Assessment Related to Sleep

a self-reported 19-item instrument that assesses sleep quality and sleep disturbances over a 1-month period.

Pittsburgh Sleep Quality Index

Which sleep instrument is used to assess sleep quality and disturbance over a one-month period of time? Epworth Sleepiness Scale Pittsburgh Sleep Quality Index Sleep Hygiene Index Multiple sleep latency

Pittsburgh Sleep Quality Index The Pittsburgh Sleep Quality Index, a self-reported 19-item instrument that assesses sleep quality and sleep disturbance over a one-month period.

records eye movements, muscle movement and activity, heart and respiratory rates, oxygen levels, airflow, and brain activity while a patient sleeps.

Polysomnography

Which diagnostic assessment component tests for OSA? Electroencephalogram Magnetic resonance imaging Polysomnography Echocardiogram

Polysomnography Polysomnography is an assessment component related to sleep. Polysomnography is a comprehensive recording of the biophysiological changes that occur during sleep.

a 13-item self-reported assessment that examines sleep hygiene behaviors.

Sleep Hygiene Index

Who interprets the results of a polysomnography? Health care provider Nurse Sleep specialist Neurosurgeon

Sleep specialist A sleep specialist interprets polysomnography.

Which question should a nurse include in a sleep history meeting with a patient? What time do you wake up? Do you have a pacemaker? How often do you exercise? Do you drink water?

What time do you wake up? Wake-up time is an indicator of how many hours slept.

Severe OSA is more than

30 episodes per hour.

A person suffering from mild obstructive sleep apnea would have _________ to 30 episodes per hour. Use numbers only.

15

Moderate OSA ranges from _____ to _____ episodes per hour.

15 to 30

Which number of apnea or hypopnea episodes per hour would be indicative of severe obstructive sleep apnea (OSA)? 10 20 25 35

35 Thirty-five apnea-hypopnea episodes (absent or shallow breathing episodes) per hour would be indicative of severe OSA. Severe OSA is associated with greater than 30 episodes of apnea-hypopnea per hour.

A patient is complaining of insomnia. Which question should a nurse ask the patient as part of a focused sleep assessment? "How are you coping with your lack of sleep?" "You know you shouldn't drink caffeine, right?" "People might think you're lazy when you don't have any energy, correct?" "Why have you been treating yourself with over-the-counter sleep aids? "

"How are you coping with your lack of sleep?" Coping is assessed with an open-ended respectful question that will promote discussion between the patient and nurse.

Which statement by the patient requires a focused assessment of a sleep problem by the nurse? "I am so stressed at work lately." "I have not changed any of my medications." "I wish my husband could sleep as soundly I sleep." "I do not think I have trouble sleeping."

"I am so stressed at work lately." The patient describes the timeframe for the stress as "lately," thus, indicating the possible change. A change in work could affect sleep.

Which statement by the patient requires further questioning by the nurse to determine if the patient has a sleeping disorder? "I usually fall asleep within 15 minutes of lying down and awake well rested." "I get around eight hours of sleep every night." "I painted my bedroom a peaceful blue color." "My family says I wake them with my snoring."

"My family says I wake them with my snoring." Snoring with decreased breathing is a symptom of sleep apnea, so this patient requires further questioning.

Normal number of episodes for an adult is fewer than

5 per hour

Mild OSA ranges from _____ to ______ episodes per hour.

5 to 15

What is the number of apnea or hypopnea episodes per hour for mild obstructive sleep apnea (OSA)? Fewer than 5 5 to 15 15 to 30 More than 30

5 to 15 Five to 15 episodes per hour is the range for mild OSA.

A patient is being tested for obstructive sleep apnea (OSA). What is the normal number of apnea-hypopnea episodes for an adult? Fewer than 5 per hour Twelve per hour Greater than two per minute Greater than 35 per hour

Fewer than 5 per hour The normal number of apnea-hypopnea episodes (absent or shallow breathing episodes) for an adult is fewer than five per hour.

Which question(s) asked by a nurse relate to a sleep assessment? Select all that apply. Do you eat a snack before going to bed? Do you remember your dreams? How many hours a night do you sleep? Do you feel rested in the morning? What is your bedroom like?

Do you eat a snack before going to bed? A snack could be part of a bedtime routine; thus it is related to conducting a sleep assessment. The type and amount of food and liquid consumed are recognized to affect sleep. How many hours a night do you sleep? This question is important for the nurse to assess the patient's waking and sleeping times. Do you feel rested in the morning? This question is important to assess sleep as how a person feels upon awakening, and how satisfied they are with sleep. Any changes should also be assessed. What is your bedroom like? Qualities of the bedroom could reveal relevant aspects of the normal sleep environment which is important to assess.

The health care provider refers a patient to the nurse-led sleep clinic to rule out narcolepsy. What should the nurse ask when assessing for narcolepsy? Do you sleep walk? Do you use an alarm clock? Do you fall asleep unexpectedly at random times? Do family members tell you that you snore?

Do you fall asleep unexpectedly at random times? This is a narcolepsy assessment question as individual's suffering from narcolepsy will fall asleep at random times, even during activities such as eating, playing games, and working.

Which question should a nurse ask a patient who describes symptoms of insomnia? Do you snore? Do you fall asleep at random times? Do you have trouble staying asleep? Do you have headaches when you wake up?

Do you have trouble staying asleep? Patients with insomnia wake up frequently during the night.

