Sleep

Which statements made by the patient would indicate a sleep medication was ineffective?

"It took a lot longer to fall asleep than normal." "I woke up more frequently in the night." "My mind was very active last night after taking the medication."

Which statement made by a patient after education regarding the safe administration of common sleep medications indicates a need for further teaching?

"Maybe I should take a higher dose of antidepressants since it is my first time taking them for my sleep problems."

Which statements made by a 7-year-old patient alert the nurse about the child's ability to cope with stressors?

"My dad is not home very often." "Sometimes I talk to my friends when I am sad." "My mom and I do things together all the time."

Which statements made by an 8-year-old patient indicate school-related stress?

"My tests are so hard." "I want to be the best in my class." "The kids in my class are so competitive."

Which statement regarding common side effects would the nurse include in a teaching session for a patient who is prescribed an antidepressant for insomnia?

"Nervousness often occurs; however, this should improve within several weeks."

Sleep related breathing disorders

- Central sleep apnea and obstructive sleep apnea(OSA) -soft tissues of mouth and throat block the airway -breathing stops 60-120 seconds

REM sleep

- Increase brain activity, loss of skeletal muscle tone, gastric secretions increase, vital signs fluctuates -Vivid dreams

Parasomnias

- Undesirable behaviors that happen during sleep • Sleepwalking, sleeping, night terrors, nightmares, teeth grinding and bedwetting

Stage 1 (NREM, lighter sleep)

- decreased respiratory rate, heart rate, metabolism. -Easily arousable

Sleep deprivation can lead to an increased risk for which diseases?

-Depression -Obesity -Cardiovascular disease -Diabetes

insomnia

Symptom, not a disease. -chronic difficulty in falling asleep, frequent awakenings from sleep, and or a short sleep or non-restorative sleep

Which nonpharmacologic interventions would the nurse suggest to a patient for a healthy bedtime routine?

Taking a warm bath Reading for 20 minutes Aromatherapy

According to Roy's Adaptation Model, which is an example of a nursing action that would help a patient adapt?

Teaching the patient how to cope with the stress through deep breathing

A patient whose child died of a brain tumor several years ago initiates a fundraiser to raise money for cancer research. According to Roy's Adaptation Model, in which way is this patient adapting to stress?

Performing social role functions

A nurse is teaching a patient about the effects of medication on sleep. Which statement indicates a need for further teaching?

"Barbiturates increase REM sleep."

Which patient statement exemplifies stress appraisal?

"I am taking the loss of my job as a challenge to find a more interesting career."

Which statement by the patient regarding foods that promote sleep indicates the need for further education from the nurse?

"I should drink a few glasses of red wine in the evening to enhance the sleep I get overnight."

A female patient with tremors and circadian rhythm disorder complains that she is having difficulty sleeping and is often awakened. She frequently works nights during shift rotation. Which questions by the nurse are appropriate?

-"Have you considered switching to days permanently?" -"Are you taking any medications that may be causing you to have trouble sleeping?" -"How do you feel about a care plan to reduce awakenings?" -"Have you been tested for Parkinson disease?"

Which patient statement regarding coping indicates that teaching by the nurse has been effective?

-"The way I cope may change over time."

Which coping mechanisms are healthy for a 12-year-old who is stressed about school grades?

-Creating a daily study schedule -Talking with a teacher about how to improve grades -Making an appointment with the guidance counselor -Giving up video games for an hour a day to study

Which age-related situations are associated with increased stress in older adults?

-Dementia -Impaired hearing -Inability to dress oneself

Match the type of anxiety experienced to the patient's response to stress.

-Difficulty focusing on one task on the first day of a new job-Moderate anxiety -Enhanced focus during an important test-Mild anxiety -Heart palpitations and a sense of dread related to the loss of employment-Panic -Inability to make health care decisions for a dying parent Severe anxiety

Which situations can significantly affect the level of stress in a 50-year-old patient?

-Divorce -Physical illness -New job promotion -Upcoming presidential election

Stage 2 (NREM, lighter sleep)

-Easily arousal, brain and muscle activity decrease.

Which structures of the central nervous system are affected by a light or dark environment?

-Hypothalamus -Pineal gland -Brain stem

Which phrases describe how stress increases a patient's susceptibility to disease?

-Impairs lymphocyte activity -Increases reactivation of viruses -Accelerates progression of HIV to AIDS

Which effects on sleep can be attributed to alcohol use?

-Increased wakefulness in the last half of the night -Limited rapid eye movement (REM) sleep

Which situations would evoke general adaptation syndrome (GAS)?

-Marital infidelity -Promotion at work -Death of a loved one -Injury in a car accident

Match the central nervous system structure to its role in sleep.

-Match the central nervous system structure to its role in sleep. -Relays sensory information~ Brain stem -Secretes melatonin- basal forebrain -secretes hypocretins- Thalamus -Processes emotions- Pineal gland

Match the situation with the type of stress it exemplifies.

-Physiologic stress -Nausea felt prior to an important meeting -Psychological stress-Marital problems -Sociocultural stress-Racist remarks overheard at work

Which reactions to stress are considered unhealthy coping mechanisms?

