NUR 102 - EXAM 4 (Module I)

Biological clock

An internal mechanism in organisms that controls the regularity of various functions, such as sleep cycle.

Examples of Visceral Pain

Appendicitis, cholecystitis. It can cause referred pain in other body locations not associated with the stimulus

Visceral Pain

Coming from internal organs such as stomach, kidney, intestines, gallbladder, pancreas.

Examples of Cold & Heat Applicators

moist heat- tension headache; cold pack- inflammed joints

REM Sleep

rapid eye movement

Treatment for Insomnia

sleep hygiene measures, biofeedback, & relaxation techniques. Emotional or medical problems should be treated.

Examples of Parasomnias

sleepwalking, nightmares, talking in sleep, nocturnal enuresis, grinding teeth

Implementation (Pharmacologic interventions)

* Medication use * Sedatives or hypnotics - Benzodiazepines: lorazepam (Ativan), temazepam (Restoril) - Nonbenzodiazepines: zolpidem (Ambien), eszoplicone (Lunesta)

Nature of Pain

* More than a single physiological sensation by a specific stimulus - Subjective & Individualized * Health care providers may have prejudices about pts in pain. - Can limit a nurse's ability to offer care - TJC mandates a pain standard. - Nurses need to develop a "pain conscience"

Normal Sleep Requirements & Patterns (Infant)

(3 months +) * sleep 9 to 11 hours at night and several short day time naps * 30% of sleep is REM sleep

OSA

(Obstructive Sleep Apnea) * Most common form * Characterized by cessation of airflow despite the effort to breath * Occurs when muscles or structures of the oral cavity or throat relax during sleep * Usually have loud snoring * Excessive daytime sleepiness (EDS) is the most common complaint. * Loud snoring

Circadian Process

(Process C) * organization of sleep

Homeostatic Process

(Process S) * length/depth of sleep

Normal Sleep Requirements & Patterns (Neonate)

(newborn to 3 months) * average about 16 hours/day * 50% of sleep is REM sleep

Circadian Rhythms

* 24-hour, day-night cycle * Natural secretion of melatonin helps to ensure a smooth transition from wakefulness to sleep.

Normal Sleep Requirements & Patterns (School-age Children)

* 6-year-old: sleeps 11-12 hours/night * 11-year-old: sleeps 9-10 hours/night

Narcolepsy

* A CNS dysfunction of mechanisms that regulate the sleep and wake states * Falls asleep uncontrollably at inappropriate times * Treated with stimulants

Factors of Influencing Pain

* Age * Culture * Fatigue * Attention * Previous Experience * Support * Meaning of Pain * Anxiety/Depression * Coping Style

Implementation (Pharmacological)

* Analgesics - Non-opioids, opioids * Patient-Controlled Analgesia (PCA) pump * Local anesthetics * Epidural analgesia * Invasive pain relieving device

Nursing Diagnoses (sleep)

* Anxiety * Ineffective breathing pattern * Acute confusion * Ineffective coping * Fatigue * Insomnia * Sleep deprivation * Readiness for enhanced sleep * Disturbed sleep pattern

Neuropathic Pain

* Atypical processing of stimuli by the peripheral or CNS. * It is associated with damaged nerve fibers and includes phantom limb pain, pain below the level of a spinal cord injury, and diabetic neuropathy. * Usually intense, shooting, burning, or described as "pins and needles." * Typically responds to antidepressants, antispasmodics, skeletal muscle relaxants.

