Exam 5 ch. 43
The patient reports episodes of sleepwalking to the nurse. Through understanding of the sleep cycle, the nurse recognizes that sleepwalking occurs during which sleep phase? Rapid eye movement (REM) sleep Stage 1 non rapid eye movement (NREM) sleep Stage 4 NREM sleep Transition period from NREM to REM sleep
Stage 4 NREM sleep Stage 4 NREM sleep is the deepest stage of sleep. It is difficult to rouse the sleeper in this stage. During this stage sleepwalking and enuresis (bed-wetting) sometimes occur.
Stage 1: NREM
Stage lasts a few minutes Lightest level of sleep gradual fall in vital signs and metabolism easily woken up if awaken feel like they have been daydreaming
infants sleep
8 to 10 hours at night for a total of 15 hours per day
School Age sleep
9 to 10 hours
A 72-year-old patient asks the nurse about using an over-the-counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse's best response? "Antihistamines are better than prescription medications because these can cause a lot of problems." "Antihistamines should not be used because they can cause confusion and increase your risk of falls." "Antihistamines are effective sleep aids because they do not have many side effects." "Over-the-counter medications when combined with sleep-hygiene measures are a good plan for sleep."
"Antihistamines should not be used because they can cause confusion and increase your risk of falls." Older adults should avoid the use of over-the-counter antihistamines. These medications have a long duration of action in older adults and can cause confusion, constipation, urinary retention, and increased risk of falls.
Which statement made by the parent of a school-age child requires follow-up by the nurse? "I encourage evening exercise about an hour before bedtime." "I offer my daughter a glass of warm milk before bedtime." "I make sure that the room is dark and quiet at bedtime." "We use quiet activities such as reading a book before bedtime."
"I encourage evening exercise about an hour before bedtime." Best evidence related to sleep hygiene recommends avoiding exercise within 2 hours of bedtime. Exercise should be in the morning or afternoon. Encourage the parent to use quiet activities before bedtime to promote sleep.
Which statement made by the patient indicates a need for further teaching on sleep hygiene? "I'm going to do my exercises before I eat dinner." "I'm going to go to bed every night at about the same time." "I set my alarm to get up at the same time every morning." "I moved my computer to the bedroom so I could work before I go to sleep."
"I moved my computer to the bedroom so I could work before I go to sleep." This statement requires further teaching. Good sleep-hygiene practices state that the bedroom should only be used for sleeping. Work and study should not be done in the bedroom.
Which statement made by an older adult best demonstrates understanding of taking a sleep medication? "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." "Sleep medicines won't cause any sleep problems once I stop taking them." "I'll talk to my health care provider before I use an over-the-counter sleep medication." "I'll contact my health care provider if I feel extremely sleepy in the mornings."
"I'll talk to my health care provider before I use an over-the-counter sleep medication." The statement, "I'll talk to my health care provider before I use an over-the-counter sleep medication" shows an understanding of the risks of over-the-counter sleep medications. The use of nonprescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption even when they initially seemed effective. Caution older adults about using over-the-counter antihistamines because of their long duration of action that can cause confusion, constipation, urinary retention, and increased risk of falls.
The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? "I feel refreshed when I wake up in the morning." "I use soft music at night to help me relax." "It takes me about 45 to 60 minutes to fall asleep." "I take the pain medication for my leg pain about 30 minutes before I go to bed."
"It takes me about 45 to 60 minutes to fall asleep." Good sleep-hygiene practices indicate that individuals should fall asleep within 30 minutes of going to bed. Taking 45 to 60 minutes to fall asleep indicates a potential sleep problem and requires follow-up on sleep-hygiene practices. If an individual does not fall asleep within 30 minutes, encourage him or her to get out of bed and do a quiet activity until he or she feels sleepy.
Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? "I'll give the baby a bottle to help her fall asleep." "We'll place the baby on her back to sleep." "We put the baby's stuffed animals in the crib to make her feel safe." "I know the baby will not need to be fed until morning."
"We'll place the baby on her back to sleep." This is based on the current evidence that shows that parents need to place an infant on his or her back to prevent suffocation. Bottles, stuffed animals, and pillows should not be placed in the bed with an infant.
