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Module 1 > Sleep And Sleep Orders > Flashcards

Sleep And Sleep Orders Flashcards

1
Q

Sleep

A

A physiological process
The body’s rest cycle
Associated with recumbency and immobility
Lacks conscious awareness but easily awakened
Esssential for healthy functioning and survival

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2
Q

Actually definition of sleep

A

State in which an individual lacks conscious awareness of environmental surroundings but can be easily aroused

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3
Q

Insufficient sleep

A

Obtaining less than the recommended hour of sleep most adults require 7-8 hours in a 24 hour period

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4
Q

Fragmented sleep

A

Frequent arousal or actual awakening that interrupt sleep

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5
Q

Recumbency

A

To be laying down

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6
Q

Non restorative sleep

A

Sleep that is an adequate duration but does not result in the individual feeling fresh and alert the next day

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7
Q

What causes a person to have poor sleep quality?

A

Insomnia
Narcolepsy
Sleep apnea
Abnormalities unique to sleep

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8
Q

What is the sleep wake cycle controlled by?

A

The brain

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9
Q

What is our wake behavior controlled by

A

RAS - reticular activation system

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10
Q

What helps keep people awake?

A

Orexin

A person who has low levels of orexin tend to have narcolepsy

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11
Q

Activation of RAS causes

A

Alertness and attention

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12
Q

When RAS is activated what does it effect?

A

Motor sensory visceral consciousness

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13
Q

What does visceral mean ?

A

Normal Organ function like our heart beating

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14
Q

Rest is essential to what?

A

RAS

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15
Q

Circadian rhythm **

A

The biologic rhythm of behavior and physiology within a 24 hour period

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16
Q

What is strongly linked to circadian rhythm?

A

Light!!!! Day light is a huge factor in our circadian rhythm

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17
Q

Our body is built to be awake when it is light and asleep when it is dark

A

T/f

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18
Q

What can help a pt’s circadian rhythm if you are a nurse who works night shift to keep it normal

A

Quiet time, turn off the TV, dark curtains

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19
Q

ICU Psychosis

A

Patient not being able to distinguish day from night

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20
Q

REM

A

Rapid eye movement

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21
Q

Sleep latency

A

The time it takes for a person to fall asleep
Starts when eyes are closed for sleep and ends when NON-rem sleep is entered and can take 10-40 min

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22
Q

NREM

A

Non rapid eye movement 3 stages

75%to 80% of sleep time divided into three stages

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23
Q

Three stages of NREM

A

Stage 1 slow eye movement
Stage 2
HR and temp decrease
Stage 3 deep or slow wave sleep
SWS: delta waves. Parasomnias

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24
Q

Stage one of REM

A

A person can be easily awakened

Slow eye movements

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25
Q

Stage 2

A

HR and tempature decreases and this is where we spend most of our sleep

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26
Q

Stage 3

A

Deep or slow wave sleep

Difficult to awaken may have parasomnias

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27
Q

The older we get

A

The less deep or slow wave sleep we have

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28
Q

Parasomnias

A

Unusual and often undesirable behaviors while falling asleep, transitioning between sleep stages or during arousal from sleep due to CNS activation

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29
Q

Example of parasomnias

A

Nightmares
Sleep walking
Sleep terrors
Sleep paralysis
Sleep hallucinations

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30
Q

REM sleep

A

Brain is very active but mentally restful
Greatly reduced skeletal muscle tone
Period when most vivid dreaming occurs

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31
Q

Middle age

A

More shifts in their stages in sleep
Resistant to sleep deprivation
Increased awakenings
Changes in sleep efficiency

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32
Q

Older adults

A

Phase changes go to bed earlier and arise earlier

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33
Q

What are things that sleep deprivation can do to our bodies? Neurological

A

Cognitive impairment
Behavioral changes

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34
Q

What are things sleep deprivation can do to the body (immune)

A

Impaired function

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35
Q

What are things that sleep deprivation can affect the body (respiratory wise)

A

Asthma exacerbated during sleep

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36
Q

Cardiovascular what are things that can happen in the body because of sleep deprivation?

A

Heart diseases like hypertension dysrythmias)
BP in people with hyper tension
Stroke

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37
Q

Gastrointestinal what are some risk that can happen because of sleep deprivation?

A

Risk of obesity
Gastroesophageal reflux (GERD) disease

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38
Q

What are things that can happen because of sleep deprivation endocrine

A

Risk for type 2 diabetes
Insulin resistance
Growth hormones

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39
Q

What are some examples of sleep disturbances in the hospital?

A

Enviromental sleep-disruptive factors like beeping
Psychoactive medications
Acute and critical illness

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40
Q

Acute insomnia

A

Difficulty falling asleep or remaining asleep for at least 3 nights a week for less than a month

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41
Q

Chronic insomia

A

Same symptoms as acute
Daytime symptoms that persist for 1 month or longer

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42
Q

What can cause insomnia?

