Chapter 43 Sleep NUR 225

what should a patient do if they can't fall asleep within 30 minutes of going to bed?

get out of bed and do some quiet activity until feeling sleepy enough to go back to bed

adolescence and sleep

-Adolescents typically have electronic devices such as televisions, computers, smartphones, or video games in their rooms, which further contribute to sleep disruption, poor sleep quality, and decreased amount of sleep -Shortened sleep time often results in EDS, which frequently leads to reduced performance in school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol

what are some things that hinder sleep?

-Any illness that causes pain, physical discomfort, or mood problems such as anxiety or depression often results in sleep problems -Respiratory disease often interferes with sleep -Nocturia, or urination during the night, disrupts sleep and the sleep cycle -Connections among heart disease, sleep, and sleep disorders exist -RLS (restless leg syndrome) -People with peptic ulcer disease often awaken in the middle of the night

what are the factors that influence sleep?

-drugs and substances -lifestyle -emotional stress -environment -exercise and fatigue (exercise 2 or more hours before bed) -food

sleep goes through stages ___ to ___, then reversal from ___ to ___ to ___, followed by REM

1 to 4 4 to 3 to 2

if naps are taken what is the limit?

20 minutes or less twice a day

how many hours of sleep do adolescents get/need?

7 1/2 hours

how long do sleep cycles last?

90 to 100 minutes

Which statement made by the parent of a school-age child requires follow-up by the nurse? A. "I encourage evening exercise about an hour before bedtime." B. "I offer my daughter a glass of warm milk before bedtime." C. "I make sure that the room is dark and quiet at bedtime." D. "We use quiet activities such as reading a book before bedtime."

A. "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 sleep-hygiene actions at bedtime can the nurse delegate to the nursing assistant? (Select all that apply.) A. Giving the patient a backrub B. Turning on quiet music C. Dimming the lights in the patient's room D. Giving a patient a cup of coffee E. Monitoring for the effect of the sleeping medication that was given

A. Giving the patient a backrub B. Turning on quiet music C. 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.) A. Go to bed at the same time each night. B. Study in your bedroom to have a quiet place. C. Turn on the television to help you fall asleep. D. Avoid drinking coffee or soda before bedtime. E. Turn off your cell phone at bedtime.

A. Go to bed at the same time each night. D. Avoid drinking coffee or soda before bedtime. E. Turn off your cell phone at bedtime. Going to bed at the same time each night, avoiding drinking coffee and soda before bedtime, and turning off electronic devices are effective sleep-hygiene practices for adolescents. Use of electronic devices is a main cause of sleep disruption in adolescents.

The nurse is taking a sleep history from a patient. Which statement made by the patient need further follow-up? A. I always feel tired when I wake up in the morning B. I got to bed at the same time each night C. It take me about 15 minutes to fall asleep D. Sometimes I have to get up during the night to urinate

A. I always feel tired when I wake up in the morning

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.) A. Take brief, 20-minute naps during the day. B. Drink a glass of wine with dinner. C. Eat the large meal at lunch rather than dinner. D. Establish a regular exercise program. E. Teach the patient about the side effects of modafinil (Provigil).

A. Take brief, 20-minute naps during the day. D. Establish a regular exercise program. E. 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.

Which intervention is appropriate to include on a care plan for improving sleep in the older adult? A. decrease fluids 2 to 4 hours before sleep B. exercise in the evening to increase fatigue C. allow the patient to sleep as late as possible D. take a nap during the day to make up for lost sleep

A. decrease fluids 2 to 4 hours before sleep

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) A. do not study in your bed B. go to sleep each night when you feel tired C. turn off your cell phone at bed time D. avoid drinking coffee or soda before bedtime E. turn on the television to help you fall asleep

A. do not study in your bed B. go to sleep each night when you feel tired C. turn off your cell phone at bed time D. avoid drinking coffee or soda before bedtime

The nurse is gathering a sleep history from a patient who is being evaluated for obstructive sleep apnea. Which common symptoms does the patient most likely report? (Select all that apply) A. headache B. early wakening C. excessive daytime sleepiness D. difficult falling asleep E. snoring

A. headache C. excessive daytime sleepiness E. snoring

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? A. "Antihistamines are better than prescription medications because these can cause a lot of problems." B. "Antihistamines should not be used because they can cause confusion and increase your risk of falls." C. "Antihistamines are effective sleep aids because they do not have many side effects." D. "Over-the-counter medications when combined with sleep-hygiene measures are a good plan for sleep."

B. "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 a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? A. "I'll give the baby a bottle to help her fall asleep." B. "We'll place the baby on her back to sleep." C. "We put the baby's stuffed animals in the crib to make her feel safe." D. "I know the baby will not need to be fed until morning."

B. "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.

The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? A. Have patient follow hospital routines. B. Avoid waking patient for nonessential tasks. C. Give prescribed sleeping medications at dinner. D. Turn television on low to late-night programming.

