What is Bulbar synchronizing reging(BSR)
-includes the hypothalamus
-thought to involve release of serotonin
-injury to the hypothalamus may cause a person to sleep for abnormally long periods of time.
With --------- stimuli the RAS is not activated, and eventually the BSR takes over to produce sleep.
Decreased
What keeps up awake?
the active RAS
What are the functions of sleep?
-conserves energy
-physiological and psychological restoration of the body
What lifestyle factors affect rest and sleep?
-nutrition
-exercise
-smoking
-lifestyle disruptions
What environment factors affect rest and sleep?
-hospitalization
-temperature
-client perception of the environment
What are the factors for newborns (up to three months old)?
-sleep 16-17 hours/day; have shorter sleep cycle, and alternate between REM (50%) and wakefulness.
What are the factors for infants?
-14-20 hours/day; may still awaken at night if hungry
What are the factors for toddlers?
-12 hours/day; sometimes unwilling to go to bed at night; usually take one nap/day
What are the factors for preschoolers?
-12 hours/day; have difficulty settling down; establishing a consistent routine helps.
What are the factors for school-age?
-9-11 hours/day depending on age.
What are the factors for adolescents?
-7 1/2 hours/day but research is finding that this is due to outside activities and teen actually need more sleep rather then less; internal clock shifts so have difficulty falling asleep until 2-3 a.m. and then need to sleep 7-8 hours
What are the factors for adults?
7-9 hours/day
What are the factors for the elderly?
Tend to nap more during the day, have a harder time falling asleep, and sleep a shorter period of time; aslo have much less stage 4 NREM
What are the factors of hormone levels?
-pregnancy leads to an increase for sleep.
-menopause leads to sleep disturbances.
What are the physiologic factors?
-gentics
-sleep postion (back sleepers-tend to be poor sleepers, change position more have increased risk of sleep apnea)
-pain (don't sleep as well)
-medications
-psychiatric disorders
-illness
What does medication do to affect rest and sleep?
-hyponotics-shorten sleep onset, reduce nighttime wakefulness and decrease anxitey
What does psychiatric disorders do to affect rest and sleep?
-depression
-anxiety-decreases Stage 4 and REM
What does illnesses do to affect rest and sleep?
epilepsy-seizures more frequent during REM sleep.
-liver failure/ecephalitis-tend to cause reversal in day/night sleep patterns
-hypothyroidism-causes decreased NREM Stages 1 & 4
-asthma-attacks less frequent during Stage 4 NREM
-infections-require increased amounts of sleep
Nursing Diagnosis for rest and sleep:
-disturbed sleep pattern
-fatigue
What is rest?
-implies "decreased activity which allows a person to relax and become refreshed" (not necessarily true)
-it involves a state of mental and physical activity that leaves the individual feeling refreshed, rejuvenated, and ready to resume the activities of the day
-a person can be inactive and not be mentally rested
Stage 1 NREM
-5% of sleep
-lightest level of sleep
-transition from wakefulness to sleep
-nurse may observe jerkeing
-person still somewhat aware of surroundings
-easily aroused
-if awakened, person may feel like they have been daydreaming
Stage 2 NREM
-50-55% of sleep
-a period of sound sleep
-person can still be easily aroused
-lasts 10-20 minutes
Stage 3 NREM
-10% of sleep
-a deep sleep
-difficult to arouse person
-person rarely moves
-15-30 minutes
Stage 4 NREM
-10% of sleep
-greatest depth of sleep
-called delta sleep
-very difficult to arouse sleeper
-muscles are very relaxed
-if person lacks sleep, they will spend more time in this stage
-lasts 15-30 minutes
-sleepwalking occurs here
Explain the sleep cycle:
-begins with NREM Stage 1, progresses consectutively through the NREM stage then reverses going back to NREM 2 and then into REM sleep, then to NREM 2, etc.
What happens if a person is awakened at any time during the cycle?
Begin again at NREM Stage 1
How long does each sleep cycle last?
each cycle lasts about 90-100 minutes
What sleep increases as the night progress?
REM sleep increases as the night progresses
What happens when a person is deprived of sleep?
NREM Stages 3 & 4 take priority, so only 2/3 of REM and all of Stages 3 & 4 is recovered
What is a subjective experience in assessing sleep and rest for a client?
only the client knows whether sleep is sufficient and restful
What are physiological symptoms of sleep deprivation?
-ptosis, blurred vision
-fine motor clumsiness
-decreased reflexes
-slowed response time
-decreased reasoning & judgement
-decreased auditory & visual alertness
-cardiac arrhythmias
What are phychological symptoms of sleep deprivation?
-confusion & diorientation
-increased sensitivity to pain
-irritable, withdrawn, apathetic
-excessive sleepiness
-agitatin
-hyperactivity
-decreased motivation
The 24-hour day-night cycle is known as:
circadian rhythm
What substances will promote normal sleep patterns?
*1-tryptophan
All of the following are sypmptoms of sleep deprivation except:
-hyperactivity
-irritability
-rise in body temp.
-decreased motivation
rise in body temperature
Mrs. Peterson c/o difficulty falling asleep, awakening earlier than desired, and not feeling rested. She attributes these problems to leg pain that is secondary to her arthritis. What would be the appropiate nursing diagnosis for her?
sleep pattern disturbances r/t chronic leg pain
A nursing care plan for a client with sleep problems has been implemented. What are the expected outcomes?
client reports no episodes of awakening during the night, reports satisfaction w/amount of sleep and rates sleep as an 8 or above on the visual analog scale.