Understanding Sleep Stages and Their Impact on Health, Study Guides, Projects, Research of Nursing

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Nursing 226 Fundamentals Exam 2 Study Guide Sleep & Rest Ch. 42 ➢ What is circadian rhythm and how does it affect our day and how does it affect our day and night if we change our sleeping habits/job? • Circadian rhythm: 24hr, day/night cycle -Circadian rhythms= influence pattern of major biological & behavioral functions; predictable changing of body temp., HR, BP, hormone secretion, sensory acuity & mood depend on maintenance of 24hr. circadian cycle. -When sleep-wake cycle becomes disrupted ( working rotating shifts) = other physiological functions change  anxiety, restlessness, irritability, impaired judgment are common s/s of sleep cycle disturbances. *Failure to maintain and individual’s usual sleep- wake cycle= negatively influences PT’s overall health ➢ Identify the stages of sleep & what happens in each stage: • NREM= NON-rapid eye movement REM= rapid eye movement • Stage 1: NREM o Stage lasts a few minutes; it includes lightest level of sleep. o Decrease physiological activity begins with gradual fall in vital signs and metabolism. o Sensory stimuli (ex. Noise) easily arouses person. o Awakened person feels as though daydreaming has occurred. *You don’t always remember dreams; ONLY when you are awoken by a disturbance (ex: alarm) • Stage 2: NREM o Stage lasts 10-20 minutes o A period of sound sleep o Relaxation progresses o Body functions continue to slow o Arousal remains relatively easy • Stage 3 NREM o Stage lasts 15-30 minutes o Involves initial stages of deep sleep o Muscles are completely relaxed o Vital signs decline but remain regular o Sleeper is difficult to arouse and rarely moves • Stage 4 NREM o Stage lasts approximately 15-30 minutes o Deepest stage of sleep o If sleep loss has occurred, sleeper spends a majority of the night in this stage o Vital signs are significantly lower than during waking hours o Sleep walking and enuresis (bed-wetting) sometimes occur o It is very difficult to arouse sleeper • REM Sleep: o Begins about 90 minutes after sleep has begun; *Very difficult to arouse the sleeper o Duration increases with each sleep cycle and averages 20 min. o Vivid, full-color dreaming occurs; less-vivid dreaming occurs in other stages o Characterized by: rapidly moving eyes, fluctuating heart & respiration rates, Increased or fluctuating BP, Decreased skeletal muscle tone, and increase of gastric secretions. *REM sleep necessary for brain tissue restoration & important for cognitive restoration ➢ What bedtime rituals would prevent a person from falling asleep? o Going to bed fully awake & thinking about other things causes insomnia o Trying to finish work or resolve family problems before bedtime o If pt. doesn’t fall asleep within 30 min. Advise pt. to get out of bed and do a quiet activity until sleepy enough for bed o Limit caffeine to morning coffee and limit alcohol intake o Avoid heavy meals for 3 hours before bedtime ➢ What are healthy bedtime rituals? o Comfortable room temp., proper ventilation, minimal sources of noise, comfortable bed, proper lighting, sometimes extra pillows are important; Important for person to go to sleep when they feel fatigued or sleepy; Avoid excessive mental stimulation before bedtime. Relaxation (deep breathing, guided imagery, reading, soft music); Wear loose-fitting nightwear; Void before bed ➢ When performing a sleep assessment, what are some questions you might want to ask? o What time do you usually get in bed each night? o How much time does it usually take to fall asleep? Do you do anything special to help you fall asleep? o How many times do you awaken during the night? Why? o What time do you typically wake up in the morning? o How many hours do you sleep each night? ➢ What are sleep assessments? o Description of sleep problems; Usual sleep patterns; Physical and psychological illness; Current lifestyle events; Emotional and mental status; bedtime routines; bedtime environment; behaviors of sleep deprivation; Meds, medical history, observation ➢ Tools for sleep assessment: o Epworth sleepiness scale (evaluates severity) o Pittsburgh sleep quality index (assesses quality and sleep patterns) o Visual analogue scale (best night/worst night sleep) o Numeric scale (0-10 sleep rating) ➢ Looking at the following sleep diagnosis, what nursing diagnosis would you choose for each patient? **(Be able to define each disorder, along with appropriate outcomes for each as well!!) o Insomnia: Chronic difficulty falling asleep, frequent awakenings from sleep, and/or a short sleep/nonrestorative sleep, associated with poor sleep hygiene- the most common sleep- related complaint. o Narcolepsy: Dysfunction of mechanisms that regulate sleep and wake states ▪ Excessive daytime sleepiness is most common complaint associated with