Sleep apnea
**10 SECONDS OR LONGER** Disorder characterized by lack of airflow through the nose and mouth for periods of *10 seconds or longer* during sleep Primary central sleep apnea, central sleep apnea caused by medical condition, obstructive sleep apnea syndromes, excessive daytime sleepiness 3 types of sleep apnea
Homeostatic process (Process S)
*Two Processes:* *Process S* (The homeostatic process) *Process C* (Circadian Rhythms) Process S and Process C operate simultaneously to regulate sleep and wakefulness Time of wake up is defined by the intersection of Process S and Process C
Stage 2:NREM
10-20 minutes sound sleep
Preschoolers sleep
12 hours a night
Neonates sleep
16 hours a day
The nurse is contacting the health care provider about a patient's sleep problem. What is the correct order for the steps for SBAR? 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 2. "Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 3. "I'm calling to ask if you would order a hypnotic such as zolpidem (Ambien) to use on a prn basis." 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1° C (98.8° F). 2, 1, 3, 4 1, 2, 3, 4 2, 1, 4, 3 1, 2, 4, 3
2, 1, 4, 3 SBAR is Situation, Background, Assessment, and Recommendation. This is the correct sequence of steps in SBAR for the patient and sleep problem.
Circadian rhythms (24 hour, day/night cycle)
Affected by light, temperature, social activities, and work routines. Nerve Cells in *hypothalamus* control the rhythm of the sleep-wake cycle
Physiology of Sleep contd
All persons have "biological clocks" that synchronize their sleep cycles Different people also function best at different times of the day Key is the failure to maintain an individual's usual sleep-wake cycle negatively influences the patient's overall health
Nursing Diagnosis
Anxiety Ineffective breathing pattern Acute confusion Compromised family coping Ineffective coping Insomnia Fatigue Sleep deprivation Readiness for enhanced sleep
Parasomnias
Are sleep problems that are more common in children Somnambulism (sleepwalking), Night terrors, Nightmares, Nocturnal enuresis (bed-wetting), Body rocking, Bruxism these include sleep walking, night terrors, nightmares, bed wetting, body rocking, and tooth grinding (bruxism)
The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? Have patient follow hospital routines. Avoid waking patient for nonessential tasks. Give prescribed sleeping medications at dinner. Turn television on low to late-night programming.
Avoid waking patient for nonessential tasks. Avoiding awakening patient for nonessential tasks promoted sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as laboratory draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits. The other tasks do not promote sleep.
Maintenance of biological functions
Body needs sleep to routinely restore biological process During NREM stage 4 sleep, the body releases human growth hormone for the repair and renewal of epithelial and specialized cells such as brain cells. Protein synthesis and cell division for renewal of tissues such as the skin, bone marrow, gastric mucosa, or brain occur during rest and sleep. NREM sleep is especially important in children, who experience more stage 4 sleep. Body also conserves energy during sleep.
Sleep deprivation
Causes include fever, difficulty breathing, pain, emotional stress, medications, and disturbances in the health care setting. Owing to long work schedules and rotations, health care providers are prone to sleep deprivation Emotional stress, Medications, Environmental disturbances, Symptoms hospitalization makes its particularly vulnerable to sleep deprivation caused by noises, environment, and interruptions for care
Description of sleeping problems
Description of sleeping problems Conduct a more detailed history when a patient has a sleep problem. This ensures that you provide appropriate therapeutic care. Open-ended questions help a patient describe a problem more fully. Ask specific questions related to the sleep problem. Usual sleep pattern Have patients describe their normal sleep patterns. Physical and psychological illness Current life events Emotion and mental status Bedtime routines Bedtime environment Behaviors of sleep deprivation
Sleep history
Description of: Sleeping problems: anxiety about trouble sleeping, excessive waking in night, nocturia, restlessness Usual sleep pattern: what time do you go to sleep? How many hours do you sleep? What time do you wake? Current life events: stress, changes in work schedule Physical and psychological illness Emotional and mental status Bedtime routines Bedtime environment Behaviors of sleep deprivation- irritability, disorientation (similar to drunken state), frequent yawning and slurred speech if sleep deprivation has lasted a long time; psychotic behavior such as delusions and paranoia
Factors Influencing Sleep
Drugs and substances Hypnotics, diuretics, narcotics, antidepressants, alcohol, caffeine, beta-blockers, anticonvulsants Lifestyle Work schedule, social activities, routines Usual sleep patterns May be disrupted by social activity or work schedule Emotional stress Worries, physical health, death, losses Environment Noise, routines Exercise and fatigue Moderate exercise and fatigue cause a restful sleep Food and calorie intake Time of day, caffeine, nicotine, alcohol
The nurse is developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? Instruct the patient to sleep in a supine position. Have patient limit fluid intake 2 hours before bedtime. Elevate the head of the bed to sleep. Encourage patient to take an over-the-counter sleep aid.
Elevate the head of the bed to sleep. Lifestyle changes and modifications of sleep habits should be included on a plan of care for a patient with OSA. Individuals should sleep with the head of the bed elevated and use a side or prone position. Other modifications include good sleep-hygiene practices, alcohol modification, smoking cessation, and weight reduction.