-Refusing to discuss the stress -Chronically using pain medication -Refusing to acknowledge the stress

Which pharmacologic interventions would the nurse suggest for a patient with chronic insomnia who prefers to use supplements over medications?

Melatonin Valerian

Which patients would most likely suffer from sleep disturbances?

-Young adult female with marital problems -Older adult male who recently lost his wife in death -Child who is spending the summer away from home at camp -Adult female caring for a family member with a chronic illness

Stage 3&4(NREM, slow wave sleep)

-heavy sleep, difficulty to arouse, heart rate, respiratory rate, brain and muscle activity all at low levels -Deepest stage of sleep

Hypersomnias of central origin

-narcolepsy - falls asleep at inappropriate times - Two states: with or without cataplexy - Cataplexy - loss of voluntary muscles control

amount of sleep that neonates need

16-18 hours a sleep

A person suffering from mild obstructive sleep apnea (OSA) would have how many apneic or hypopneic episodes per hour?

5 to 15

Amount of sleep adults need

7-8 hours of sleep

Which individual would require the least amount of sleep?

70 year old

Recurring patterns of sleep last approximately how many minutes? Record your answer as a whole number.

90 minutes

Why is more sleep required for young human beings

Because they're at an important stage of their growth and development

Which patient is most likely in the rapid eye movement (REM) sleep stage?

Adolescent who awakens from a night terror

Pupil dilation in response to a stressor is an example of which type of physiologic response?

Allostasis

When assessing sleep, discuss who can provide information on a patient's sleep patterns, and how a sleep diary and assessment of sleep environment, bedtime routines, bedtime environment (temperature, safety), physical illness, and medications can provide insight into implementing solutions with patients to help reduce their sleep problems.

Assess a patient's sleep pattern to gather information about factors that usually influence sleep -sleep habits -sleep problems Sources for sleep assessment -patient, bed partners, parent. Sleep History -sleep pattern and equality, description of sleep problem, sleep diary, physical illness, medications, current life events, emotional and mental status, bedtime routines, bedtime environment, behaviors of sleep deprivation, Older adult considerations -Decline in REM sleep -Circadian rhythms change as the body ages -still require 7-8 hours of sleep per day -sleep disturbances are often related to illnesses, medications, and losses Patient expectations -Asses needs and preferences

Which medications may be effective in managing sleep disorders?

Benzodiazepines Antidepressants

positive effects of sleep and rest

Biological restoration: -Heart rest, metabolic slowdown(respirations, temperature, blood pressure, muscle tone) preserving energy. -human growth hormone released - repairs cells(brain cells) - REM sleep: Brain development, cognition, and memory -Restoration, memory consultation, and preparation.

In which way are sleep deprivation and narcolepsy similar?

Both disorders can cause hallucinations.

Which nonpharmacologic interventions would the nurse provide to an inpatient as part of evening care to promote uninterrupted sleep?

Changing bed linens Providing skin care Providing oral care Performing a partial bath

symptoms of sleep/wake disruptions

Decreased appetite, weight loss, anxiety, restlessness, irritability, impaired judgement period

A patient reports being unable to sleep, lack of energy, and no longer enjoying activities that used to be pleasurable. Which response to stress would the nurse suspect that the patient is experiencing?

Depression

The nurse is caring for a patient who reports a lack of energy and insomnia caused by stress. Which other assessment finding would the nurse anticipate?

Depression

Which question would the nurse ask when assessing for narcolepsy?

Do you fall asleep unexpectedly at random times?

Which type of coping strategy is being utilized by a patient who uses alcohol to ease anxiety?

Emotion-focused

Which nonpharmacologic intervention is most appropriate to promote rest in a patient with restless legs syndrome (RLS)?

Encouraging deep knee bends

A patient received a highly desired promotion and reports feeling anxious when thinking about beginning the new job. Which type of stress is the patient experiencing?

Eustress

Which factors are measured by polysomnography?

Eye movements Brain activity Heart rate Oxygen level

A patient with numerous medical bills experiences a physical reaction when the bills come due, including a "racing heart" and an "upset stomach." Which term describes this physiologic response?

Fight-or-flight response

Which interventions related to sleep would the nurse recommend to the parent of a pediatric patient?

Give a warm bath Read a bedtime story Provide a favorite soft toy or blanket Play soft, soothing music

Which nonpharmacologic intervention would the nurse initiate for a patient who is having difficulty falling asleep because of mild back pain?

Giving the patient a massage

Which responses to stress are considered healthy coping mechanisms?

Going to church Seeing a therapist Taking up a hobby Changing one's outlook

Which nighttime snack is appropriate for a patient with a history of insomnia?

Graham crackers

Which physiologic changes occur during sleep?

Heart rate decreases Body temperature drops Blood pressure decreases

Match the hormone to its role in the onset and duration of sleep.

Helps maintain homeostasis-Hypocretin Released in response to light-Dopamine Decreases rapid eye movement (REM) sleep when released in high levels -Cortisol Increases alertness when released in response to stress-Melatonin

Which statement made by the adult patient, while providing a sleep history, needs further follow-up?