this disorder ▪ During day, patient suddenly feels overwhelming sleepiness and falls asleep; REM occurs within 15 min. **Nursing Diagnoses for Insomnia and narcolepsy: 1. Disturbed sleep pattern R/T excessive daytime sleeping AEB difficulty falling or remaining asleep. o Ex: Physical activities, meal times, type/amount intake (alcohol & caffeine), time/length of daytime naps, evening & bedtime routines, time patient tries to fall asleep, nighttime awakenings & time of morning awakening. o Compare patient data with their pattern before sleep problem or with pattern found for other patients of same age o On the basis of this comparison: Assess for identifiable patterns (ex: insomnia) Older Adult Ch. 14 ➢ What is the best method to teach an older adult? o Use past experiences to connect new learning to previous knowledge o Make sure patient is ready to learn o Face patient (see lips) use slow and normal tone of voice ➢ How do we handle the family of an older adult? o Nurses help older adults and their families by providing information and answering questions as they make choices among care options o Help in the decision to enter a nursing home o Nurses help give info & care options (ex. Hospice, nursing home, etc…) ➢ What is the skin like of an older adult? o Loss of skin elasticity with fat loss o Pigmentation changes o Glandular atrophy (oil, sweat glands, moisture) o Thinning/ gray- white hair o Slower nail growth o Facial hair decrease in men and increase in women ➢ Healthy people 2020 o Increase the # of older adults with one or more chronic conditions who report confidence in maintaining their conditions o Decrease # of emergency department visits resulting from fall among older adults o Increase the proportion of older adults with reduced physical or cognitive functions who engage in light, moderate, vigorous leisure- term physical activities ➢ Is loss of taste and smell normal? o Yes. Both diminish; fewer taste buds ➢ What are normal and abnormal cognitive changes? o Reduction of brain cells, deposition of liposfuscin and amyloid in cells and changes in neurotransmitter levels occur with or without cognitive impairments  reducing brain cells and neuro levels ▪ Disorientation, loss of language skills, loss of ability to calculate, poor judgement is not normal ▪ Deliriumm dementia, depression ➢ What are normal and abnormal physiological changes in older adults? Normal: *Loss of skin elasticity, pigmentation changes, glandular atrophy, thinning hair white/gray *Decrease cough reflex, (Increase chest diameter, Increase airway resistance, Increase risk respiratory infections) *Thicker blood vessels , narrowing vessel lumen, loss of vessel elasticity, decreased cardiac output, decreased peripheral circulation, decreased renal blood flow, decreased bladder capacity, enlarged prostate (men), reduced sphincter tone (female) *Male: Sperm count decreased, testes smaller *Female: Decreased estrogen, atrophy of vagina/ovaries/uterus, breasts shrink *Alterations in hormone production *Decrease in saliva, gastric secretions, peristalsis, increase stomach pH * Decrease muscle mass/strength, decalcification of bones *Degeneration of nerve cells, decrease in neurotransmitters/ impulses  Decrease in vision, hearing, tastes, touch, and smell (Everything decreases except stomach pH and respiratory) Abnormal: *Pain, Memory impairment (dementia), Heart disease, HTN, Cancer, Stroke ➢ What are normal and abnormal functional changes in older adults? o Functional status  includes day-to-day ADL’s involving physical, psychological, cognitive, & social domains. o Decline in function: linked to illness or disease and its degree of chronicity (how chronic it is) o Functional status the capacity & safe performance of ADL’s & instrumental activities of daily living (IADLs) o Indicators of health/illness  ADLs ( bathing, dressing, and toileting) & IADLs (ability to write a check, shop, prepare meals, or make phone calls) Essential to independent living o Assess whether or not patient has changed the way he completes these tasks o A sudden change in function (decline in patient’s ability to perform one or more ADL’s) = sign of acute illness (Ex: pneumonia, UTI or electrolyte imbalance) or a chronic problem (Ex. DM or CVD- cardiovascular disease) ➢ What is our goal with the health of an older adult? o Focus interventions on maintaining & promoting PT’s function & quality of life o Help older adults become empowered to make their own health care decisions and realize their optimum level of health, function, and quality of life ➢ How do we promote physical well- being? o Participation in screening activities *ex. BP, mammography, pap-smears, depression, vision & hearing testing, colonoscopy o Regular exercise o Weight reduction if overweight  Eating a low-fat well- balanced diet o Moderate alcohol use o Regular dental visits o Smoking cessation o Immunization for