A

Stimulus like caffeine
Medication
Using alcohol to induce sleep
Irregular sleep schedules
Nightmare
Excercising near bed time
Jet lag

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43
Q

Why should you never use alcohol to induce sleep?

A

Alcohol reduces your rem sleep

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44
Q

It’s not good to excercise two hours before bed

A

T/f

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45
Q

Chronic insomnia

A

Often no known cause
Highly linked to stressful life event
Psychiatric illness or medical condition
Medications or substance abuse

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46
Q

Clinical manifestations of insomia

A

Difficult falling asleep (long sleep latency )
Frequent awakening (fragment sleep )
Prolonged nighttime awakenings
Feeling unrefreshed on awakenings (non restorative sleep)
Fatigue trouble with concentration
Forgetfulness confusion
Anxiety

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47
Q

How do we diagnose insomnia?

A

Self report
Actigraphy
Polysomnography (PSG)

48
Q

Actigraphy

A

Watch like device, worn on the wrist that can determine sleep and wake over a 14 day period

49
Q

What is the first thing you are going to do when a person thinks they have insomnia?

A

Tell them to keep a sleep log
Write down what time they went to bed
What time they woke up
Did they get up during the night
Did they feel refreshed when they woke up

50
Q

What is the next step after a sleep log?

A

Actigraphy

51
Q

What is the third thing we can do when a patient reports insomnia

A

Polysomnography

52
Q

Polysomnography

A

EEG
EOG/ECG
Thoracic movement
Abdominal movement
Breathing patterns
Heart rate
Sleep wake cycle

53
Q

Inter-professional care of insomnia

A

Education (teach what will help sleep)
Track sleep (keep log for two weeks)
Sleep hygiene
Cognitive-behavioral therapy for insomia (CBT-I)
Comple,emtatu and alternative therapies
Drug therapy

54
Q

What is the first line of treatment for insomnia

A

Cognitive-behavioral therapy for insomnia(CPT-I)

55
Q

What are the next things we can do for insomnia

A

Complementary and alternative therapies (aroma therapy melatonin)
Drug therapy

56
Q

What are two things that will help you sleep?

A

Fat and protien

57
Q

What are some things that you can include during education about sleep?

A

What will help you sleep

58
Q

Insomnia causes

A

Psychiatric
Medical illness, medications
Stress:Sundance’s employment school life
Substances caffeine alcohol nicotine
Excercise
Age gender
Other factors :travel

59
Q

Insomnia

A

Began with least invasive
Cognitive behavior therapy
Therapist
Counseling

60
Q

Melatonin

A

Hormone that helps reduce sleep designed for short term use. If patients use it for longer than a month it will no longer work

61
Q

Sedative hypnotic drug

A

A drug for sleep
Designed to decrease the CNS function
Can be used for anxiety and help with insomnia

62
Q

What is another name for antianxiety drugs?

A

Anxiolytics

63
Q

Benzodiazepines

A

Can be used for anxiety and insomnia, during general anesthesia
Used to manage sizer disorders, muscles spasms, panic disorder and alcohol withdrawal. Watch patients very carefully can get addicted

64
Q

What are some common benzodiazepines?

A

Diazepam (Valium)
Lorazepam (Ativan)
alprazolam (xanax)

65
Q

What are the common benzodiazepines used for?

A

Can cause sleepiness but not commonly used for sleep

66
Q

What are the benzodiazepines that are only used for sleep

A

Temazepam (restoril)
Triazolam (halcion)

67
Q

What can benzodiazepines will cause

A

Slow respiratory- breathing it slows down respiratory

68
Q

Adverse effects

A

CNS depression
Amnesia
Sleep driving
Paradoxical effect
Respiratory depression
Abuse

69
Q

Oral overdose of benzodiazepines

A

Drowsiness lethargy (super sleepy) and confusion

70
Q

If a person gets too much benzodiazepines

A

Gastric lovage
Activated charcoal
Dialysis

Goal is to get it out of their system

71
Q

Gastric lavage

A

We wash out their GI tract

72
Q

Activated charcoal

A

Make them throw up

73
Q

Flumazenil (Romazicon)

A

Reverses sedative effects if benzodiazepines but may not reverse respiratory depression
Monitor for seizures when benzodiazepine stopped monitor!!!!

74
Q

Benzodiazepine receptor like agents

A

Zolpidem (ambien)
Zaleplon ( sonata)
eszopiclone (lunesta)

75
Q

Zolipidem (ambien)

A

Sedative-hypnotic
Short term management of insomnia
Side effects :day time drowsiness and dizziness

People have been known to do crazy stuff like (sleep driving, doing things unknowingly)

Only for short term use

76
Q

Zaleplon (sonata)

A

Short term management of insomnia

Less bizarre side effects

77
Q

Eszopiclone (lunesta)

A

Approved for treating insomnia
Less side effects
No limitation on how long to use
Well tolerated

Low potential for abuse

78
Q

Antidepressants

A

Trazodone (oleptro)
Doxepin and amitriptyline

79
Q

Amitriptyline

A

Common antidepressant that can be used to help them sleep

80
Q

Antihistamines

A

Diphenhydramine (Benadryl)
Doxylamine (unisom)

81
Q

Unisom (doxlamine)

A

Can be used without prescription been around forever can only be used for 1-2 weeks

Can develop a tolerance

82
Q

Alternatives medicines

A

Melatonin
Valerian root, chamomile, Passion flower, lemon balm, lavender
White noise and relaxation strategies

83
Q

Epworth sleepiness scale

A

Give it to the patient to rate their sleepiness

84
Q

Sleep apnea

A

Absence of breath while sleeping

85
Q

What should you do when a pt is having trouble breathing?

