What is sleep?
altered state of consciousness Person’s perception of & reaction to the environment are decreased decrease in physical activity Changes in body's physiological processes RAS is involved with “sleep-wake” cycle
Why is sleep important?
normal development restoring energy & mental function balancing nervous system good health improve healing
What are the two physiology stages of sleep?
1) Non-Rapid Eye Movement Sleep (NREM) 2) Rapid Eye Movement Sleep (REM) (occurs every 90 minutes, stay in REM for 5-30 minutes then go back to NREM and cycle restarts
What happens in stage 1 of NREM sleep?
Decrease in physiological activity- (Decrease HR & RR) feeling drowsy Easily awakened
What happens in stage 2 of NREM sleep?
(last for 10-15 min. 44-55% of sleep/night) relaxation continues RelaxBodily processes starts to slow down
What happens in stage 3 of NREM sleep?
Initial stage of “deep sleep” HR + PR slows down Skeletal muscles relax, reflexes diminished Basal metabolic rates decrease 10% to 30% snoring
What happens in stage 4 of NREM sleep?
deepest stage of sleep HR + PR significantly lower Difficult to arouse
What are the deepest stages of NREM sleep?
Best stage for restoring energy in NREM?
What are the characteristics of REM sleep?
Dreams Fluctuating VS- HR & RR often irregular, BP surges can occur, T regulation is minimal/absent Increase brain activity Distinctive rapid eye movement Voluntary muscle tone decreased Gastric secretions increase
When does REM sleep happen?
Occurs at end of each cycle (about every 90 mins. and lasts 5-30 mins.)
What is the purpose of REM sleep?
memory storage learning & thinking stimulated
Factors affecting sleep?
health & illness emotional stress environment lifestyle stimulant (caffeine) & alcohol diet smoking motivation medication
Consequences of chronic sleep loss?
increase risk of hypertension Increased risk of diabetes increase risk of obesity Increased risk of depression increase risk of heart attack Increased risk of CVA (stroke)
What are 3 sleep disturbances?
insomnia sleep apnea parasomnia
What is insomnia?
Most common sleep problem inability to fall asleep/remain asleep
What is sleep apnea?
Frequent periodic cessation of breathing during sleep (> 5 apneic episodes longer than 10 seconds/hour)
What is parasomnia?
(sleep disorder where abnormal events occur during sleep) Somnambulism (sleep walking) Sleeptalking Bruxism (grinding of the teeth) Nocturnal enuresis (bedwetting)
Complications of insomnia?
obesity hypertension risk of heart disease risk of diabetes poor immune system
What is sleep deprivation?
Decrease in the quantity & quality of sleep Due to prolonged sleep disturbance
Responses to sleep deprivation?
- physiological (objective data) -behavioural (objective data)
Objective Data (Physiological): Inspection for lack of rest?
Reddened conjunctiva dark circles under eyes Dull, glazed eyes limited facial expression Slumped posture slurred speech
Objective Data (Behavioural): Inspection for lack of rest?
Inattentiveness confusion Slowed speech yawning Rubbing eyes lethargy
Subjective data collection for lack of rest?
"fatigue" irritable "difficulty sleeping" "difficulty concentrating" “decreased attention” "increased distractibility" "reduced motivation" "melaise" “sleep is interrupted during the night”
Self Care Practices (SCPs) Subjective Data for rest?
what time do you go to sleep? How many hours of sleep/night? what is your usual bedtime routine? Have you noticed a change in your usual sleep pattern? How long? do you engage in activities to help you relax before bed? Do you take medications to help you sleep?
Data Collection for “Rest” (BCF)?
age developmental stage patterns of living health state health care system factors
Data Collection for “Rest” in patient's chart?
patient’s sleep history nurse’s notes on patient’s sleep
Non-Parmacologic actions to enhance quality & quantity of sleep?
Establishing a regular wake-sleep routine engaging in exercise during the day creating a conductive environment to sleep. Environment that is dark, quiet, comfortable. drinking warm milk before bedtime
Actions to enhance quality & quantity of sleep?
Engaging in relaxation techniques prior to bedtime (reading, listening to soft music, taking a warm bath) Avoiding naps during day (> 30 minutes) Avoiding the following items in the evening: -alcohol/caffeine 4 hours before bed -engaging in stimulating activities - using bedroom for activities associated with stressful activities -drinking too much fluid 2-4 hours before bedtime -avoid heavy meals 2-3 hours before bedtime
Actions to enhance quality & quantity of sleep in hospital?