Acute care
Environmental controls Promoting comfort Establishing periods of rest and sleep Promoting safety Stress reduction
Stages of the Adult Sleep Cycle
Four stages of NREM Sleep cycle lasts 90 to 100 minutes Sleep goes through stages 1 to 4, then reversal from 4 to 3 to 2, followed by REM
Young Adults sleep
Get 6 to 8½ hours
Adolescents sleep
Get ~7½ hours
Which sleep-hygiene actions at bedtime can the nurse delegate to the nursing assistant? Select all that apply. Giving the patient a backrub Turning on quiet music Dimming the lights in the patient's room Giving a patient a cup of coffee Monitoring for the effect of the sleeping medication that was given
Giving the patient a backrub Turning on quiet music Dimming the lights in the patient's room Giving the patient a backrub, turning on quiet music, and dimming the lights are all appropriate sleep-hygiene measures. These activities are within the scope of practice for the nursing assistant. Coffee, tea, cola, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night and should not be ingested before bedtime. Monitoring medication effect is a registered nurse activity.
The school nurse is teaching health-promoting behaviors that improve sleep to a group of high-school students. Which points should be included in the education? Select all that apply. Go to bed at the same time each night. Study in your bedroom to have a quiet place. Turn on the television to help you fall asleep. Avoid drinking coffee or soda before bedtime. Turn off your cell phone at bedtime.
Go to bed at the same time each night. Avoid drinking coffee or soda before bedtime. Turn off your cell phone at bedtime.
Planning
Goals and outcomes example Follow professional standards Create a concept map Collaborate Setting priorities Frequently sleep disturbances are the result of other health problems Teamwork and collaboration Partner closely with the patient and sleep partner --minimize disturbances in patients sleep as much as possible
Implementation
Health promotion (Box 43-9) --Environmental controls Comfortable temperature, good ventilation, minimize sources of noise, good lighting Safe environment for walking to bathroom (may need lighting for this) --Promoting bedtime routines Newborns and Infants : Feeding, Story, sleep Avoid excessive mental stimulation just before bed ---relaxation techniques before bed--- --Promoting safety-*no throw rugs, reduce clutter* Promoting comfort Establishing periods of rest and sleep-*more active in day* Stress reduction Bedtime snacks-*avoid stimulants* Pharmacological approaches Environment controls *If not sleepy within 30 minutes, get up* *anything but take a pill when trying to help pt sleep, medication is the last resort*
Physical illness can cause pain, physical discomfort, anxiety, depression, and sleep disturbances:
Hypertension Respiratory disorders Nocturia-need to urinate at night Restless leg syndrome (RLS) American Academy of Sleep Medicine Classification of Sleep Disorders sleep apnea
critical thinking
In the case of sleep, integrate knowledge from nursing and disciplines such as pharmacology and psychology Use personal experience Professional standards
Central sleep apnea (CSA)
Involves dysfunction in the respiratory control center of the brain The impulse to breathe fails temporarily, and nasal airflow and chest wall movement cease. The oxygen saturation of the blood falls. Common in brainstem injury Less than 10% of sleep apnea is predominantly central in origin. People with CSA tend to awaken during sleep and therefore complain of insomnia and excessive daytime sleepiness (EDS). Mild and intermittent snoring is also present.
Stage 4: NREM
Lasts 15-30 minutes Deepest stage of sleep If sleep loss has occurred, sleeper spends considerable part of night in this stage Vital signs are significantly lower than during waking hours very difficult to arouse sleeper sleep walking and euresies (bed wetting) sometimes occurs
Stage 3: NREM
Lasts 15-30 minutes Initial stages of deep sleep muscles completely relax more difficult to awaken
*Hypothalamus *
Major sleep center in the body Secretes hypocretins that promotes wakefulness and rapid eye movement sleep Prostaglandin D2 L-tryptophan, and growth factors control sleep
Rest contributes to:
Mental relaxation Freedom from anxiety State of mental, physical, and spiritual activity Bed rest does not guarantee that a patient will feel rested.
Restorative or continuing care
Promoting comfort Controlling physiological disturbances Pharmacological approaches
Sleep Regulation
Regulated by a sequence of physiological states integrated by central nervous system (CNS) activity Hypothalamus Reticular activating system (RAS) Homeostatic process (Process S)
Purpose of sleep
Remains unclear Physiological and psychological restoration NREM sleep contributes to body tissue restoration decrease in heart rate to 60 bpm or less which benefits cardiac function
The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? Incontinence Nausea and vomiting Bradycardia Respiratory depression
Respiratory depression Benzodiazepines in older adults should be used on a short-term, limited basis. Respiratory depression is an adverse effect of benzodiazepines in older adults. Other adverse effects for which to assess include next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination.
