rest sleep comfort, pain

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rest: resting mental activity; calmness, relaxation; w/o emotional stress
anxiety reducing: physically calming; decrease BP and heart rate.
sleep: altered state of consciousness, individuals perception of and reaction to the environment are decreased.
rest can be inactive or active: active resting is taking a walk, getting some fresh air
cyclic of sleep controlled by?: centers in the lower part of the brain. These centers inhibit wakefullness, thus causing sleep.
physiological process of sleep: brain is active when sleeping--various stages
REM sleep: occurs about every 90 minutes
2 types of sleep identified by eeg: NREM and REM (rapid eye movement)
NREM: SLOW WAVE SLEEP, deep restful sleep;VS, metabolism, and muscle action slow.
most sleep during the night is?: NREM
NREM divided into 4 stages: stage 1; very light sleep, person drowsy and relaxed, eyes roll from side to side, V.S drop slightly. sleeper can be waken and this stage lasts only a few minutes.
stage 2 of NREM sleep: light sleep, eyes still, temp falls, lasts 10 to 15 minutes but constitutes 40-45% of total sleep
stage 3 of NREM sleep: more difficult to arouse; not disturbed bysensory stimuli, reflexes diminished, snoring my occur
stage 4 of NREM sleep: deep sleep called delta sleep; heart and resp drop 20-30%, very relaxed, rarely moves, difficult to arouse, restores the body physically, eyes usually roll and some dreaming occurs.
how long does REM sleep last?: 5-10 minutes
is REM sleep as restful as NREM sleep?: No, Nrem is more restful
does dreams take place during REM sleep and if so are they remembered?: yes, most dreams take place during REM sleep.dreams are usually remembered.
How does the brain react during REM sleep?: the brain is highly active, and brain metabolism increases as much as 20%.
REM sleep is also called what?: paradoxical sleep
If the sleeper is tired REM cycles are?: short- 5 min instead of 20.
the role of sleep in psychological well-being is best noticed by the deterioration in mental functioning related to sleep loss: people w/ inadequate amounts of sleep become irritable, poor concentration, difficulty making decisions.
newborns sleep how much?: 16-18 hrs a day-seven sleep periods. most time is spent in stage 3 and 4 of NREM sleep. 50% in REMinfants
infants: as long as 22 hours ;
20-30% REM sleep; half time in light sleep-movement,coughing.
toddlers: 20-30% REM sleep. most still need afternoon nap.normal sleep wake cycle established by 2 or 3 yrs.
preschoolers: 11-12 hrs of sleep;20-30 % higher than adults.
school age children: 8-12 hrs REM reduced by 20%
adolescents: 8-10 hrs;20% REM.
young adults: 7-8 hrs.
middle age adults: 6-8 hrs- 20% REM stage 4 begins to decrease.
elders: 6 hours a night; 20-25% REM. stage 5 is markedly decreased and in some instances absent. 1st REM is longer. awake more often in the night; less restorative sleep b/c of decrease in stage 4
factors affecting sleep: illness
environment
comfort
anxiety/stress
lifestyle
diet
meds
physical factors
developmental situations
fatigue
quality of sleep: getting appropriate amount of REM and NREM sleep.
quantity of sleep: total time of sleeping
illness that causes pain can result in sleep problems.: people who are ill require more sleep than normal and the normal wakefulness and rhythm of sleep is disturbed
people deprived of REM sleep do what?: spend more time in REM than normal in this stage.
reasons elders sleep is often diminished: side effects of medsgastric reflux
respiratory problems
pain
nocturia
depression
loss of partner
disruptions of bedtime routine
confusion
interventions that will promote sleep and rest: maintain usual bedtime routine, be sure environment is safe and warm, provide comfort measures such as analgesics, proper positioning, evaluate the situation and find out what the rest disturbances mean to client
fatigue: the more tired a person is, the shorter the 1st pd of REM sleep
emotional stress: anxiety increase norepinephrine through stimilation of sympathetic nervous system. results in less stage 4 NREM and REM.
alcohol: excessive alcohol disrupts REM sleep.
diet: avoid heavy meals 3 hours before bedtime
avoid alcohol and caffeine at least 4 hrs before bed
decrease fluid 2-4 hrs before sleep
avoid heavy or spicy food befor bed, can cause gi upset that disturb sleep
drugs interfere w/ sleep: alcohol
amphetamines
antidepressants
beta-blockers
bronchodilators
caffeine
decongestants
narcotics
steroids
signs/symptoms of sleep deprivation: verbal complaint
circles under eyes
change in mood
decreased attention span
insomnia: inability to obtain adequate amount or quality of sleep.