Pain Assessment

* Behavioral responses - Facial expressions - Decreased attention span - Crying, moaning - Body movement * Effect of pain on ADLs

Central Sleep Apnea

* Caused by cessation of diaphragmatic and intercostal respiratory effort as a result of dysfunction of the brain's respiratory control center * Impulse to breath fails, temporarily * Least common form

Insomnia

* Chronic difficulty falling asleep * Frequent awakenings from sleep * Short sleep or non-restorative sleep * Feels sleepy, fatigue, depressed, & anxious * Make sure it isn't medications you take

Rest

* Conserves and restores energy * Relieves stress * Produces enjoyment & relaxation

Sleep Apnea

* Disorder in which the individual cannot breath and sleep at the same time * Lack of airflow through the nose and mouth for periods from 10 seconds to 1-2 minutes, there can be 10 to 15 or more than 100 respiratory events per hour of sleep

Implementation (Non-pharmacologic interventions)

* Environmental controls * Bedtime routines * Promoting comfort * Promote daytime physical activity * Stress reduction * Bedtime snacks

Planning

* Goals & Outcomes * Setting priorities * Collaborative thinking

Sleep Disorders?

* Insomnia * Sleep Apnea * Narcolepsy * Deprivation * Parasomnias

Stage 3: NREM

* Involves initial stages of deep sleep * Sleeper is difficult to arouse and rarely moves * Muscles are completely relaxed * VS decline but remain regular * Lasts 15-30 minutes

Stage 1: NREM

* Lightest level of sleep * Lasts a few minutes * Easily aroused by sensory stimuli * If awakened, person feels as though daydreaming has occurred

Implementation (Non-pharmacological pain measures)

* Massage, music, meditation, exercise * Reduce pain reception and perception—promote comfort by removing or preventing painful stimuli * Anticipatory guidance * Provide procedural information * Distraction—direct pt's attention to something else. * Transcutaneous electrical nerve stimulation (TENS unit) * Relaxation * Guided Imagery * Cold & heat applications

Deprivation (Signs & Symptoms)

* May cause the following signs and symptoms: - blurred vision, fine motor clumsiness, decreased reflexes, slowed response time, decreased reasoning and judgment, inability to concentrate, cardiac arrhythmias, confusion, disorientation, increased sensitivity to pain, irritability, moodiness, withdrawn, agitation, decreased motivation, decreased productivity

Deprivation may increase?

* May increase risk for development of health problems * May increase medical errors by health care workers * May increase risk for accidents (increased risks for falls, work-related injuries)

Pain Management in the Older Adult

* Multiple chronic conditions * Polypharmacy - Drug interactions - Decreased drug absorption, metabolism, & excretion * May have increased pain threshold * Manifestations may include decreased energy, loss of appetite, lethargy, withdrawal * May deny pain to prevent becoming dependent on others

Stage 2: NREM

* Period of sound sleep * Relaxation progress * Arousal is still relatively easy * Stage lasts 10-20 minutes * Body functions slow - Rolling, shifting position - Low level muscle movements in neck & jaw

Functions of Sleep

* Physical & psychological restoration * Maintains normal biological processes and optimal immune performance * Body releases human growth hormone for repair & renewal of epithelial and specialized cells during stage 4 NREM. * Basal Metabolic Rate is lowered to conserve body's energy supply * REM important for early brain development, cognition, & memory

Factors Affecting Sleep

* Physical illness * Drugs and substances * Lifestyle * Emotional stress * Environment * Sound * Exercise and fatigue * Food and caloric intake

Acute Pain

* Physiological mechanism that protects the individual from a harmful stimulus. - Can be a warning sign of tissue damage * Follows injury, disease, or surgery * Has a rapid onset, varies with intensity and usually of short duration (minutes-6 months) * Self-limiting, an end is in sight * Threatens the patient's recovery by hampering the patient's ability to become active and involved in self-care. * Can contribute to exhaustion, immobility, sleep deprivation, pulmonary complications

Chronic Pain

* Prolonged, varies in intensity, & last longer than expected (> 6 months) * Cancer or non-cancer related - Tumor, chemotherapy, back pain * Periods of remission and exacerbation - Unpredictable

PQRRSTU

* Provocative or aggravating factors; Palliative or relieving factors * Quality * Relief measures * Region (location) or Radiation * Severity Scale * Timing (onset, duration, & frequency) * U (Usual effect of pain on patient)

