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42 Cards in this Set
- Front
- Back
stage of sleep that is only a few minutes long, is very light, person can be awakened easily-but feels relaxed/drowsy, vital signs and metabolism are just beginning to diminish |
stage 1 NREM
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deeper sleep lasting 10-20 minutes, increased relaxation-but person can still be awakened easily
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stage 2 NREM
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deep sleep lasting 15-30min, difficult to awaken, relaxation is such that person seldom moves
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stage 3 NREM |
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deepest sleep 15-30min in length, vital signs very low compared to when awake, very difficult to awaken.
The stage in which the body achieves PHYSICAL rest and restoration The stage at which enuresis and talking/walking in one's sleep occur |
stage 4 NREM
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stage of sleep in which dreams occur, 5-30 min long and start 50-90 min after falling asleep, varying vital signs, very difficult to awaken.
Brain is highly active, brain metabolism may increase as much as 20% The stage at which MENTAL rest and restoration occur |
REM
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Describe the sleep cycle
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the sleep cycle consists of NREM and REM sleep. Typically, after a person experiences stage 1 of NREM, he will cycle through the other stages 4-6 times throughout the night. |
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difficulty falling asleep or the inability to receive restorative sleep
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insomnia
(more common in women than men) |
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Disorder of the sleep and wake mechanisms. Person may lose ability to stay awake.
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narcolepsy
often happens at inappropriate times, putting person at risk |
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absence of breathing for > than 10 seconds 5 times per hour during sleep
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sleep apnea
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instructions for the narcoleptic client
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participate in regular exercise |
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nursing interventions for the client experiencing difficulty with sleep
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assist client to establish and follow a bedtime routine |
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assessment tool used to determine presence of sleep problem and gauge its extent
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Epworth Daytime Sleepiness Scale
<10 probably normal 10-12 mild sleepiness 13-17 moderate sleepiness 18-24 severe sleepiness when the last two items on the list are rated as "chance of happening", client requires counseling and referral. (last 2 are falling asleep at stoplight and falling asleep while driving alone on monotonous road for an hour) |
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Typical sleep requirements by age
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birth-3 months....16hr a day
infants (3 months-1 year)...8-10 hrs with 2-3 daytime naps preschoolers....12 hrs with less napping during the day school-age....11-12 for younger children, 9-10 for older children adolescents....7.5hrs per night young adults....6-8.5 hrs per night middle adults....6-8.5 hrs per night older adults....6-8.5 hrs with daytime naps possibly accounting for some of the hours |
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Three types of sleep apnea
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Obstructive apnea, central apnea, and mixed apnea
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What is obstructive apnea?
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occurs when structures of the pharynx or oral cavity block the flow of air. Person continues to try to breathe, chest/abdominal muscles still continue to move. Diaphragm movements become stronger and stronger until obstruction is cleared. (That's why a person will often "snort" when coming out of an apneic episode.)
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What is central apnea?
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thought to involve a defect in the respiratory center of the brain. All actions involving breathing, such as airflow and chest movement, cease during a central apneic episode.
(clients who have brain stem injuries and muscular dystrophy often have central apnea) |
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what is mixed apnea?
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a combination of obstructive and central apnea
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condition in which individual gets sufficient sleep at night but still cannot stay awake during the day
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hypersomnia
usually caused by a medical condition. (CNS damage, some kidney, liver, metabolic disorders-such as diabetic acidosis and hypothyroidism) hypersomnia rarely has a psychological origin. |
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four types of drugs that can cause excessive daytime sleepiness
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antidepressants
antihistamines beta-blockers narcotics |
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what effect can beta-blockers have on sleep?
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they have been known to cause nightmares and insomnia
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What effects can narcotics have on sleep?
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some narcotics (Demerol, morphine) are known to suppress REM sleep and cause frequent awakenings and drowsiness
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What effect can antidepressants have on sleep?
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They suppress REM sleep, HOWEVER... this is considered a therapeutic effect. Selectively depriving a depressed client of REM sleep will result in an immediate but transient improvement in mood.
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what instruction should be given to a client who is planning on discontinuing long-term antidepressant or hypnotic medication?
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REM rebound may occur.
(a period of more intense dreams) |
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What effect does nicotine have on sleep?
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As nicotine is a stimulant, smokers often have more difficulty falling asleep than non-smokers, and are often more easily aroused from sleep.
Refraining from smoking after the evening meal usually helps the person to sleep better. former smokers report iimproved sleep patterns following tobacco cessation. |
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What effect does caffeine have on sleep?
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caffeine disrupts sleep by stimulating the central nervous system
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What effect does alcohol have on sleep?