Stages of the Adult Sleep Cycle cont'd
Seventy-five to 80% of sleep time is spent in NREM sleep. With each successive cycle stages 3 and 4 shorten, and the period of REM lengthens. REM sleep lasts up to 60 minutes during the last sleep cycle. Not all people progress consistently through the stages of sleep. sleep becomes more fragmented w/ aging and a person spends more time in lighter stages
The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? Can cause urinary retention Should not be used indefinitely May have toxic effects on the liver May cause diarrhea and anxiety Are not regulated by the U.S. Food and Drug Administration (FDA)
Should not be used indefinitely May have toxic effects on the liver Are not regulated by the U.S. Food and Drug Administration (FDA) Herbal products help promote sleep. These products need to be used cautiously because they are not regulated by the U.S. Food and Drug Administration. They should not be used long term and can interact with prescribed medications. Kava needs to be used cautiously because it can be toxic to the liver.
REM Sleep
Stage usually begins about 90 minutes after sleep has begun Duration increased with each sleep cycle and averages 20 minutes Characterized by rapidly moving eyes, fluctuating heart and respiratory rates, increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions A loss of REM sleep leads to feelings of confusion and suspicion. vivid full color dreaming, less vivid dreaming occurs in other stages very difficult to arouse sleeper *RAPID eye movement *
The nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? Select all that apply. Take brief, 20-minute naps during the day. Drink a glass of wine with dinner. Eat the large meal at lunch rather than dinner. Establish a regular exercise program. Teach the patient about the side effects of modafinil (Provigil).
Take brief, 20-minute naps during the day. Establish a regular exercise program. Teach the patient about the side effects of modafinil (Provigil). Taking short naps, no longer than 20 minutes, during the day and regular exercise are management strategies that help reduce the feeling of sleepiness. Modafinil is a stimulant used to treat narcolepsy; therefore it is important for patients to understand its side effects.
Sleep Requirements by Age
Teens with decreased sleep have excessive sleepiness which leads to reduced performance in school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol. In middle age, the amount of stage 4 sleep begins to fall—a decline that continues with advancing age. Older adults experience weakening, desynchronized circadian rhythms that alter the sleep-wake cycle ----episodes of REM sleep tend to shorten. there is a progressive decrease in stages 3 & 4 NREM sleep; some older adults have almost no stage 4
Reticular Activating System (RAS)
The RAS receives visual, auditory, pain, and tactile sensory stimuli Activity from the cerebral cortex (e.g emotions or thought processes) also stimulates the RAS. Arousal, wakefulness, and maintenance of consciousness result from neurons in the RAS releasing catecholamines such as norephinephrine. --located in upper brainstem --contains special cells that maintain alertness and wakefullness
Physiology of Sleep
The biological rhythm of sleep frequently becomes synchronized with other body functions. Circadian rhythms influence the pattern of major biological and behavior functions Predictable changing of the body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood all depend on the maintenance of the 24-hour circadian cycle
assessment
Through the patient's eye Sleep assessment Sources for sleep assessment-pt, family, bed partners, parents of children Tools for sleep assessment- epworth sleepiness scale sleep is subjective only the patient is able to report whether or not it is sufficient or restful
Evaluation
Through the patient's eyes Patient outcomes Determine whether expected outcomes have been met. Are you able to fall asleep within 20 minutes of getting into bed? Describe how well you sleep when you exercise. Does the use of quiet music at bedtime help you to relax? Do you feel rested when you wake up?
Obstructive sleep apnea (OSA) (most common type)
Top risk factors are obesity and hypertension OSA occurs when muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing nasal airflow (hypopnea) or stopping it (apnea) for as long as 30 seconds. Usually have hypertension, obesity --excessive daytime sleepiness is the most common complaint --causes a serious decline in arterial oxygen saturation level
Middle and Older Adults sleep
Total number of hours declines
The nurse is discussing lack of sleep with a middle-aged adult. The nurse recognizes that insomnia in this age group is commonly due to a. Anxiety. b. Teenagers keeping them awake. c. Caring for pets. d. Late night television.
a. Anxiety. During middle adulthood, the total time spent sleeping at night begins to decline. Anxiety, depression, and illness can affect sleep, and women can experience menopausal symptoms. Insomnia is common because of the changes and stresses associated with middle age. Teenagers, caring for pets, and late night television can influence the amount of sleep; however, these are not the most common causes of insomnia in this age group.
The nurse is caring for a patient on the medical-surgical unit who is experiencing an exacerbation of asthma. Which of the following interventions would be most appropriate to help the patient sleep? a. Bed placed in semi-Fowlers position b. Increased BNC oxygen to 5 L a minute c. A snack provided before bedtime d. Encouraging the patient to read
a. Bed placed in semi-Fowlers position For patients with a physical illness, the nurse helps control symptoms that disrupt sleep. Placing the patient in an upright position eases the work of breathing. Increasing the oxygen provided would require a reason to do so, and a physicians order is required. Providing a snack and encouraging the patient to read may be good interventions for patients, but the most appropriate would be raising the head of the bed.
