Chapter 34: Sleep And Rest

Front 1

CircadianRhythm

Back 1

isa biorhythm based on the day-night pattern in a 24-hour cycle.

Front 2

Biorhythm

Back 2

are"biological clocks" that are controlled within the body andsynchronized with environmental factors.

Front 3

REM

Back 3

(Rapid eye movement) the brainbecomes highly active and the brain waves resemble those of a person who isfully awake. Rapid eye movements occur, which can often be detected even thoughthe sleepers eyelids are closed. More spontaneous awakenings occur during thisstage than any other. Rem is essential for mental and emotional restoration.Loss of REM sleep impairs memory and learning. (pg883) usually 5-30 mins.Typically 20-30 mins.

Front 4

RAS

Back 4

Reticularand cortical neurons are called the reticular activating system (RAS).Neurotransmitters associated with excitatory and inhibitory sleep mechanismsinclude catecholamines, acetylcholine, serotonin, histamine, andprostaglandins. L-Tryptophan and adenosine promote feelings of sleepiness.

Front 5

EEG

Back 5

(electroencephalogram) usedto record the electrical activity of the neurons in the brain. electricalimpulses are transmitted from the brain through electrodes attached to thescalp.

Front 6

RLS

Back 6

(restlessleg syndrome) is a disorder of the central nervous system characterized by anuncontrollable movement of the legs while resting or before sleep onset. Ittends to run in families. It affects 5% to 15% of americans. Children and youngadults experience this condition but it is especially common in older adultsand it is sometimes associated with low levels of iron and use of someantidepressants. More often in women than men. Symptoms: unpleasant creeping,crawling, itching, or tingling sensations in legs. Relieved only by moving thelegs, which prevents the person from relaxing/falling asleep

Front 7

Somnambulation

Back 7

(sleepwalking)occurs during stage III of NREM sleep, usually 1-2 hrs after the person fallsasleep. The sleeper leaves the bed and walks about, with little awareness ofsurroundings. He may preform what appears to be conscious motor activities (ie:brush teeth, make coffee) but he does not wake up. The person is not aware ofsleepwalking and has no memory of the event upon waking. The event may last 3-4 mins or longer.Children sleepwalk more than adults. If the child does not outgrow thecondition or serious safety ricks exist, meds may be given to supress thedeepest stage III sleep. Stress, fatigue, and some drugs can triggersleepwalking.

Front 8

Parasomnias

Back 8

includesleepwalking, sleep talking, bruxism, nigh terrors, REM sleep behaviordisorders, and nocturnal enuresis.

Front 9

Sleepapnea

Back 9

isa periodic interruption in breathing during sleep—an absence of air flowthrough the nose or mouth during sleep. Typically the soft tissue of thepharynx and soft palate collapse and obstruct the airway. Episodes may occurseveral or a hundred times a night and may last for as long as 1 min or longer.During periods of apnea, the oxygen level in the blood drops, and the carbondioxide level rises, causing the person to wake up. This may result in cardiacdysrhythmias (irregularities) and increases in pulse and blood pressure.

Front 10

Describeat least 5 sleep disorders.

Back 10

Restless leg syndrome- uncontrollable movement of legs during sleep/rest.

Hypersomnia- excessive sleeping(especially during daytime), Sleep related or disease related, can be related to depression.

Sleep apnea- periodic breathing cessation for at least 10 sec. during sleep.

Narcolepsy- chronic disorder caused by the brains ineffectiveness in regulating sleep-wake cycles normally. Also uncontrollable episodes of sleep during the day.

Parasomnias- sleepwalking/talking, bruxism, night terrors, REM sleep behavior disturbances, and enuresis.

Front 11

During which developmental stage does a persontend to need the most hours of sleep? How much sleep should you individuallyhave at your age?

Back 11

Newborns (16-20 hrs/day)Young adults=7-8 hrs/day (pg881)

Front 12

Give the primary concern for parents or for the nurses of a 6-year-old child who sleepwalks.

Back 12

safety

Front 13

Givesymptoms of obstructive sleep apnea.

Back 13

Causedby airway occlusion(usually by the tongue or palate) during sleep the personcontinues to try to breathe. Sleeping patterns often report that the personsnores, grunts, or thrashes about during sleep. Airway occlusion ya also be dueto a collapse of the hypo pharynx or from other structural abnormalities( ieenlarged tonsils, adenoids, a deviated nasal septum, or thyroid enlargement)although most often males over the age of 40, particularly if overweight, areaffected by sleep apnea, the condition occurs in females of any age or weight.