What question(s) would a nurse ask if narcolepsy was suspected? Have you started any new medications? Has anyone told you that you snore loudly? Is there anyone else at home who does not sleep well? Do you have vivid dreams when falling asleep?

Do you have vivid dreams when falling asleep? This is a question the nurse would ask if narcolepsy was suspected, as vivid dreams and hallucinations are symptoms of this disorder.

a self-reported 8-item questionnaire that can differentiate between sleep disorders and sleep deprivation.

Epworth Sleepiness Scale

What does polysomnography measure? Select all that apply. Eye movements Brain activity Heart rate Oxygen level Blood pressure

Eye movements Polysomnography measures eye movements, which is essential in determining REM sleep. Brain activity Polysomnography measures brain activity. Brain cells and chemicals work together to regulate sleep and the changes that take place in the brain when a person is sleep-deprived. Heart rate Polysomnography measures heart rate. Sleep related breathing disorders are linked to increased heart rates; therefore, measuring heart rate is important in validating sleep disorders. Oxygen level Polysomnography measures oxygen level. Oxygen and breathing affect sleep and can cause OSA and other sleep disorders.

A nurse is preparing an information tip sheet for clinic patients. Which question(s) could be included on the tip sheet so that patients may be prepared for a focused sleep assessment? Select all that apply. How many hours do you sleep a night? Do you have a driver's license? Do you work steady night shift? Do you have a pacemaker? Do you drink caffeinated soda?

How many hours do you sleep a night? Amount of sleep is part of a sleep assessment. Each individual depending on their age requires a specific amount of sleep. Do you work steady night shift? Work schedule is part of a sleep assessment. Individuals who rotate shifts frequently may suffer from an imbalance in their circadian rhythm. Do you have a pacemaker? A pacemaker is part of a physical assessment that is part of a sleep assessment. Heart conditions can frequently affect sleep. Do you drink caffeinated soda? Caffeinated beverages and other stimulants can affect a person's sleep and keep him or her up at night; therefore, this question is necessary as part of a sleep assessment.

Which statement is true regarding the multiple sleep latency test? It is used for patients suspected of having insomnia. It monitors patients during prolonged sleep at night. It measures brain waves during several 20 minute naps. It indicates if a patient enters NREM sleep shortly falling asleep.

It measures brain waves during several 20 minute naps. The multiple sleep latency test monitors the patient for brain waves, heartbeat, and eye movement during several 20-minute naps during the day.

A nurse is assessing a patient for a sleep disorder. The patient falls asleep during the assessment. Which disorder would the nurse suspect? Hypersomnia Sleep apnea Narcolepsy Enuresis

Narcolepsy The nurse would suspect narcolepsy. Narcolepsy is an uncontrollable desire to sleep. People with this disorder fall asleep while engaged in activities such as talking.

Which physical sign indicate potential sleep problems? Select all that apply. Nasal polyps Thick neck Deviated septum Shortness of breath Low body mass index

Nasal polyps Nasal polyps are signs of a potential sleep problem and may lead to obstructive sleep apnea. Thick neck A thick neck may be a causative factor in obstructive sleep apnea. A thick neck can affects breathing because the base of tongue and airway lining contains more fat tissue. Deviated septum A deviated septum or nasal obstruction is a sign of a potential sleep problem and a causative factor in obstructive sleep apnea because airflow is decreased. Shortness of breath Shortness of breath is a sign of a potential sleep problem and a causative factor in sleep apnea.

Presence of muscle contractions and jerks that arouse the patient from sleep Snoring Sleep apnea, a sleep disorder characterized by periods in which respiration is absent

Other physical signs that can be assessed while observing a patient sleep include:

Which are behavioral signs that may validate a sleep disturbance? Select all that apply. High energy level Slow speech Frequent yawning Normal strength Increased affect

Slow speech Slow speech is a behavioral sign that may validate a sleep disturbance. Frequent yawning Frequent yawing is a behavioral sign that may indicate a sleep disturbance.

monitors a patient's brain waves, heartbeat, and eye movements during several 20-minute naps during the day. This test is used for patients suspected of having narcolepsy, and it shows whether they enter REM sleep shortly after falling asleep.

The multiple sleep latency test

Which questions are appropriate to ask during a focused sleep assessment? Select all that apply. When did the sleep problem start? What are the symptoms of the problem? How does the problem affect daily activities? What is the type of sleep problem? Is the problem identified an officially-recognized sleep disorder?

When did the sleep problem start? When the problem or disturbance began is assessed when a problem is identified. What are the symptoms of the problem? The signs and symptoms of the problem or disturbance are assessed when a problem is identified. How does the problem affect daily activities? How the problem or disturbance affects activities of daily living is assessed when a problem is identified. What is the type of sleep problem? The type of problem or disturbance is assessed when the patient identifies a problem.

Key physical assessment findings of sleep disturbance include

inadequate energy levels for tasks, physical weakness, fatigue, lethargy, decreased affect, and behavioral findings such as yawning or slow speech.

How long does it take you to go to sleep?

insomnia

Do you have episodes of weakness, causing you to fall to the floor?

narcolepsy

Physical findings of conditions that may contribute to sleep problems include

obesity, thick neck, nasal polyps or deviated septum, and shortness of breath.

Do you have headaches when you wake up?

sleep apnea

Have you recently had any changes at home or at work?

sleep disorders