Download Sleep - Nursing - Lecture Slides and more Slides Nursing in PDF only on Docsity! 6/7/2009 1 Sleep Objective #1 Describe stages of normal sleep cycle Sleep • A cyclical physiological process • Influences physiological function & behavior • Ill require more sleep & rest than healthy • 50% suffer from sleeplessness at some point in their lives • Quality sleep important in the recovery of ill • Hospital settings & the activities of its personnel make getting quality sleep difficult • Nurse needs to understand the nature of sleep, factors influencing it, & the clients’ sleep habits 2 Non‐Rapid Eye Movement • NREM – 75‐80% of sleep – Brain activity ↓ Blood pressure ↓– – Respiration ↓ – Heart rate↓ • Has four stages: 1: Drowsy transition from waking to sleeping 2: Intermediate sleep, arousal more difficult 3: Beginning of "deep" or slow‐wave, sleep 4: Deepest sleep, little contact with external sensations 3 Docsity.com 6/7/2009 2 Stage 1 NREM • Lightest level of sleep • Lasts only a few minutes • Gradual fall in vital signs • Easily aroused by sensory stimuli such as noise • If awakened, feel like daydreaming has occurred 4 Stage 2 NREM • Period of sound sleep • Relaxation progresses‐‐arousal easy • Lasts 10 to 20 minutes • Body functions continue to slow 5 Stage 3 NREM • 15 to 30 minutes • Initial stages of deep sleep • Arousal more difficult • Muscles completely relaxed • Vital signs decreased but regular 6 Docsity.com 6/7/2009 5 Objective #3 Factors Affecting Sleep • Daily routines influence sleep patterns – Working alternating shifts – Going to bed at an unaccustomed time L t i ht i l ti iti– a e n g soc a ac v es – Changing evening mealtime – Children especially sensitive to changes in bedtime routine • Illness: Pain, discomfort, or mood problems • Meds: Sleepiness & sleep deprivation common side effects of many meds • Caffeine & alcohol r/t insomnia (al ↑ onset, but wake more often) 13 Factors Affecting Sleep • Pain: Most disruptive factor to sleep • Stress linked to: – Delay in falling asleep Less deep stages– – F & early awakening • Exercise • Exercising ≥ 2‐3 hrs before h.s. allows body to cool down and promotes relaxation • Environment • Temperature, ventilation, “hospital noise” and bed size, firmness & position can negatively impact sleep quality 14 Factors Affecting Sleep Circadian rhythm: Latin term "circa dies”(about a day) Synchronized to environmental factors that are about 24 hours in length (Earth’s rotation) Influence biological & behavioral functions Fluctuations of body temperature, HR,BP,Hormone secretion Different people function best at different times Biological clock‐ ea. Person has Synchronizes the sleep cycle. i.e., morning person prefers to go to bed early & performs best in the morning Hospitals/schools do not adapt to individual’s sleep‐wake cycle preference 15 Docsity.com 6/7/2009 6 Factors Affecting Sleep • Nocturia • Need to urinate at night disrupts sleep • R/t excess fluids • Most common in older people, people with cardiac disease, diabetes, urethritis, and prostate disease F d i k• oo nta e • Eating a large, heavy and/or spicy meal at h.s. • Allergies to milk, corn, wheat, nuts, chocolate, eggs, seafood, food dyes & yeast produce insomnia • Restless leg syndrome (RLS) • Often felt by older adults • Repeated, rhythmical movements of the feet and legs • “Itching” sensation deep in the muscles • Relief only from moving the legs. Linked to low levels of iron & arterial circulation problems 16 Objective #4 Explain effects of Sleep Deprivation • Prolonged ↓ in the amount, quality, & consistency of sleep • Not a true sleep disorder 17 Sleep Deprivation Causes (for