The nurse is caring for a patient who has not been able to sleep well while in the hospital. The nurse recognizes that lack of sleep can manifest in which of the following signs and symptoms? (Select all that apply.) a. Changes in physiological function such as temperature b. Decreased appetite and weight loss c. Anxiety, irritability, and restlessness d. Impaired judgment e. Nausea, vomiting, and diarrhea f. Shortness of breath and chest pain
a. Changes in physiological function such as temperature b. Decreased appetite and weight loss c. Anxiety, irritability, and restlessness d. Impaired judgment The biological rhythm of sleep frequently becomes synchronized with other body functions. Changes in body temperature correlate with sleep pattern. When the sleep-wake cycle becomes disrupted, changes in physiological function such as temperature can occur. Patients can experience decreased appetite, loss of weight, anxiety, restlessness, irritability, and impaired judgment. Gastrointestinal and respiratory/cardiovascular symptoms such as shortness of breath and chest pain are not symptoms of a disrupted sleep cycle.
The nurse is completing an assessment on an older patient who is having difficulty falling asleep. Which factor has the potential to contribute to this difficulty? a. Depression b. Smoking c. Alcohol d. Fatigue
a. Depression Older adults and other individuals who experience depressive mood problems experience delays in falling asleep, earlier appearance of REM sleep, frequent awakening, increased total bed time, feelings of sleeping poorly, and early awakening. Smoking (nicotine) decreases the total sleep time and REM and causes awakening or difficulty staying asleep. Alcohol speeds the onset of sleep. A person who is moderately fatigued usually achieves restful sleep.
The nurse is caring for a patient who has been in holding in the emergency department for 24 hours. The nurse is concerned about the patient experiencing sleep deprivation. What would be the best action for the nurse to take? a. Expedite the process of obtaining a medical-surgical room for the patient. b. Pull the curtains shut, dim the lights, and decrease the number of visitors. c. Obtain an order for a medication to help the patient sleep. d. Ask everyone in the unit to try to be quiet so the patient can sleep.
a. Expedite the process of obtaining a medical-surgical room for the patient. The most effective treatment for sleep deprivation is elimination or correction of factors that disrupt the sleep pattern. Nurses play an important role in identifying treatable sleep deprivation problems. Obtaining a private room in the designated unit for the patient will help with decreasing stimuli and promoting more rest than an individual can obtain in an emergency department even with the interventions mentioned.
Which nursing observation of the patient in intensive care indicates that the patient is sleeping comfortably? a. Eyes closed, lying quietly, respirations 12, heart rate 60 b. Eyes closed, tossing in bed, respirations 18, heart rate 80 c. Eyes closed, mumbling to self, respirations 16, heart rate 68 d. Eyes closed, lying straight in bed, respirations 22, heart rate 66
a. Eyes closed, lying quietly, respirations 12, heart rate 60 During NREM sleep, biological functions slow. During sleep, the heart rate decreases to 60 beats per minute or less. The patient experiences decreased respirations, blood pressure, and muscle tone
The nurse is providing an educational session on sleep regulation for new nurses in the Sleep Disorder Treatment Center. Which of these statements by the nurses would best indicate that learning has occurred? a. If the patient has a disease process in the central nervous system, it can influence the functions of sleep. b. If the patient has a disease process in the cranial nerves, it can influence the functions of sleep. c. If the patient has an interruption in the motor pathways, it can influence the functions of sleep. d. If the patient has an interruption in the spinal reflexes, it can influence the functions of sleep.
a. If the patient has a disease process in the central nervous system, it can influence the functions of sleep. Sleep involves a sequence of physiological states maintained by the central nervous system. Current theory indicates that it is an active multiphase process that involves many parts of the brain and hormone and chemical secretion. A disease process associated with the cranial nerves, motor pathway, or spinal reflexes may influence a persons ability to sleep, but the best answer is the central nervous system.
The nurse is evaluating outcomes for the patient with the nursing diagnosis of Insomnia. During this process, the nurse recognizes that a. The patient is the best evaluator of sleep. b. Interventions will need to be adjusted. c. Medical conditions will not influence outcomes. d. Observations of the patient provide needed data.
a. The patient is the best evaluator of sleep. The patient is the source for evaluating outcomes. The patient is the only one who knows whether sleep problems have improved and what has been successful. Interventions may or may not need to be adjusted. Observations do provide needed data, but in the case of insomnia, the patient is the source for evaluating the restfulness of sleep. Sometimes, the nurse has to work with the patient to redefine sleep expectations associated with medical conditions.
