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NU 236 Chapter 43
Terms in this set (53)
Purpose of Sleep
Conserve energy, restore biological processes
Physiological and psychological restoration
-->During sleep the heart rate falls to 60 beats/min or less, which benefits cardiac function. Other biological functions decreased during sleep are respirations, blood pressure, and muscle tone.
Maintenance of biological functions
Occur in NREM and REM sleep
-->NREM sleep contributes to body tissue restoration.
Important for learning, memory, and adaptation to stress
-affected by light, temperature, social activites, and work routines
-The biological rhythm of sleep frequently becomes synchronized with other body functions.
-Circadian rhythms influence the pattern of major biological and behavioral functions.
nerve cells in the hypothalamus control the rhythm of the sleep-wake cycle and coordinate this cycle with other circadian rhythms.
carcardian rhythms influence
the pattern of major biological and behavioral functions. The predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood
-synchronize their sleep cycles. This explains why some people fall asleep at 8 p.m., whereas others go to bed at midnight or early in the morning. Different people also function best at different times of the day.
-Failure to maintain an individual's usual sleep-wake cycle negatively influences the patient's overall health.
-Regulated by a sequence of physiological states integrated by central nervous system (CNS) activity
Reticular Activating System
located in the upper brainstem contains special cells that maintain alertness and wakefulness.
primarly regulates the length and depth of sleep
stages of adult sleep cycle
i. Four Stages of NREM
ii. Sleep cycle lasts 90 to 100 minutes
iii. Sleep goes through 1-4, then reversal from 4 to 3 to 3 followed by REM
a. During deep slow-wave (NREM stage 4) sleep, the body releases human growth hormone for the repair and renewal of epithelial and specialized cells such as brain cells. Protein synthesis and cell division for renewal of tissues such as the skin, bone marrow, gastric mucosa, or brain occur during rest and sleep.
b. NREM sleep is especially important in children, who experience more stage 4 sleep.
a. REM sleep is necessary for brain tissue restoration and appears to be important for cognitive restoration and memory.
b. A loss of REM sleep leads to feelings of confusion and suspicion.
c. Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate; and some believe that they are functionally important to learning, memory processing, and adaptation to stress.
d. The ability to describe a dream and interpret its significance sometimes helps resolve personal concerns or fears.
a. Can cause pain, physical, discomfort, anxiety, depression, and sleep disturbances
ii. Respiratory disorders
iv. Restless leg syndrome (RLS)
v. American Academy of Sleep Medicine Classification of Sleep Disorders
Adjustment sleep disorder (acute insomnia), Inadequate sleep hygiene, Behavioral insomnia of childhood, Insomnia caused by medical condition
Primary central sleep apnea, central sleep apnea caused by medical condition, obstructive sleep apnea syndromes, excessive daytime sleepiness
Cataplexy, Sleep paralysis
Emotional stress, Medications, Environmental disturbances, Symptoms
Somnambulism (sleepwalking), Night terrors, Nightmares, Nocturnal enuresis (bed-wetting), Body rocking, Bruxism
Rest contributes to
mental relaxation, freedom from anxiety, and state of mental, physical and spiritual activity
does not guarantee that a patient will feel rested
rest conserves and restores activity
-does not imply inactivity
i. State of altered consciousness
ii. Restores energy
iii. Provides time for repair and recovery
8 to 10 hours at night for a total of 15 hours per day
8-10 at night, 15 per day
6 to 8 ½
Middle and Older Adults
total number of hours declines
a. Older adults experience weakening, desynchronized circadian rhythms that alter the sleep-wake cycle.
b. Episodes of REM sleep tend to shorten. There is a progressive decrease in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep sleep.
factors affecting sleep
a. Physical illness
b. Drugs and substances
d. Usual sleep patterns and excessive daytime sleepiness
e. Emotional stress
h. Exercise and fatigue
i. Food and caloric intake
Drug and Substances
Hypnotics, diuretics, narcotics, antidepressants, alcohol, caffeine, beta-blockers, anticonvulsants
Work schedule, social activities, routines
Usual Sleep Patterns
May be disrupted by social activity or work schedule
Worries, physical health, death, losses
Exercise and Fatigue
Moderates exercise and fatigue cause a restful sleep
Food and Calorie Intake
Time of day, caffeine, nicotine, alcohol
a. In the case of sleep, integrate knowledge from nursing and disciplines such as pharmacology and psychology
b. Use personal experience
c. Professional standards
Sources for sleep assesssessment = Patient, family
Tools for sleep assessment
Description of sleeping problems, usual sleep pattern, current life events, physical and psychological illness, emotional and mental status, bedtime routines, bedtime environment, behaviors of sleep deprivation
Description of sleeping problems
i. Conduct a more detailed history when a patient has a sleep problem. This ensures that you provide appropriate therapeutic care.
ii. Open-ended questions help a patient describe a problem more fully.
iii. Ask specific questions related to the sleep problem.
usual sleep patterns
have patients describe their normal sleep patterns
Physical and psychological illness
Current life events
Emotion and mental status
Behaviors of sleep deprivation
b. Ineffective breathing pattern
c. Active confusion
d. Compromised family coping
e. Ineffective coping
h. Sleep deprivation
i. Readiness for enhanced sleep
Goal and outcome examples
i. Follow professional standards
ii. Create a concept map
frequently sleep distrubances are the result of other health problems
Team work and collaboration
partner closely with the patient and sleep partner
i. Environmental controls
ii. Promoting bedtime routines
iii. Promoting safety
iv. Promoting comfort
v. Establishing periods of rest and sleep
vi. Stress reduction
vii. Bedtime snacks
viii. Pharmacological approaches
i. Environmental controls
ii. Promoting comfort
iii. Establishing periods of rest and sleep
iv. Promoting safety
v. Stress reduction
Restorative or continuing care
i. Promoting comfort
ii. Controlling physiological disturbances
iii. Pharmacological approaches
a. Through the patient's eyes
b. Patient outcomes
i. Determine whether expected outcomes have been met.
1. Are you able to fall asleep within 20 minutes of getting into bed?
2. Describe how well you sleep when you exercise.
3. Does the use of quiet music at bedtime help you to relax?
4. Do you feel rested when you wake up
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