Front 14

Explicateon at least 5 independent nursing interventions to promote sleep. Do not listmedications as one.

Back 14

Schedule nursing care to avoid interrupting sleep.

Create a restful environment.

Promote comfort.

Support bedtime rituals and routines.

Offer appropriate bedtime snacks or beverages Promote relaxation .

Maintain pt safety.

Teach about sleep hygiene.

Administer and teach about sleep meds

Front 15

Compare/Contrastsleep and rest.

Back 15

• Sleep– Cyclicalstates/altered consciousness

– Decreasedmotor activity/perception

– Selectiveresponse to external stimuli

• Rest

– Mild tono activity

– Relaxation;stress freeLeads to feeling refreshed

Front 16

Describe at least 5sleep disorders.

Back 16

• Insomnia– Inabilityto fall or remain asleep or go back to sleep

• Circadiandisorders– Abnormalityin sleep/wake times (e.g., jet lag, working night shift, rotating shifts)

• Restlessleg syndrome– Uncontrollablemovement of legs during sleep/rest

• Hypersomnia– Excessive sleeping (especially during daytime)– Sleep related or disease related– Can be related to depression

• Sleepapnea– Periodicbreathing cessation for at least 10 sec during sleep

• Narcolepsy– Chronicdisorder caused by the brain’s ineffectiveness in regulating sleep-wake cyclesnormally– Uncontrollableepisodes of sleep during the day

• Parasomnias– Sleepwalking/talking– Bruxism– Nightterrors– REMsleep behavior disturbances– Enuresis

Front 17

List 5 reasons weneed sleep (why it is important).

Back 17

• Increasesmental performance– Improveslearning

– Helpsthe storage of long-term memory• Restoresenergy

• Improvesability to cope

• Strengthensthe immune system

• Sleep may also improve learning and adaptation.

• Sleep also appears to reduce stress and anxiety

Front 18

During which developmentalstage does a person tend to need the most hours of sleep? How much sleep shouldyou individually have at your age?

Back 18

New born, then infants thentoddlers

Front 19

Give the primary concernfor parents or for the nurses of a 6-year-old child who sleepwalks.

Back 19

SAFETY AND NURSINGDIAGNOSIS WOULD BE RISK FOR INJURY RELATED TO SLEEPWALKING

Front 20

Give symptoms of obstructive sleep apnea.

Back 20

• feels drowsy during the day and isfatigued

• unrefreshedsleep

• morningheadache

• the person snores, snorts, grunts orthrashes during the night

• Sleepapnea– Periodicbreathing cessation for at least 10 sec during sleep

Front 21

Name at least 5 sleepprovoked disorders.

Back 21

Coronary arterydisease

COPD

Diabetes

Gastric andintestinal ulcers

Epilepsy

Asthma

Front 22

List 3 prescriptionmedications (including generic and Trade name and classification), 1 nonprescriptionmedication and 2 herbal remedies that promote sleep.

Back 22

Non benzodiazepine

Hypnotic:• Ambien (zolpidem tartrate)

• Sonata (zalepon)

Benzodiazepines: • Valium (diazepam)

• Ativan (lorazepam)

• Xanax (alprazolam)

• Halcion (triazolam)

Barbiturates: • Amytal (amobarbital)

• Nembutal (phenobarbital)

• Seconal (secobarbital)

MELATONIN NON PRESCRIPTIONHerbs:

• Lavender

• Chamomile Tea

• Valerian Root

• Hops

• Passionflower

Front 23

Explicate on at least5 independent nursing interventions to promote sleep. Do not list medicationsas one.

Back 23

• Cluster/schedulenursing care to avoid interrupting sleep.

• Createa comfortable/restful environment.• Promotecomfort/relaxation.

• Supportbedtime rituals/routines

• Offerfoods that help promote sleep.

• Maintainsafety of the client.

• Teachabout sleep hygiene.

Front 24

Explain why a nonbenzodiazepine such as Ambien ispreferred over a benzodiazepine such as Valium or Xanax.

Back 24

BENZODIAPINES CAUSE DAYTIME DROWSINESSAND ALTER THE SLEEP CYCLE.

Risk for rebound insomnia anddependency and tolerance is greater along with potentially being dangerous ifcombined with alcohol and some medications

Front 25

What informationwould you give the mother of a 7 year old who has enuresis?

Back 25

A majority of Childrenusually outgrow it so patience helps. Can use a protective waterproof pad onthe mattress. Use an alarm on childrenolder than 10 years of age not this young