The nurse is completing a sleep assessment on a patient. The nurse utilizes which of the following tools to complete the assessment? a. Visual Analogue Scale b. OUCHER scale c. FACES scale d. Glasgow Coma Scale
a. Visual Analogue Scale The Visual Analogue Scale is utilized for assessing sleep quality. The OUCHER and FACES scales are used to measure pain, and the Glasgow Coma Scale is used to measure level of consciousness.
People experience cyclical rhythms
as part of their everyday lives
The nurse is having a conversation with an adolescent regarding the need for sleep. The adolescent states that it is common to stay up with friends several nights a week. Which nursing action should the nurse take? a. Discuss with the adolescents parent staying up with friends and the need for sleep. b. Discuss with the adolescent sleep needs and the effects of excessive daytime sleepiness. c. This is a normal occurrence for adolescents and action is not required. d. Explore the reason for staying up late with friends several nights a week.
b. Discuss with the adolescent sleep needs and the effects of excessive daytime sleepiness. On average, a teenager needs about 71/2 hours of sleep per night. Many activities at school, social activities, and jobs can reduce the number of sleep hours, resulting in excessive daytime sleepiness. This can lead to decreased performance at school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol. Discussion regarding adolescent sleep needs should first occur with the adolescent. Although it may be common for this adolescent to want to visit with friends and experience activities that go late into the night, these activities can and do impact the hours of sleep and the physical needs of the adolescent, no matter the reason for the late nights, and they do need to be addressed.
The nurse is caring for a patient who is having trouble sleeping. To encourage decreased stimulus to the reticular activating system and activation of the bulbar synchronizing region, which actions would the nurse implement? a. Encourage television for distraction. b. Encourage relaxed positions. c. Walk with the patient. d. Provide a favorite beverage.
b. Encourage relaxed positions. Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness. Researchers also hypothesize that the release of serotonin from specialized cells in the bulbar synchronizing region (BSR) produces sleep. As the patient closes his eyes and assumes relaxed positions, stimuli to the RAS decrease, and at some point the BSR takes over. Television, walking, and drinking a favorite beverage would not necessarily encourage sleep.
The nurse is beginning a sleep assessment on a patient. Which of the following would be the most appropriate question to ask? a. What is going on? b. How are you sleeping? c. Are you taking any medications? d. What did you have for dinner last night?
b. How are you sleeping? Asking patients how they are sleeping is an introductory question. After this beginning question is asked, problems with sleep such as the nature of the problem, signs and symptoms, onset and duration of the issue, severity, predisposing factors, and the effect on the patient can be assessed. What is going on is too broad and open ended for information about sleep to be obtained specifically. Medications and food intake can be part of the detailed assessment of sleep issues.
A patient has received a nursing diagnosis of sleep deprivation. Which of the following statements by the patient would indicate that outcomes are being met? a. I wake up only once a night to go the bathroom. b. I feel rested when I wake up in the morning. c. I go to sleep within 30 minutes of lying down. d. I only take a 20-minute nap during the day.
b. I feel rested when I wake up in the morning. Being able to sleep and feeling rested would indicate that outcomes are being met for sleep deprivation. Limiting a nap to 20 minutes is an intervention to promote sleep. Going to sleep within 30 minutes indicates that the patient may not be experiencing insomnia. Waking up during the night may indicate insomnia, and decreasing fluids in the evening is an intervention to help prevent this situation.
The nurse is discussing with a new mother the sleep requirements of a neonate. Which of these comments would indicate that the patient has an understanding of the neonates sleeping pattern? a. I cant wait to get the baby home to play with the brothers and sisters. b. I will ask my mom to come after the first week, when the baby is more alert. c. I will get the baby on a sleeping schedule the first week while my mom is here. d. I wont be able to nap during the day because the baby will be awake.
b. I will ask my mom to come after the first week, when the baby is more alert. The neonate averages about 16 hours of sleep. During the first week of life, the child sleeps almost constantly.
The nurse is caring for an adolescent who is complaining of difficulty falling asleep. Which intervention would be most appropriate? a. Adjust the temperature in the patients room to 21 C (70 F). b. Ensure that the night light in the patients room is working. c. Encourage the discontinuation of soda and chocolate nightly snack. d. Close the door to decrease noise from unit activities.
c. Encourage the discontinuation of soda and chocolate nightly snack. Cola and chocolate contain caffeine, which interferes with the ability to fall asleep. Personal preference influences the temperature of the room, as well as the lighting of the room. Noise can be a factor in the unit and can awaken the patient, but caffeine can make it difficult to fall asleep.