I usually feel tired in the mornings.

Which physiologic response to stress is an example of why a patient might experience gastrointestinal distress during stressful situations?

Increase in blood flow to the muscles

Which disorder is the most common type of dyssomnia?

Insomnia

Which statement regarding coping is true?

It can improve mental status.

Which disorders are potential causes of hypersomnia?

Kidney disorders Diabetic ketoacidosis Central nervous system damage

Which interventions would the nurse take to reduce noise and promote sleep for a hospitalized patient?

Lower volume of telephone ringtones. Limit overhead pages to emergencies only at night. Monitor equipment frequently. Provide privacy by drawing curtains between patients.

Which components would be included in a sleep diary?

Meal times Caffeine intake Naps

Which reaction is a person experiencing when enhanced memory and focus occur on the first day of a new job?

Mild anxiety

A patient displaying small muscle jerks is in which stage of sleep?

NREM 2

During which sleep stage can sleepwalking occur?

NREM3

A patient with no known medical conditions reports constant fatigue and inability to stay awake. The patient also reports falling asleep while at work, having vivid hallucinations upon awakening, and brief episodes of paralysis at the beginning of sleep. The nurse suspects that this patient is suffering from which condition?

Narcolepsy

Which physical signs indicate potential sleep problems?

Nasal polyps Deviated septum Shortness of breath

Which patient has the greatest risk of developing obstructive sleep apnea (OSA)?

Obese, adult male smoker with a large neck circumference

When dealing with stressors, to which group will a 17-year-old patient most readily relate?

Peers that go to school with the patient

Which bedtime snack would be appropriate for the nurse to offer a patient to promote sleep?

Piece of oat bran toast

Which sleep instrument is used to assess sleep quality and disturbance over a 1-month period?

Pittsburgh Sleep Quality Index

Which type of coping strategy is being utilized by a cancer patient who is actively fundraising for cancer research in the community?

Problem-focused

How is factor S involved in sleep regulation

Process S ~sleep factor - rises when highest person goes to sleep

Hypothalamus

Promotes both wake and states of sleep

which sleep stage vivid dreaming occurs.

REM sleep - increased brain activity, loss of skeletal muscle tone, gastric secretions increased, vital signs fluctuate - Vivid dreams

A patient with a fluctuating heart rate is in which stage of sleep?

Rapid eye movement (REM)

How exercise and fatigue can positively and negatively impact sleep

Right before bed can will increase HR, breathing rate, adrenaline and these don't help induce sleep in the body

which of the four stages of sleep the deepest of sleep occurs?

STAGE 3&4 (NREM, slow wave sleep) ~ Heavy sleep, difficult to arouse, HR, RR, brain a muscle activity all at low levels ~ Deepest stage of sleep

Match the hormone involved in the stress response with the relevant physiologic reaction.

Secretion of corticosteroids and aldosterone-Adrenocorticotropic hormone (ACTH) Sympathetic adrenal response-Epinephrine and norepinephrine Increase of blood glucose and muscle endurance-Cortisol

Match the medication prescribed for sleep with the corresponding category.

Sedative-hypnotic ~Doxylamine Benzodiazepine ~Diphenhydramine Melatonin receptor agonist ~Zolpidem Antidepressant ~Alprazolam

Which functions of the human body are impacted by the circadian rhythm?

Sleep Digestion Body Temperature Endocrine function

Symptoms of sleep deprivation

Sleep deprivation negatively affects: - Nitrogen balance - Protein catabolism -REM sleep loss: confusion and suspicion - prolonged negative impacts on mood, equilibrium - Decreased reflexes - Decreased reasoning and judgment - confusion and disorientation - Irritability, withdrawn, apathetic - Decreased motivation - Agitated

Which behavioral cues may validate a sleep disturbance?

Slow speech Frequent yawning

Which parasomnia may be associated with self-injury and sleep-related violence?

Somnambulism

Which term is used to refer to the process of evaluating a threat by interpreting it as a threat or a challenge?

Stress appraisal

Which type of exercise would the nurse suggest a patient perform just before bed to promote sleep?

Yoga

How drugs, especially alcohol, nicotine, caffeine, and diuretics can positively and negatively impact sleep

affects sleep wake cycle prevents falling asleep shortens sleep

Which foods or drinks are examples of nervous system stimulants that disrupt the sleep cycle?

coffee, soda, and chocolate

How diuretics impact sleep

having to get up 6-8 times at night to urinate Interrupted sleep bc of urination

Which symptoms caused by low estrogen levels may interfere with a woman's sleep?

night sweats daytime fatigue

Which characteristics may a sleep-deprived person experience?

~Decreased concentration ~Difficulty making decisions ~Difficulty making decisions

Sleep related movement disorders

• Restless legs syndrome • Periodic limb movements • Sleep-related bruxism (teeth grinding)

Circadian rhythm sleep disorder

• acute or chronic • Caused by illness for example fever, difficulty breathing, or pain)emotional stress, medication's, environmental disturbances for example (frequent interruptions and sleep during nursing care, noisy neighbors or pets), and variability in the timing of sleep as a result of shift work