what is the most common sleep disorder?: insomnia
people suffering from insomnia do not feel?: refreshed on arising.
initial insomnia: difficulty falling asleep
intermittent insomnia: difficulty staying asleep.
terminal insomnia: early morning or premature waking
insomnia can result in?: mental overstimulation due to anxiety
hypersomnia: excessive sleep-daytime
narcolepsy: sudden wave of sleepiness that occurs in the day; nod off when conversing with someone or driving a car
what age do onset symptoms come on for narcolepsy?: between age 15-30
sleep apnea: periodic cessation of breathing during sleep.
signs/symptoms of sleep apnea: loud snoring
frequent nocturnal awakenings
excessive daytime sleepiness
insomnia
morning headaches
intellectual deteriration
irritability
other personal changes
hypertension
cardiac arrythmias
when is sleep apnea most frequent?: in men over 50 and postmenopausal women.
how long does pds of apnea last?: 10 seconds to 2 minutes, occurring during REM or NREM sleep. frequency- 50-600 times per night.
3 common types of sleep apnea: obstructive apnea
central apnea
mixed apnea
obstructive apnea: occur when the structures of the pharynx or oral cavity block the flow of air.enlarged tonsils, a deviated nasal septum, nasal polyps, and obesity predispose the client to obstructive apnea.
central apnea: defect in respiratory center of brain, breathing and airflow cease. clients with brain stem injuries and MS often have sleep apnea
mixed apnea: combo of central and obstructive apnea
when do episodes of sleep apnea begin?: usually begins with snoring;thereafter breathing ceases, followed by snorting as breathing resumes.at the end of the episode increased carbon dioxide levels in the blood cause the client to awake.
overtime apnea can cause?: arrythmias, pulmonary hypertension, and subsequent left sided heart failure, may lead to HBP or cardiac arrest.
what causes sleep deprivation?: prolonged disturbance in amount, quality and consistency of sleep; not a sleep disorder but a result of sleep disturbance
causes of REM deprivation: alcohol, barbiturates, shift work, jet lag morphine, extended stay in hospital
causes of NREM deprivation: all of those of REM plus valium, depression, resp distress, apnea, age
signs of sleep REM deprivation: restlessness, irritability, increase sensitivity to pain, excitability
signs of sleep NREM deprivation: withdrawal, lack of facial expression, excessive sleepiness
nursing history for sleep: sleep pattern (sleeping hours)
quality of sleep
sleep environment
bed time routine (glass of hot fluid)
med history
physical assessment for sleep history: facial appearance
behavior
energy level
(dark circles under eyes
puffy eyelids
reddened conjunctiva
limited facial expression indicate sleep deficiency)
main goal for clients with sleep disturbances: is to maintain or develope a sleeping pattern that provides sufficient energy for daily activities.
interventions: reducing distractions, promoting bedtime rituals, providing comfort measures, scheduling care around sleep pds, teaching stress reduction, relaxation techniques, ways to develop good sleep habits.
examples of bedtime rituals: evening stroll, listening to music, watching television, take a soothing bath, and praying.
restful environment: minimal noise, comfortable room temp, appropriate ventilation, appropriate lighting.
promoting rest and sleep: establish regular bedtime and wake up time
eliminate lengthy naps (limit to 30 min)
adequate exercise
avoid physical exertion 2 hrs before bedtime
establish routine such as a bath or a book
use bed mainly for sleep so u associate the bed for sleep only.
promoting good environment: ensure appropriate lighting, temp, ventilation
teaching; meds: use sleeping med as last resort
take analgesics before bedtime to releive aches and pains
promote client comfort and sleep by: provide loose-fitting nightwear
assist w/ hygiene
make sure be dis smooth, clean, and dry
encourage the client to void before bedtime
offer a back massage before sleep
position appropriately to aid muscle relaxation
administer analgesics 30 minutes before sleep
listen to clients concerns and deal with problems as they arise.
to keep elders warm, you may?: warm the bed with prewarmed bath blankets before the client goes to bed
use 100%cotton flannel sheets or thermal blankets b/n sheet and bedspread
encourage client to wear own clothing such as flannel nightgown
relaxation tips before bedtime: slow, deep breathing for a few minutes followed by slow rhythmic contraction and relaxation of muscles can alleviate tension and induce calm.
imagery, meditation, and yoga can also be taught.
effleurage: back massage-long, slow, gliding strokes-enhance client comfort and positive effect on blood pressure, heart rate, and resp rate.

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