B. 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.

The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? (Select all that apply.) A. Can cause urinary retention B. Should not be used indefinitely C. May have toxic effects on the liver D. May cause diarrhea and anxiety E. Are not regulated by the U.S. Food and Drug Administration (FDA)

B. Should not be used indefinitely C. May have toxic effects on the liver E. 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.

The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? A. have patient follow hospital routines B. avoid waking patient for nonessential tasks C. give prescribed sleeping medications at dinner D. turn television on low to late-night programming

B. avoid waking patient for nonessential tasks

A patient suffers from sleep pattern disturbance. To promote adequate sleep, the most important nursing intervention is: A. administering a sleep aid B. synchronizing the medication, treatment, and vital signs schedule C. encouraging the patient to exercise immediately before sleep D. discussing with the patient the benefits of beginning a long-term nighttime medication regiment

B. synchronizing the medication, treatment, and vital signs schedule

Which statement made by an older adult best demonstrates understanding of taking a sleep medication? A. "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." B. "Sleep medicines won't cause any sleep problems once I stop taking them." C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." D. "I'll contact my health care provider if I feel extremely sleepy in the mornings."

C. "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? A. "I feel refreshed when I wake up in the morning." B. "I use soft music at night to help me relax." C. "It takes me about 45 to 60 minutes to fall asleep." D. "I take the pain medication for my leg pain about 30 minutes before I go to bed."

C. "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.

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). A. 2, 1, 3, 4 B. 1, 2, 3, 4 C. 2, 1, 4, 3 D. 1, 2, 4, 3

C. 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.

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? A. Instruct the patient to sleep in a supine position. B. Have patient limit fluid intake 2 hours before bedtime. C. Elevate the head of the bed to sleep. D. Encourage patient to take an over-the-counter sleep aid.

C. 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.

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? A. Rapid eye movement (REM) sleep B. Stage 1 non rapid eye movement (NREM) sleep C. Stage 4 NREM sleep D. Transition period from NREM to REM sleep

C. 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.

A 4-year-old pediatric patient resists going to sleep. To assist this patient, the best action to take would be: A. adding a daytime nap B. allowing the child to sleep longer in the morning C. maintaining the child's home sleep routine D. offering the child a bedtime snack

C. maintaining the child's home sleep routine

Which statement made by the patient indicates a need for further teaching on sleep hygiene? A. "I'm going to do my exercises before I eat dinner." B. "I'm going to go to bed every night at about the same time." C. "I set my alarm to get up at the same time every morning." D. "I moved my computer to the bedroom so I could work before I go to sleep."

D. "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.

The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? A. Incontinence B. Nausea and vomiting C. Bradycardia D. Respiratory depression

D. 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.

The nurse is developing a plan of care for a patient experiencing narcolepsy. Which intervention is appropriate to include in the plan? A. instruct the patient to increase carbohydrates in the diet B. have patient limit intake 2 hours before bedtime C. preserve energy by limiting exercise to morning hours D. encourage patient to take one or two 20-minute naps during the day

D. encourage patient to take one or two 20-minute naps during the day

During rounds on the night shift, you note that a patient stops breathing for 1 to 2 minutes several times during the shift. This condition is known as: A. cataplexy B. insomnia C. narcolepsy D. sleep apnea

D. sleep apnea

what can help a patient fall asleep?

a light snack of warm milk or cocoa that contains tryptophan

when does REM start how long does it last?

about 90 mins into sleep cycle lasts about 60 minutes

what regulates sleep?

hypothalamus

questions to ask to assess a patients sleep

• Describe for me the type of sleep problem you're having. • Why do you think you're not getting enough sleep? • Describe a recent night's sleep. How is this sleep different from your usual sleep? • Do you have difficulty falling asleep, staying asleep, or waking up? • Have you been told that you snore loudly? • Do you have headaches when awakening? • When did you notice the problem? • What do you do to relieve the symptom? • How long has this problem lasted? • How long does it take you to fall asleep? • How often during the week do you have trouble falling asleep? • How many hours of sleep a night did you get this week? • How does this compare to your usual amount of sleep? • What do you do when you awaken during the night or too early in the morning? • What do you do just before you go to bed? • Have you recently had any changes at work or at home? • How is your mood? Have you noticed any changes recently? • Which medications or recreational drugs do you take on a regular basis? • Are you taking any new prescriptions or over-the-counter medications? • Do you eat food (spicy or greasy foods) or drink substances (alcohol or caffeinated beverages) that affect your sleep? • Do you have a physical illness that affects your sleep? • Does anyone in your family have a history of sleep problems? • How has the loss of sleep affected you? • Do you feel excessively sleepy or irritable or have trouble concentrating during waking hours? • Do you have trouble staying awake? Have you fallen asleep at the wrong times (e.g., while driving, sitting quietly in a meeting)?

what are some signs of sleep deprivation?

• Ptosis, blurred vision • Fine-motor clumsiness • Decreased reflexes • Slowed response time • Decreased reasoning and judgment • Decreased auditory and visual alertness • Cardiac arrhythmias • Confused and disoriented • Increased sensitivity to pain • Irritable, withdrawn, apathetic • Agitated • Hyperactive • Decreased motivation • Excessive sleepiness