A

You should raise the head of the bed

86
Q

OSA / sleep apnea

A

Obstructive sleep apnea

87
Q

Why does sleep apnea get closed?

A

Our airway gets closed

Our tongue may shifts back as well as the epiglottis

88
Q

Symptoms of sleep apnea

A

Loud snoring
Excessive day time sleepiness
Frequent episodes of obstructed breathing during sleep
Morning headache
Unrefreshing sleep
Increased irritability

89
Q

Non surgical Treatments of sleep apnea

A

Raise HOB
Decrease weight
CPAP
Drug therapy for underlying cause

90
Q

Surgical therapy

A

Adenoldectomy
Uvulectomy
Remodeling posterior oropharynx
Bariatric surgery to decrease weight

91
Q

Respiratory and sleep problems

A

Sleep apnea
Snoring and hypoventilation
Obesity hypoventilation syndrome
Reduced chest wall compliance
Increase work breathing
Decreased total lung capacity and functional residual capacity
OSA
Partial or complete upper airway obstruction during sleep
Apneic period may include hypoxemia and hypercapnia

92
Q

Complications of respiratory and sleep problems can be

A

Hypertension
Cardiac changes
Poor concentration/ memory
Impotence
Depression

93
Q

Polysomnography aka

A

Sleep study

94
Q

Mild sleep apnea treatments

A

Sleep on one side
Elevating the head of the bed
Avoid sedatives and alcohol 3 to 4 hours before sleep
Weight loss
Oral appliance

95
Q

Sleep apnea treatment severe > 15 apnea/hypopnea events/hr

A

CPAP
BiPAP
surgery
Uvulopalatopharyngoplasty (UPPP or UP3)
Genioglossal advancement and hyoid myotomy

96
Q

Narcolepsy

A

Brain unable to regulate sleep wake cycles normally
Causes uncontrollable urges to sleep often go directly into REM sleep

Unknown causes

Low levels of orexin lead to difficulty staying awake

97
Q

What are two types of narcolepsy

A

Type 1: with cataplexy
Type 2 : without cataplexy

98
Q

BiPAP

A

Is for sicker patients
One pressure on inspiration and one pressure on expiration

Try to give patient a BiPAP before they incubate them in the hospital

99
Q

If patient is on CPAP or BiPAP and they go on over night trips

A

Recommend that they take the CPAP and BiPAP with them due to shortages

100
Q

Cataplexy

A

Is a brief and sudden loss of skeletal muscle tone that can manifest as an episode of muscle weakness or complete collapse and falling

101
Q

What are some symptoms of narcolepsy

A

Sleep paralysis
Cataplexy
Fragmented nighttime sleep

102
Q

Nursing and inter professional management
Of narcolepsy

A

Teach about sleep and sleep hygiene
Take naps
Avoid heavy melas and alcohol
Ensure patient safety
Lifestyle changes

103
Q

How many naps a day should someone with narcolepsy nap

A

3 or more short naps for 15 minutes through out the day

Avoid large meals and alcohol

104
Q

Drug therapy for narcolepsy

A

Modafinil (provigil)
Armodafinil (nuvigi)
Both are wake promotion drugs

105
Q

What happens as people age?

A

They get less sleep

106
Q

Sleep paralysis

A

Mentally alert of body but body is not awake

107
Q

Why would older people get up a lot at night

A

May use the restroom
Be in pain
Medication
Need a drink of water due to dry mouth
Respiratory issues
Symptoms of insomnia

108
Q

What does more awakenings during the night for older people increase

A

The risk of falls

109
Q

Why should we avoid long acting benzodiazepines in geriatric patients

A

It can cause day time sleepiness

110
Q

Nurse fatigue

A

Inadequate sleep
Extended work hours
Increased risk for errors

111
Q

When a nurse is awake for 17 hours it is the same as

A

Blood alcohol level being at 0.05%

112
Q

If nurses are awake for more than 24 hours

A

Equivalent to blood alcohol level .10%

113
Q

What it is recommended for a nurse to work

A

No more than 12 hours in a 24 hour period
Limit to 60 hours 7 days period

114
Q

Dos of nurse fatigue

A

Take at least one break addition to lunch break
We caffeine therapeutically as a stimulant to stay awake
Nutrition
Complex carbs and proteins
Excercise

115
Q

DO NOT

A

Drink alcohol (depressant)

Module 1 (18 decks)

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