seasonal influenza, tetanus, diphtheria, pertussis, shingles, and pneumococcal disease ➢ For older adults that live alone… think of important outcomes… o Alcohol abuse (loneliness, depression) o Loss of vision o Nutrition (may not have access to food, may not be able to cook) o Fall risks, mobility issues (withering- atrophy of muscles over time with discontinued use) o Mental health (loneliness, depression, dementia, medications, ect…) ➢ What are the variabilities among older adults? o Aging does not lead to disability or dependence o Strengths and abilities o Dependence vs. Independence o Variation of physiological, cognitive, and psychosocial health o Some are involved in their community o Small # of older adults lose the ability to care for themselves  b/c they are confused o Most live in a non-institutional setting ➢ What are the stereotypes for older adults? o Physical, cognitive, psychosocial health o That they are ill, disabled, and unattractive o That they are forgetful, confused, rigid, boring, and unfriendly o That they are not interested in sex or sexual activities o Finances and living arrangements o That they are unable to understand or learn new info o Ageism: discrimination against people b/c of increasing age ➢ What are the theories of aging? o Stochastic: View aging as a result of … o Nonstochastic: genetically programmed o Disengagement: Oldest theory; aging patient’s withdraw from (no longer do) customary roles  engage in more introspective, self-focused activities o Activity: Continuing activities performed during middle age as necessary for successful aging o Continuity/ Developmental: Personality remains same but behavior changes o Gerotranscendence; Shif t of perspective with age (how an older adult looks at things changes); change from a materialistic to a natural view. ➢ What are therapeutic interventions to assist with the aging process? o Touch, reality orientation, validation therapy, reminiscence, body-image interventions ▪ Reality Orientation: Bring back to reality ex: think they are home; remind them they are in the hospital o Sodium-containing isotonic solutions such as 0.9 normal saline are indicated for ECV replacement to prevent or treat ECV deficit ➢ What do we do when and IV hurts? o Discontinue IV, clean site, elevate extremity (if edema) start new line. ➢ IV complication and what to do? o Fluid overload: IV solution infused too rapidly or in too great an amount ▪ Signs: swelling, crackles in lungs o Infiltration : IV fluid entering subcutaneous tissue around venipuncture site (fluid leakage outside vein) ▪ Signs: edema, shiny, tight skin, coolness, pain o Extravasation: term used when a vesicant (tissue-damaging) drug enters tissue (causing damage to tissue) o Phlebitis: Inflammation of inner layer of a vein ▪ Signs: Warm, red streak  stop IV, start new line, apply moist heat o Local infection : Infection at catheter- skin entry point, during infusion or after removal of IV catheter ▪ Signs: red, warm, swelling at site o Bleeding at infusion site: Oozing or slow, continuous seepage of blood from venipuncture site ➢ Potassium is closely related to what body system? Muscular system o The body relies on potassium for a regularly contracting heart o It regulates the water balance and the acid-base balance in blood and tissues along with sodium o Known as the Sodium/Potassium pump ➢ Be able to identify normal and abnormal labs: o Normal: ▪ Specific Gravity  1.0053-1.030 ▪ HCT  Men: 42-52 Women: 37-47 ▪ Osmolarity  230-800 ▪ BUN  10-20 ▪ Sodium (Na)  135-145 ▪ Hemoglobin (Hg)  Men: 14-18 Women: 13-16 ➢ Why would a patient have edema of cardiac origin? o Venous congestion from weakened heart which no longer pumps effectively, Increase capillary hydrostatic pressure, causing edema by moving excessive fluid into interstitial space. o PT’s who have chronic heart failure have diminished cardiac output, which reduces kidney perfusion and activates RAAS edema. Action of aldosterone on the kidneys causes ECV excess & risk of hypokalemia. o Most diuretics used to treat heart failure increase risk of hypokalemia while reducing the ECV excess, Dietary sodium restriction is important with heart failure because Na+ holds water in the ECF, making the ECV excess worse. In severe heart failure restriction of both fluid and sodium is prescribed to decrease workload of heart by reducing excess circulating fluid volume. ➢ Know the foods for electrolytes- o Sodium: table salt, processed/canned food, deli foods (lunch meat) o Potassium: Bananas, citrus, melon, apricots, broccoli, potatoes, instant coffee, molasses, Brazil nuts o Magnesium: grains, beans, green leafy vegetables, seafood, meat, chocolate (undigested fat prevents absorption) o Calcium: Dairy, canned fish, broccoli, oranges (needs vitamin D for absorption, undigested fat prevents absorption) ➢ What are colloids? o Colloids: proteins in blood. Proteins are