The nurse assigns a nursing diagnosis of ineffective breathing pattern. Which of the following sleep conditions would support this diagnosis? a. Insomnia b. Narcolepsy c. Obstructive sleep apnea d. Sleep deprivation
c. Obstructive sleep apnea Obstructive sleep apnea (OSA) occurs when the muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing airflow or stopping it for as long as 30 seconds. The person still attempts to breathe because chest and abdominal movements continue, resulting in snoring or snorting sounds. With narcolepsy, the person feels an overwhelming wave of sleepiness and falls asleep. Insomnia is characterized by chronic difficulty falling asleep. Sleep deprivation is a condition caused by dyssomnia. OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe.
Which of the following would be most important for the nurse to monitor in a patient who has obstructive sleep apnea? a. Gastrointestinal function b. Circulatory status c. Respiratory status d. Neurological function
c. Respiratory status In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing airflow and stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status take priority.
The patient has just been diagnosed with narcolepsy. The nurse provides an educational session and teaches the patient to avoid a. Antidepressant medications. b. Naps shorter than 20 minutes. c. Sitting in hot, stuffy rooms. d. Chewing gum.
c. Sitting in hot, stuffy rooms. Patients with narcolepsy need to avoid factors that increase drowsiness such as alcohol, heavy meals, exhausting activities, long-distance driving, and long periods of sitting in hot, stuffy rooms. Patients are treated with antidepressants, and management techniques involve scheduling naps no longer than 20 minutes and chewing gum. Additional management techniques include exercise, light high-protein meals, deep breathing, and taking vitamins.
The older patient is visiting the clinic after a fall during the night. Which of the following data points obtained most likely would contribute to this fall? a. The patient has been taking glucosamine. b. The patient has been taking a fish oil. c. The patient has been taking Benadryl (diphenhydramine). d. The patient has been taking vitamin C.
c. The patient has been taking Benadryl (diphenhydramine). When older adults are using Benadryl (diphenhydramine), an over-the-counter medication for sleep, caution them that they may experience dizziness, drowsiness, confusion, constipation, and urinary retention because of the long duration of action of the medication. This can contribute to a fall in an older adult. Fish oil given for the treatment of cholesterol, although an issue after a fall with potential bleeding, is not a cause for the fall, nor is glucosamine, which is used in the treatment of joint issues. Neither of these substances are utilized for sleep. Vitamin C is used to support the immune system; it is not used for sleep and does not cause falls.
The nurse is caring for a patient in the sleep lab. The nurse recognizes that the patient is in stage 4 NREM from which of the following assessments? a. The patient awakens easily. b. Body functions slow. c. The patient is difficult to awaken. d. Eyes rapidly move.
c. The patient is difficult to awaken. Stage 4 NREM is the deepest stage of sleep. The patient is difficult to arouse, vital signs are significantly lower, and this stage lasts about 15 to 30 minutes. Sleep walking and enuresis sometimes occur. Lighter sleep is seen in stages 1 and 2, where the patient awakens easily. In stage 2, body functions slow and REM sleep is characterized by rapid eye movement.
The nurse is caring for a young adult patient on the medical-surgical unit. When doing midnight checks, she sees that the patient is awake and is doing a puzzle. What is the best explanation for the patient being awake? a. The patient was waiting to talk with the nurse. b. The patient misses his family and is lonely. c. The patients sleep-wake cycle preference is late evening. d. The patient has been kept up with the noise on the unit.
c. The patients sleep-wake cycle preference is late evening. All persons have biological clocks that synchronize their sleep-wake cycle. This explains why some individuals fall asleep in the early evening and some late evening or early morning. This patient is awake and alert enough to do a puzzle. The individuals sleep-wake preference is probably late evening. Waiting to talk with the nurse, being lonely, and noise on the unit may contribute to lack of sleep, but the best explanation for the patient being awake is the biological clock.
The patient presents to the clinic with reports of irritability, being sleepy during the day, not being able to fall asleep, and being tired. Select the most appropriate nursing diagnosis. a. Anxiety b. Fatigue c. Sleep deprivation d. Insomnia
d. Insomnia Insomnia is experienced when the patient has difficulty falling asleep, frequent awakenings from sleep, and/or short sleep or nonrestorative sleep. It is the most common sleep-related complaint and includes symptoms such as irritability, excessive daytime sleepiness, not being able to fall asleep, and fatigue. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fatigue is an overwhelming sustained sense of exhaustion with decreased capacity for physical and mental work at a usual level. Sleep deprivation is a condition caused by dyssomnia and includes symptoms caused by illness, emotional distress, or medications.
The nurse is preparing an older patients evening medications. Which of the following does the nurse recognize as relatively safe for difficulty sleeping? a. Benadryl (diphenhydramine) b. Melatonin c. V alerian d. Lorazepam
d. Lorazepam One group of medications that are relatively safe are the benzodiazepines such as lorazepam. These medications cause relaxation and antianxiety and hypnotic effects. Caution older adults about using over-the- counter antihistamines because their long duration of action can cause confusion, constipation, and urinary retention. Use of nonprescription sleeping aids is not advisable. Patients need to learn the risks associated with these drugs and should be aware that the U.S. Food and Drug Administration does not regulate herbal products.
