ATI Chapter 38: Rest & Sleep

sleep -promotes health -too little sleep leads to inability to concentrate, poor judgment, moodiness, and increased risk for accidents chronic sleep loss increased risk for obesity, depression, hypertension, diabetes mellitus, heart attack, and stroke NREM (after stage 1 NREM people cycle 4-6x through other stages-each time REM time increases) -nonrapid eye movement sleep -Stage 1 NREM-light sleep, only a few minutes, vital signs/metabolism beginning to diminish, awakens easily, feels relaxed and drowsy -Stage 2 NREM- 10-20 min in length, slightly more stimulation to awaken, increased relaxation Stage 3 NREM-deep sleep, relaxation with little movement, 15-30 min Stage 4 NREM-delta sleep, deepest sleep, 15-30min, vital signs low, physiologic rest & restoration, enuresis, sleep walking, sleeptalking possible, repair & renew of tissue REM (accounts of 75-80% of sleep time) -rapid eye movement sleep -vivid dreaming, about 90min after falling asleep, average length 20min, varying vital signs, very difficult to awaken, cognitive restoration Infant/Toddlers average 14-16 hr/day Adolescents 9-10 hr/day Adults 7-9 hr/day Common Sleep Disorders insomnia-most common- inability to get adequate sleep and feel rested-acute or chronic or intermittent- women & older adults are more prone sleep apnea more than 5 breathing cessations lasting longer than 10 seconds per hour during sleep, decreased arterial oxygen saturation levels (central (CNS) or obstructive (mouth, throat, upper airway)) narcolepsy-sudden attacks of sleep during waking hours, risk for injury Assessment sleep patterns, history, recent changes, sleep problems, linear scale (best & worst sleep), factors interfering with sleep (illness, life events, emotional stress, mental illness, diet, exercise, sleep environment, medications - bronchodilators anti-hypertensives) Nursing Interventions bedtime routine, limit waking clients, personal hygiene (back rub),don't exercise 2 hours before bedtime, comfortable sleep environment, limit alcohol, caffeine, & nicotine at least 4 hours before bed, limit fluids 2 -4 hrs before bed, muscle relaxation if anxious or stressed, consider CPAP (continuous positive airway pressure) device, OTC products (melatonin, valerian, chamomile), as provider to prescribe drugs (benzodiazepine-like medications, sedative-hypnotics zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) Nursing Interventions (Narcolepsy) exercise regularly, eat small meals high in protein, avoid activities that increase sleepiness, avoid activities that would cause injury should the client fall asleep, take stimulants provider prescribes A nurse in a provider's office is caring for a client who states that, for the past week, she has felt tired during the day and cannot sleep at night. Which of the following questions should the nurse ask when collecting data about the client's difficulty sleeping? (Select all that apply.) A. Does your lack of sleep interfere with your ability to function during the day? B. Do you feel confused in the late afternoon? C. Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day? D. Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep? E. Tell me about any personal stress you are experiencing. A, C, D, E A nurse is talking with a client about ways to help him sleep and rest. Which of the following recommendations should the nurse give to the client to promote sleep and rest? (Select all that apply.) A. Practice muscle relaxation techniques. B. Exercise each morning. C. Take an afternoon nap. D. Alter the sleep environment for comfort. E. Limit fluid intake at least 2 hr before bedtime. A, B, D, E A nurse is caring for an older adult client who has been following the facility's routine and bathing in the morning. However, at home, she always takes a warm bath just before bedtime. Now she is having difficulty sleeping at night. Which of the following actions should the nurse take first? A. Rub her back for 15 min before bedtime. B. Offer her warm milk and crackers at 2100. C. Allow her to take a bath in the evening. D. Ask the provider for a sleeping medication. C A nurse is preparing a presentation at a local community center about sleep hygiene. When explaining rapid eye movement (REM) sleep, which of the following characteristics should the nurse include? (Select all that apply.) A. REM sleep provides cognitive restoration. B. REM sleep lasts about 90 min. C. It is difficult to awaken a person in REM sleep. D. Sleepwalking occurs during REM sleep. E. Vivid dreams are common during REM sleep. A, C, E A nurse is instructing a client who has a new diagnosis of narcolepsy about measures that might help with self-management. Which of the following client statements indicates understanding of the instructions? A. "I'll add plenty of carbohydrates to my meals." B. "I'll take a short nap whenever I feel a little sleepy." C. "I'll make sure I stay warm when I am at my desk at work." D. "It's okay to drink alcohol as long as I limit it to one drink per day." B