larger than electrolytes, glucose, & other molecules that dissolve easily. Most colloids are too large to leave capillaries in the fluid that is filtered, so they remain in the blood. B/c they are particles; colloids exert osmotic pressure. o Albumin: Maintains osmotic pressure in blood, is the main protein in blood. o Hespan: A volume expander, used if person needs blood but doesn’t want blood transfusion (Jehovah’s Witness) o Mannitol: Promotes diuresis of kidneys help lose water through osmosis o Blood & blood products ➢ Know the electrolyte imbalance such as hypo/hypernatremia (not limited to): o Hyponatremia: Water excess or water intoxication, is a hypotonic condition. It arises from gain of relatively more water than salt, or loss of relatively more salt than water o Physical symptoms: Extreme thirst, dry and flushed skin, postural hypotension, fever, restlessness, confusion, agitation, coma, seizures if develops rapidly or is very severe o Hypernatremia: Water deficit, is a hypertonic condition, two causes make body fluids too concentrated: -Loss of relatively more water than salt ▪ Gain of relatively more salt than water o Physical symptoms: Apprehension, nausea & vomiting, headaches, decreased level of consciousness (Confusion, lethargy, muscle weakness, coma) Seizures if develops rapidly or is very severe o Extracellular Fluid Volume Deficit: Sodium and water intake less than output, causing isotonic loss o Cause: Severely decreased oral intake of water and salt. ▪ Increased GI output: Diarrhea, vomiting, laxative overuse, or drainage from fistulas or tubes ▪ Increased renal output: Use of diuretics, adrenal insufficiency, salt-wasting renal disorders ▪ Loss of blood or plasma: Hemorrhage, burns ▪ Massive sweating without water and salt replacement o Physical symptoms: Sudden weight loss (e.g. overnight), postural hypotension, tachycardia, thread pulse, neck veins flat or collapsing with inhalation when supine, slow vein filling, oliguria (,30 mL/hr), dark yellow urine, dry mucous membranes, inelastic skin turgor, absence of tears and sweat, longitudinal furrows in tongue, thirst, restlessness, confusion, cold clammy skin, hypotension, hypovolemic shock. o Laboratory findings: Increased hematocrit; BUN greater than 25 mg/dL (8.9 mmol/L) caused by hemoconcentration; urine specific gravity greater than 1.030 o Extracellular Fluid Volume Excess: Sodium and water intake greater than output, causing isotonic gain o Cause: Excessive administration of sodium-containing isotonic parental fluids o Excessive oral intake of salty foods and water o Decreased renal output caused by elevated aldosterone: Chronic heart failure, cirrhosis, aldosterone-secreting tumor o Decreased renal output from other causes: Oliguric acute kidney disease, end-stage chronic renal disease, glucocorticoid excess o Physical symptoms: Sudden weight gain (e.g. overnight) edema (especially in dependent areas) neck veins full when upright or semi-upright, crackles in dependent portion of lungs, pulmonary edema o Laboratory findings: Decreased hematocrit; BUN less than 10 mg/dL (3.6 mmol/L) caused by hemodilution ➢ Hypovolemia vs dehydration ➢ Hypovolemia: Loss of fluids and electrolytes, Ex. Decreased vascular volume due to hemorrhage o Water& electrolyte losses about equal ➢ Dehydration: Extracellular fluid volume (ECV) deficit & hypernatremia (water deficit) occurring at the same time, common with severe diarrhea and vomiting, gastroenteritis o More water lost than electrolytes ➢ Clinical Dehydration (Extracellular fluid volume deficit plus hypernatremia: Sodium and water intake less than output, with loss of relatively more water than salt o Causes: No water intake, often with increased insensible water output through skin with fever o Physical symptoms/laboratory findings: Combination of those ECV deficit plus those for hypernatremia ➢ Parts of blood: o PRBC’s: Packed red blood cells, have been collected, processed, and stored in bags as blood product units available for blood transfusion, have antigens in their membranes o Platelets: Thrombocytes plumping, clotting at injury site o Plasma: Yellow portion of blood, 55% of total volume, a protein, contains antibodies against specific RBC antigens o WBC: Leukocytes, immune system ▪ If incompatible blood is transfused (i.e. a patient’s RBC antigens differ from those transfused), the patient’s antibodies trigger RBC destruction in a potentially dangerous transfusion reaction ➢ IV infusion: o Bolus: Drip force of gravity, drips into IV over length of time o Push: Use a syringe to push meds directly into blood through IV o Volume Controlled infusions: ▪ Piggy backs, volume control machine, mini infusers ▪ Small amounts (50-100 mL) ▪ Pumps are safer o Micro drips: 60 gtts/mL o Macro drips: 10 or 15 gtts.mL ➢ Delegation: o NAP: ▪ Safety of patient ▪ Measure I’s&O’s ▪ Take vitals ▪ Report swelling/pain at IV site