Non-Parmacologic: loose fitting nightwear assist with hygiene practices make sure bed linen is smooth, clean, & dry assist or encourage patient to void before bedtime offer a back massage before sleep schedule medication like diuretics in the morning to prevent waking up at night for pain- administer analgesics 30 minutes before sleep for breathing problems- administer prescribed bronchodilators before bedtime & position patient in high fowlers to facilitate breathing Older patient= more cold at night = due to changes in circulation, metabolism, & body tissue density reduce the older patient's ability to generate & conserve heat= give flannel blanket & socks & sweater
How does growth & development affect Body Alignment & Activity Level?
affects body posture body proportion. body mass, movement, reflexes
How does nutrition affect Body Alignment & Activity Level?
poorly nourished = weak & fatigue. Inadequate calcium & vitamin D = risk of osteoporosis
How do values affect Body Alignment & Activity Level?
attitudes, culture, geographical location
How do external factors affect Body Alignment & Activity Level?
hot T & increased humidity = less exercise. Decreased = less ability to join groups
Other factors that affect Body Alignment & Activity Level?
prescribed limitations to movement by MD Physical health- Pain, MS, stroke, head & spinal cord injuries mental health: depression
Benefits of exercise on musculoskeletal system?
Maintains size, shape, strength, tone of skeletal muscles. Increase bone density (walking/dancing)
Benefits of exercise on cardiovascular system?
Reduces “bad” high blood cholesterol & hypertension & obesity Increases HR & strengthens heart muscle contraction and cardiac output
Benefits of exercise on respiratory system?
Increases ventilation & oxygenation = improved gas exchange
Benefits of exercise on Gastrointestinal system?
Improves appetite, increases, GI tract, tone, improves digestion & elimination
Benefits of exercise on metabolic system?
Increases metabolic rate Cells more responsive to insulin decreases body fat improves blood glucose control
Benefits of exercise on urinary system?
increased excretion of waste due to more efficient blood flow
Benefits of exercise on immune system?
potentially increasing resistance to viral infection & prevention of motion of malignant cells.
What is muscle atrophy?
decrease in the size of a muscle
What is muscle hypertrophy?
muscle enlargement due to strenuous exercise
What is muscle contracturs?
permanent shortening of a muscle & subsequent shortening of tensions and ligaments
What to look for in muscle assessment?
Inspect/palpate: Size & shape of muscles of your patient’s muscles presence of any tremors presence of contractures muscle texture: at rest (firm/soft) Muscle texture: with movement (firm, soft)
What are nodules on joints?
formation of new body growth on end of joint
What is crepitation?
A palpable or an audible crackling or grating sensation/sound produced by bone rubbing against bone (at a joint).
What to look for in muscle assessment?
Inspection/Palpate: Edema, contracture, deformity, &redness = injury or inflammation crepitation Skin T over joints nodules on joints The degree of joint movement (reported or palpable tenderness)
What is activity tolerance?
type and amount of activity an individual can perform
Changes that you would observe in a patient who is unable to tolerate strenuous activity?
1) HR or RR that significantly exceeds baseline levels 2) dizziness, weak, short of breath (SOB), chest pain 3) Diastolic B.P. changes of > 10 mmHg 4) sudden facial pallor (pale)
Define pain? (PQRST)
P= precipitating (causes) & palliation (action to relieve pain) Q= quality (described pain) R= region (location) & radiation (does pain move) S= severity (0-10 scale) T= time (constant or intermittent) Also important to assess how the pain affects patient’s daily life/impact of pain
Case Study: Carol Reed Carol Reed is a 23 year old college nursing student. She complains of fatigue and difficulty sleeping. She has dark circles under her eyes. She states she has difficulty concentrating on her course work. Objective data:? Subjective data:?
Objective data: Dark circles under her eyes Subjective data: "fatigue" and "difficulty sleeping" "difficulty concentrating on her course work"
You believe that Carol has not been getting enough sleep. Besides the data described in the above case study, identify other data that you should collect to validate your hypothesis regarding Carol’s need for rest and sleep. objective (physiological)? objective (behavioural)? SCP?
1) Objective (Physiological) Reddened conjunctiva, Dull, glazed eyes, Limited facial expression, Slumped posture, Slurred speech 2) Objective (Behavioural) Inattentiveness, Yawning, Rubbing eyes, Confusion 3) SCPs What time does Carol go to sleep? Wake-up? How long does Carol usually sleep? Determine reasons Carol cannot sleep (anxiety, fear, etc) What activities does Carol engage in the evenings
You analyze/examine all the pieces of data you have collected from Carol. Develop the following for Carol’s situation: Action demand: ? Actions (identify 4 of them)?
Action demand: Promote/Improve quality of sleep in a 23 year old nursing student by: Actions (identify 4 of them) Reducing sleep disruptions Drinking warm milk prior to bedtime Engaging in relaxation techniques prior to bedtime (reading, listening to soft music, taking a warm bath) Avoiding naps during day (> 30 minutes) Engaging in exercise during the day
Sleep cycle picture