Sleep

Question 1

rest: period of inactivity allows for what

Answer 1

• repair of damaged cells
• removal of waste products
• restoration of tissues
• body and tissues heal during rest

Question 2

during rest a client must…

Answer 2

• Feel that things are under control
• Understand what is happening to them
• Be free from discomfort and irritation
• Have adequate, purposeful activity
• Know they will receive help if they needs it
• assess their needs and figure out what will help them rest (closing the door, turning off the lights, etc.)

Question 3

sleep

Answer 3

• Natural, periodically recurring physiological rest
• Revolves around circadian rhythms
• Regulated by the CNS
• Occurs in 90-110 minute cycles
• Go through stages, if awakened must start over

Question 4

NREM sleep N1(stage 1)

Answer 4

• Stage of lightest level of sleep, lasting a few minutes.
• Decreased physiological activity begins with gradual fall in vital signs and metabolism.
• Sensory stimuli such as noise easily arouse sleeper.
• If awakened, person feels as though daydreaming has occurred

Question 5

NREM N2 (stage 2)

Answer 5

• Stage of sound sleep during which relaxation progresses.
• Arousal is still relatively easy.
• Brain and muscle activity continue to slow.

Question 6

NREM N3 (stages 3 and 4)

Answer 6

• Called slow-wave sleep.
• Deepest stage of sleep.
• Sleeper is difficult to arouse and rarely moves.
• Brain and muscle activity are significantly decreased.
• Vital signs are lower than during waking hours.
• sleep walking and bed wetting
• growth hormone = stimulated
  
  • promotes wound healing

Question 7

REM sleep

Answer 7

• 25% of the night
  Vivid, full-color dreaming occurs.
• Stage usually begins about 90 minutes after sleep has begun.
• Stage is typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates, and increased or fluctuating blood pressure.
• Loss of skeletal muscle tone occurs. (super relaxed)
• Gastric secretions increase.
• It is very difficult to arouse sleeper.
• Duration of REM sleep increases with each cycle and averages 20 minutes.
• go thru multiple cycles of sleep

Question 8

nursing assessment questions (subjective data)

Answer 8

• Sleep Patterns (How much do you usually sleep? What time do you usually go to bed? Problems falling asleep? Staying asleep? Reasons? Early morning awakening? Quality of sleep? Rate on scale 1-10. Use of sleep aids or rituals? Naps?)
• Medication/Diet: Alcohol, Caffeine, Anti-depressents, Hypnotics, Diuretics, Nicotine, Opiates

Question 9

physiological symptoms of sleep deprivation

Answer 9

• Ptosis, blurred vision
• Fine-motor clumsiness
• Decreased reflexes
• Slowed response time
• Decreased reasoning and judgement (foggy. can’t think straight)
• Decreased auditory and visual alertness
• Cardiac arrhythmias
• Frequent yawning, dozing

Question 10

psychological symptoms of sleep deprivation

Answer 10

• Confused and disoriented
• Increased sensitivity to pain
• Irritable, withdrawn, apathetic
• Agitated
• Hyperactive
• Decreased motivation
• Excessive sleepiness

Question 11

symptoms of sleep deprivation

Answer 11

• REM Deprived
  
  • Fatigue, difficulty concentrating
• Deep Sleep Deprived
  
  • Apathetic –> no energy. completely out of it
  • Physically uncomfortable –> eyes burn, weak, black under-eyes
  • Drawn appearance –> looks tired
• try to give pts 90-110 min to ensure they are getting at least one good sleep cycle

Question 12

nursing diagnostic categories

Answer 12

• Impaired Sleep (p 132 Gulanick Myers)
  
  • Difficulty initiating or maintaining sleep or a
    change in one’s normal sleep-wake pattern
• Sleep Deprivation
  
  • Prolonged periods without sleep (sustained,
    natural, periodic, suspension of relative
    consciousness.

Question 13

projected outcomes

Answer 13

NOC (Nursing Outcome Classifications)
* Rest
* Sleep
- Indicators
- Hours of sleep
- Sleep pattern
- Sleep quality
- Sleep efficiency
- pt would verbalize it

Question 14

nursing interventions

Answer 14

• Encourage daytime activity
  
  • AM naps better
  • exercise within 2 hours of bedtime
• Emotional support to relieve stress & anxiety
• Plan care
• provide a restful environ
  
  • reduce distractions in HC setting
  • TV on or off? Light on or off?
• reposition PRN (adjusting casts, turning as needed, cough suppressant if it is keeping them up)
• Adjust binders, dressings, casts
• Prevent coughing
• Provide Comfort
• Use sleeping medication judiciously
  
  • Beware of half-life of
    medications
• Good sleep hygiene
  
  • Constant sleep schedule
  • Limit caffeine intake
  • If no sleep in 30 minutes, get out of bed
• no heavy meals 3 hrs before bed
• don’t study in bed, answer emails, etc bc it sends mixed signals to brain

Question 15

evaluation

Answer 15

• Is the patent sleeping better?
  