example) include: Illness (fever, difficulty breathing or pain) Emotional stress Medications Environmental (freq. nursing care) Shift work Effects: Fatigue Decreased performance Anxiety Increased illness Disorientation Hallucinations 18 Docsity.com 6/7/2009 7 Sleep Deprivation – REM/NREM sleep deprivation • Causes: Alcohol, barbiturates, morphine, demerol, shift work, jet lag, hospitalization (esp. ICU) • Signs/symptoms: Anxiety, disorientation, ↓ reasoning ability (judgment) & ability to concentrate, & marked fatigue – REM sleep deprivation • Causes: Not having enough uninterrupted REM sleep • Signs/symptoms: Irritability, & ↑ sensitivity to pain; confusion & suspiciousness; emotional lability – Outcome Planning • Pt. will report an ↑ in quantity (8 hrs.) & quality (7 on 0‐10 scale) of sleep by 3rd day p admission 19 Nursing Dimensions Sl A teep ssessmen Nursing Diagnoses Outcomes (Goals) Interventions Evaluation Objective#5 Complete a sleep assessment that identifies methods to assist a pt with restorative sleep. Sleep Assessment • Assessment focused on: – Understanding client’s usual sleep patterns – Promoting sleep is a part of care • Sleep History – Usual sleeping pattern • Sleeping ‐ waking times? • Hours of undisturbed sleep? • Quality of/satisfaction with sleep? • Time/duration of naps? – Bedtime rituals • Food or drink • TV, reading, music, • Special positions (e.g., elevated on pillows) 21 Docsity.com 6/7/2009 10 Sleep Pharmacology Benzodiazepines Benzodiazepines • Alprazolam (Xanax®) • Clonazepam (Klonopin®) • Diazepam (Valium®) • Temazepam (Restoril®) • Triazolam (Halcion®) • Actions: ↓ CNS activity by attaching to benzodiazepine receptors • Flurazepam (Dalmane®) • Lorazepam (Ativan®) • Oxazepam (Serax®) • Indications – Sedative: ↓ CNS activity – Hypnotic: Induces sleep – Anxiolytic: Decreases anxiety • Controlled Substances – Schedule IV – Dependency & addiction can form 29 Benzodiazepines Sedative‐Hypnotic effect • Flurazepam (Dalmane) Anxiolytic effect Alprazolam (Xanax) 0.25-0.5 PO bid/tid – 15‐30mg PO qhs • Temazepam (Restoril) – 7.5‐30mg PO qhs • Triazolam (Halcion) – 0.125‐0.5mg PO qhs 30 Max: 4mg/day Lorazepam (Ativan) 0.5-2mg PO q.6-8hr. Max: 4mg/day Oxazepam (Serax) 10-30mg PO tid/qid Max: 120mg/day Docsity.com 6/7/2009 11 Benzodiazepines • Onset – 30” to 1hr. for p.o. • Duration – 2 to 3 hrs. • Side Effects – Drowsiness – Dizziness – Confusion – Slurred speech – Mild amnesia – Respiratory depression 31 Benzodiazepines • Nursing Implications – Assess for side effects q shift – Assist with ambulation – HOB/siderails ↑ with call light in reach – If elderly or child dosages should be the lowest , effective dose – Advice to arise slowly from laying or sitting to standing to avoid dizziness – Prevent abrupt discontinuation 2º withdrawal symptoms – Avoid other CNS depressant drugs 32 Non‐prescription Medicinal Rx • Non‐prescription – Benadryl, sleep‐eze, sominex • Herbal – Melatonin, valerian, hops, aromatherapy • Milk C i h i l– Limit to less than 10 consecutive days – Tolerance develops – Daytime hangover – Dry mouth, blurred vision… – onta ns a c em ca precursor of melatonin • Turkey – Tryptophan 33 Docsity.com 6/7/2009 12 Further Reading • National Sleep Foundation: – Sleep quizz Sleep diary– • Sleep Medicine 34 Study Guide • Know the sequence of NREM and REM sleep cycle. • Relate developmental stages to normative sleep pattern changes. • Identify the components of sleep deprivation. • Recognize causes of sleep disruption. • Apply the nursing process to alterations in sleep. • Familiarize yourself with sedative‐hypnotic pharmacological applications and side effects. 35 Docsity.com