The patient shares with the nurse the vivid, full color dreams experienced by the patient last night. These data would indicate that the patient has reached what stage of sleep? a. Stage 1 NREM b. Stage 2 NREM c. Stage 3 NREM d. REM
d. REM Vivid, full color dreaming occurs during REM sleep. This stage usually begins about 90 minutes after sleep has begun. The eyes move rapidly, and heart rate, respiratory rate, and blood pressure fluctuate; loss of skeletal muscle tone occurs. The patient has an increase in gastric secretions and is difficult to arouse.
The nurse is caring for a postpartum patient. The patients labor has lasted over 28 hours within the hospital; the patient has not slept and is disoriented to date and time. What is the most appropriate nursing diagnosis? a. Impaired parenting b. Insomnia c. Ineffective coping d. Sleep deprivation
d. Sleep deprivation This patient has been deprived of sleep by staying awake during a 28-hour labor. Disorientation is one potential sign of sleep deprivation. In this scenario, we have a clear cause for the patients lack of sleep, and it is a one-time episode. Insomnia, on the other hand, is a chronic disorder whereby patients have difficulty falling asleep, awaken frequently, or sleep only for a short time. This scenario does not indicate that this has been a chronic problem for this patient. Although ineffective coping can manifest as a sleep disturbance, we have clear evidence that it was labor that deprived this patient of sleep, not an inability to cope. It could be difficult to care for an infant when sleep deprived; however, this scenario gives no evidence that this mother displays impaired parenting and is not caring adequately for her child or lacks the skills to do so.
A young mother has been hospitalized for an irregular heartbeat (arrhythmia). The night nurse comes in to see the patient awake. What would be the most appropriate nursing intervention? a. Inform the patient that it is late and time to go to sleep. b. Ask the patient if she would like medication to help her sleep. c. Recommend the great movie that is on television tonight. d. Take time to sit and talk with the patient about her inability to sleep.
d. Take time to sit and talk with the patient about her inability to sleep. Assessment is the first step of the nursing process; therefore assessment needs to be done first and involves ascertaining the cause of the patients inability to sleep. Patients who are admitted to the hospital for uncertain diagnoses can be stressed and worried about the testing and outcomes. In addition, a young mother can be worried about the care of the children and those caring for the children. This uncertainty and change in routine can cause difficulty in resting or falling asleep. Take the time to talk with the patient to determine the cause of the inability to sleep. A distraction such as a television may or may not work for the patient. After assessment is completed, a sedative may or may not be in order. Telling the patient that it is late and time to go to sleep is not a therapeutic response for an adult who is under stress.
A single dad is discussing with the nurse the sleep needs of a preschooler. Which of the following directions would be most helpful to the parent? a. It is important that the 5-year-old get a nap every day. b. Preschoolers sleep soundly all night long. c. On average, the preschooler needs to sleep 10 hours a night. d. The preschooler may have trouble settling down after a busy day.
d. The preschooler may have trouble settling down after a busy day. The preschooler usually has difficulty relaxing or settling down after long, active days. By the age of 5, naps are rare for children, except those for whom a siesta is a custom. Preschoolers frequently partially awaken during the night. On average, a preschooler needs 12 hours of sleep.
hyper somnolence disorder
excessive daytime sleepiness
*Process C* (Circadian Rhythms)
influence the internal organization of sleep, timing, and duration of sleep-wake cycles
Narcolepsy
is a dysfunction of mechanisms that regulate the sleep and waking states. During the day a person suddenly feels an overwhelming wave of sleepiness and falls asleep; REM sleep occurs within 15 minutes of falling asleep. *Cataplexy*, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day Sleep paralysis is another symptom.
Insomnia
most common sleep disorder is a symptom patients experience when they chronically have difficulty falling asleep associated with poor sleep hygiene, or practices that a pt associates w/ sleep Adjustment sleep disorder (acute insomnia), Inadequate sleep hygiene, Behavioral insomnia of childhood, Insomnia caused by medical condition
nocturia
need to urinate at night
implementation-INFANTS
no pillows, toys, blankets, etc. --fitted sheet ONLY and use sleeper for warmth
Dreams
occur in NREM and REM sleep more vivid and elaborate in REM stage important for learning, memory, and adaptations to stress
*Process S* (The homeostatic process)
primarily regulates the length and depth of sleep
*Cataplexy*
sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day
Treatment for all types of Sleep Apnea includes
therapy for underlying cardiac or respiratory complications and emotional problems that occur as a result of the symptoms of this disorder. mixed sleep apnea is the 3rd one
Toddlers sleep
total 12 hours a day