  • Observation
  • Verbal Report
• reassess
  
  • are you sleeping better
  • do you feel well rested
  • are you falling asleep okay?

Question 16

Which of the following
substances will promote
normal sleep patterns?

Answer 16

A. Caffeine
B. L-Tryptophan (CORRECT ANSWER)
C. Narcotics
D. Alcohol

Question 17

In teaching methods to promote sleep habits at home, the nurse instructs the client to

Answer 17

A. Use the bedroom only for sleep or sexual activity (CORRECT ANSWER)
B. Eat a large meal 1 to 2 hours before bedtime
C. Exercise vigorously before bedtime
D. Stay in bed if sleep does not come after 1⁄2 hour

Question 18

Because of significant concerns about financial problems a middle-aged client complains of difficulty sleeping. Which of the following would be an appropriate outcome for the nursing diagnosis, Insomnia related to anxiety response secondary to financial concerns AMB difficulty falling asleep, c/o fatigue on awakening? By day 5, Mr. D will

Answer 18

A. Sleep 8 to 10 hours per day (not realistic)
B. Report falling asleep within 20-30 minutes (CORRECT) this is helpful in making his symptoms going away
C. Have a plan to pay his bills
D. Will begin an activity that will keep him busy in the evening

Question 19

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?

Answer 19

A. The patient was waiting to talk with the nurse. (would call the nurse)
B. The patient misses his family and is lonely. (we would have to assess that)
C. The patient’s sleep-wake cycle preference is late evening. (CORRECT)
D. The patient has been kept up with the noise on the unit.

Question 20

The nurse is caring for a patient in the sleep lab. The nurse recognizes that the patient is in stage 4 REM from which of the following assessments?

Answer 20

A. Irregular respirations. (CORRECT)
B. Fluctuating blood pressure. (CORRECT)
C. The patient is difficult to awaken. (stages 3 or N3)
D. Eyes rapidly move (CORRECT)

Question 21

factors affecting sleep: age

Answer 21

• Neonate—sleep 16-18 hours/ day, 50% REM
• Infants—Diurnal pattern with naps (total 15 hours)
• Pre School- 12 hours
• School age—9-12 hours/night
• Adolescents—8-10 hours of sleep
• Adults – 6-9 hours
• Older adults–amt needed doesn’t ↑, but quality ↓ due to frequent awakening

Question 22

factors affecting sleep: drugs and substances

Answer 22

• Barbiturates and alcohol—speed onset of sleep, ↓REM sleep, Withdrawal causes REM rebound
• Amphetamines—REM rebound
• Caffeine–↓ ability to fall asleep, ↑ awakening at night
• Hypnotics—only effective temporarily. Can cause rebound insomnia
• L-Tryptophan—protein in milk, cheese, meat—promotes sleep. Many prescription meds affect sleep

Question 23

factors affecting sleep: lifestyle

Answer 23

1. Working rotating shifts disrupts body’s clock
2. Changing evening meal time can disrupt sleep schedule
3. Sleep routine important—food?, reading? TV?

Question 24

factors affecting sleep: emotional stress

Answer 24

1. Depression—early morning awakening
2. Anxiety—trouble initiating or maintaining sleep

Question 25

factors affecting sleep: environment

Answer 25

1. Good ventilation is essential 2. Harder surfaces --> more body movement 3. Sounds—low level awaken in stage N1, louder awaken stage N3 4. Light—preferences differ 5. Temperature--preferences differ

Question 26

factors affecting sleep: exercise and fatigue

Answer 26

1. Exercise best 2 hours before bedtime 2. Excess fatigue can make falling sleep difficult

Question 27

factors affecting sleep: physical illness

Answer 27

1. Respiratory illness—SOB, URI impair 2. CAD--↑attack 5-6 AM 3. Sleep apnea—snores at night, c/o daytime sleepiness - Causes ↓ in arterial O2 level—can lead to dysrhythmias, right heart failure, angina 4. ↑BP—early morning awakening & fatigue 5. Nocturia—diuretics, prostate condition cause night time awakening 6. Restless leg syndrome—older adults a. Happens at rest, not when legs active b. Deep itch sensation in muscle c. Relieved by moving legs, can’t sleep 7. Endocrine disturbances a. Hypothyroid—decrease stage IV b. decrease estrogen—hot flashes, night sweats

Question 28

factors affecting sleep: food and caloric intake

Answer 28

1. Food allergies--insomnia 2. Large heavy meals --> indigestion --> insomnia 3. weight gain --> sleep periods longer w/ fewer interruptions 4. weight loss --> sleep shortened and fragmented