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Alcohol disrupts REM sleep, but it hastens the onset of sleep.
person will "make up" lost REM sleep once alcohol has worn off, but may experience nightmares |
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Describe effects illness can have on sleep
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Respiratory conditions such as shortness of breath, nasal congestion, sinus drainage make it difficult to breathe and may disrupt sleep.
Hyperthyroidism lengthens presleep time, making it difficult for the individual to fall asleep. Hypothyroidism decreases stage IV NREM sleep Pain from gastric and duodenal ulcers may disrupt sleep due to increased gastric secretions that occur at night. Women with low levels of estrogen often complain of fatigue elevated body temperatures cause some reduction in delta and REM sleep |
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It is difficult to note sleep abnormalities during a physical assessment, but there are clinical signs of sleep apnea... what are they?
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enlarged and reddened uvula and soft palate
enlarged tonsils and adenoids (in children) obesity (in adults) neck size greater than 17.5 inches in males |
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what is somnambulism and in which sleep stage does it occur?
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sleepwalking
it occurs during stages III and IV of NREM, usually 1-2 hours after falling asleep |
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define parasomnia and give examples
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behavior that may interfere with sleep and even occur during sleep
arousal disorders (sleepwalking, sleep terrors) sleep-wake transition disorders (sleep talking) nightmares and bruxism are also types of parasomnias |
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What is bruxism?
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clenching and grinding of teeth usually occurring during stage II NREM sleep.
Eventually erodes teeth, can cause fractures of teeth, may loosen them due to occlusal trauma, and lead to deterioration of the TMJ |
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compare/contrast sleep history and sleep diary
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a sleep history is a brief assessment regarding a client's sleep patterns such as hours per night, presence of snoring, bedtime rituals, medications taken to help with sleep. It should be done for all clients entering a healthcare facility and can be done in conjunction with the physical assessment. A more detailed assessment should be done if excessive daytime sleepiness is an issue, if sleep problems have been present for more than 6 months. This in-depth assessment, along with any diagnostic studies, must be performed by a nurse practitioner with specialized training
A sleep diary is a log of sleep patterns over the course of 1-2 weeks kept by the client. |
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define polysomnography
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Polysomnography is a diagnostic test in which a number of physiologic variables are recorded during sleep
Electroencephalogram (EEG, electromyogram (EMG), and electro-oculogram (EOG) are in included in a polysomnography. Respiratory effort and airflow, ECG, leg movements, oxygen saturation are also monitored. |
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Describe functions of sleep
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to cope with daily stresses
to prevent fatigue to conserve energy to restore the mind and body to enjoy life more fully enhances daytime functioning vital for optimum psychological and physiological function as well as tissue repair |
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Describe characteristics of sleep for adolescents
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require 9-10 hrs per night
circadian rhythms tend to shift at the onset of adolescence, later sleep and wake patterns are biologically determined |
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Describe characteristics of sleep for adults
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need 7-9 hrs per night (although this # varies, some do well with as little as 6, while others require 10)
Lifestyle changes for young adults such as new jobs, pregnancy, babies affect sleep Lifestyle changes for middle-aged adults such as care for aging parents or chronically ill partners may affect sleep |
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Describe characteristics of sleep for elders
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need as much sleep as adults, but the ability to sleep becomes more difficult
hallmark change with age is a tendency toward earlier bedtimes and wake times-they awaken 1.3 hours earlier and go to bed 1 hour earlier elderly clients with dementia may experience sundown sydrome |
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Describe the sleep patterns of newborns
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sleep 16-18 hours a day on a irregular schedule with periods of 1-3 hours of wakefulness
newborns enter REM sleep immediately newborns spend about 50% their sleep time in each stage of sleep. The sleep cycle is about 50min. best to put newborns to sleep when they are sleepy, but not asleep |
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Describe the characteristics of sleep for infants
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14-15 hrs in 24 hrs.
At first, they awaken every 3-4hrs to eat by 6mos, most will sleep through the night usually take 2 naps per day like infants, should be put to bed when they are sleepy, not asleep. Helps them to become "self-soothers" rather than "signalers" |
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Describe the characteristics of sleep for toddlers (1-3 years)
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12-14 hrs per night
most still need an afternoon nap may exhibit a great deal of resistance to going to bed and may awaken during the night nighttime fears and nightmares are common |
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Describe the characteristics of sleep for preschoolers (3-5 years)
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11-13 hrs per night
sleep needs fluctuate with activity and growth spurts night terrors or nightmares may be a problem |
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Describe the characteristics of sleep for the school age child (5-12 years)
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needs 10-11 hours per night, but most get less due to increasing demands of homework, sports, etc.)
May spend more time at the computer or watching tv, may drink caffeinated beverages-all of which may lead to difficulty with sleep |