Nursing Diagnoses (Pain)

* Risk for caregiver role strain * Ineffective coping * Fatigue * Impaired physical mobility * Acute pain * Chronic pain * Bathing/dressing self-care deficit * Social Isolation

Sleep Regulation

* Sleep involves a sequence of physiological states maintained by the CNS. * Reticular Activating System (RAS) * Two Process Model - Homeostatic process - Circadian Process

Care of the Older Adult

* Sleep-Wake Pattern * Environment * Medications * Diet * Physiological/Illness Factors

Normal Sleep Requirements & Patterns (Older Adults)

* Sleeping difficulties * Spend more time in stage 1 & less stage 3 & 4 NREM; some have almost no stage 4 NREM * Awaken during the night & take longer to fall asleep

Sleep

* State of altered consciousness * Restores energy * Provides time for repair and recovery of body systems

Stage 4: NREM

* Very difficult to arouse sleeper * Deepest stage of sleep * If sleep loss has occurred, sleeper will spend considerable portion of night in this stage * VS are significantly lower than during waking hours * Lasts approximately 15-30 minutes * Sleepwalking and enuresis may occu * Bed wetting can occur

REM sleep

* Vivid, full-color dreaming may occur * Usually begins about 90 minutes after sleep has begun. * Typified by autonomic response of rapidly moving eyes, fluctuating heart and resp. rates, increased or fluctuating BP. * Loss of skeletal muscle tone occurs * Gastric secretions increase * Very difficult to arouse * High brain activity - sleep paralysis

Cold & Heat Applicators

* When to use heat vs. cold—based on origin of pain * Require HCP order * Special considerations—older adults, confused patients, patients with spinal cord or neurological injuries

Normal Sleep Requirements & Patterns (Younger Adults)

* average 6-8.5 hours/night * 20% of sleep in REM sleep

What slows down during NREM?

* biological functions slow * HR slows - preserving cardiac functioning

Side Effects EDS?

* falling asleep in class * Irritability * A lot of stress

Duration of REM sleep is what with each cycle? Averages ?

* increased with each cycle * averages 20 minutes

Normal Sleep Requirements & Patterns (Adolescents)

* need between 8.5-9.5 hours sleep each night * Excessive Daytime Sleepiness (EDS)

NREM Sleep

* non-rapid eye movement * involves 4 stages

Normal Sleep Requirements & Patterns (Middle Adult)

* total hours of sleep begins to decline * Amount of Stage 4 sleep declines * Sleep disturbances

Normal Sleep Requirements & Patterns (Toddler & Preschooler)

* total sleep averages 12 hours a day - % REM sleep continues to fall - Naps - Night-time Routines - Fears, nightmares

3 Types of Sleep Apnea

- Central - Obstructive - Mixed

Stages of Sleep

- NREM sleep - REM sleep

Evaluation

- Patient care - Patient expectations

Assessment (Sleep History)

- Sleep pattern - Description of sleeping problem - Sleep diary - Physical illness - Medications - Life events - Emotional & Mental Status - Bedtime routines - Bedtime environment

Types of Pain Based on Origin

- Somatic - Visceral - Referred

Pain Assessment (Scales)

0 to 10 Numerical Pain Rating Scale FACES Pain Rating Scale (Wong-Baker) FLACC

Effects of Chronic Pain

Fatigue, anorexia, weight loss, withdrawal, depression, hopelessness, anger, job loss, inability to perform ADLs, sexual dysfunction, social isolation

Referred Pain

Sensed in a region other than the site of origin.

Parasomnias

Sleep disorders that produce abnormal sleep movements, behaviors, emotions, perceptions, and dreaming as a result of the ANS changes and skeletal muscle activity during sleep.

Treatment for Sleep Apnea

Use of a nasal continuous positive airway pressure (CPAP) device at night, sleep hygiene, weight loss program

Somatic Pain

coming from skin, bone, joints, tendon, muscle, or connective tissue