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Questions and Answers

What is the primary difference between rest and sleep?

Physical activity

Level of consciousness (correct)

Energy expenditure

Duration of inactivity

What is the sequence of stages in a normal sleep cycle?

REM, IV, III, II, then I

I, II, III, IV, then back to III, II, and REM (correct)

I, II, III, IV, REM

IV, III, II, I, then REM

What is the role of the circadian cycle in sleep preparation?

Enhancing mental activity

Increasing body temperature

Reducing energy expenditure

Releasing melatonin (correct)

What is wakefulness characterized by?

Mental activity and energy expenditure Signup and view all the answers

What happens after the person enters REM sleep?

They re-enter NREM sleep at stage II Signup and view all the answers

What is the purpose of sleep?

To restore mental and physical function Signup and view all the answers

What is the recommended sleep duration for newborns and infants in a 24-hour period?

16-24 hours Signup and view all the answers

At what age do most children typically stop taking naps during the day?

5 years old Signup and view all the answers

What is the average sleep requirement for teenagers?

7-10 hours Signup and view all the answers

What percentage of REM sleep is typically observed in young adults?

20% Signup and view all the answers

Which of the following factors can affect sleep patterns?

All of the above Signup and view all the answers

What is the recommended dietary habit to promote sleep?

Eating a small protein snack with a healthy complex carbohydrate before bed Signup and view all the answers

What is the most common sleep disorder?

Insomnia Signup and view all the answers

What is the circadian rhythm?

A biological clock that exists in all humans Signup and view all the answers

What is the effect of exercise on sleep patterns?

Exercise increases fatigue and promotes relaxation Signup and view all the answers

Which of the following is associated with poor sleep?

Smoking and nicotine Signup and view all the answers

What is a common complaint of patients with insomnia?

Recent weight gain Signup and view all the answers

What is characterized by 5 or more predominantly obstructive respiratory events?

Obstructive Sleep Apnea (OSA) Signup and view all the answers

Which disorder is characterized by excessive sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep?

Narcolepsy Signup and view all the answers

What is a characteristic of Circadian Rhythm Sleep-Wake Disorders?

an alteration in the internal circadian timing system Signup and view all the answers

What is a type of Parasomnia that involves dramatic or violent dreams while experiencing vivid dreams?

REM sleep behavior disorder Signup and view all the answers

What is a type of Parasomnia that occurs when a person eats and drinks while sleeping but has no recollection of eating when they wake up?

Sleep-related eating disorder Signup and view all the answers

What is a common feature of sleep terrors?

Waking up screaming Signup and view all the answers

What is a condition in which a person is unable to move when waking up from a nap or sleep?

Sleep paralysis Signup and view all the answers

What is a common feature of patients with Obstructive Sleep Apnea (OSA)?

They have diminished breathing efforts Signup and view all the answers

What is a document that records information about a person's sleep patterns?

Sleep Diary Signup and view all the answers

What is pain?

Pain is whatever the patient says it is, whenever it is expressed Signup and view all the answers

What type of pain is localized to the place of injury?

Localized pain Signup and view all the answers

What is the characteristic of chronic pain?

Maladaptive pain that persists or recurs for more than 3 months Signup and view all the answers

What type of pain is produced by a disease and often occurs when organs stretch abnormally?

Visceral pain Signup and view all the answers

What is the difference between acute and chronic pain?

Acute pain lasts for less than 3 months and chronic pain lasts for more than 3 months Signup and view all the answers

What type of pain is an example of a heart attack?

Referred pain Signup and view all the answers

What is the primary action to take when a patient reaches a score of 4 on the Numeric Sedation Scale?

Discontinue the opioid and consider administering naloxone Signup and view all the answers

Which of the following age groups may require special attention to non-verbal cues when assessing pain?

Children and older adults Signup and view all the answers

What is the purpose of patient-controlled analgesia (PCA) pumps?

To allow patients to self-administer medications at a fixed rate Signup and view all the answers

What is the medication administered intravenously to counteract the effects of opioid-induced somnolence?

Naloxone Signup and view all the answers

What is the primary benefit of using epidural analgesia and peripheral nerve blocks for pain management?

They allow for more targeted pain relief than other methods Signup and view all the answers

What is the primary advantage of topical anesthesia in pain management?

It is less invasive than other methods Signup and view all the answers

What is a characteristic of chronic pain?

It has periods of remission and exacerbation Signup and view all the answers

What is the term for pain that is not classified as nociceptive or neuropathic in nature?

Nociplastic pain Signup and view all the answers

What is an example of a behavioral response to pain?

Moving away when touched Signup and view all the answers

What is the term for pain that occurs in an amputated limb?

Phantom pain Signup and view all the answers

What is a factor that can affect the pain experience?

All of the above Signup and view all the answers

What is a type of pain that is initiated by actual or threatened damage to nonneural tissue?

Nociceptive pain Signup and view all the answers

What is a type of pain that is often described as burning, electric, tingling, or stabbing?

Neuropathic pain Signup and view all the answers

What is a goal of patient pain assessments?

To understand the client's pain experience and develop an effective pain management plan Signup and view all the answers

What is an example of a nonopioid analgesic?

Tylenol Signup and view all the answers

What is a potential side effect of opioid analgesic administration?

All of the above Signup and view all the answers

What is the primary indicator of abdominal fat?

Waist circumference Signup and view all the answers

Which of the following proteins is complete?

Soy protein Signup and view all the answers

What is the process by which dietary protein is broken down into amino acids?

Protein digestion Signup and view all the answers

What is the recommended WHR for females?

Less than 0.8 Signup and view all the answers

What is the function of pancreatic enzymes in protein digestion?

To break down dietary protein into amino acids Signup and view all the answers

What is the primary component of all body structures?

Protein Signup and view all the answers

What is the recommended daily protein intake for adults?

0.8 g/kg of body weight Signup and view all the answers

What is the purpose of TPN nutritional therapy?

To bypass the gastrointestinal tract and provide nutrients through a central vein Signup and view all the answers

What is the difference between fat-soluble and water-soluble vitamins?

Fat-soluble vitamins are stored in the body, while water-soluble vitamins are not Signup and view all the answers

What is the typical pH range of an aspirate from the stomach?

4 to 6 Signup and view all the answers

What is the purpose of the gate theory in pain management?

To explain why mechanical and electrical interventions may provide effective pain relief Signup and view all the answers

What is the characteristic of vitamin A deficiency?

Nightblindness Signup and view all the answers

What is the purpose of a PEG tube?

To provide nutrients through a surgically placed gastrostomy tube Signup and view all the answers

What is the difference between anorexia and obesity?

Anorexia is a decrease in food intake, while obesity is an increase in food intake Signup and view all the answers

What is the purpose of a PEJ tube?

To provide nutrients through a surgically placed jejunostomy tube Signup and view all the answers

What is the action potential of pain signals?

The exchange of ions through the nerve cell membrane Signup and view all the answers

What is the primary function of sleep?

To restore mental and physical function Signup and view all the answers

What is the characteristic of wakefulness?

A time of mental activity and energy expenditure Signup and view all the answers

What is the sequence of events in a normal sleep cycle?

NREM stage I, II, III, and IV, then REM, and back to NREM stage II Signup and view all the answers

What is the role of the circadian cycle in sleep preparation?

To decrease body temperature and release melatonin Signup and view all the answers

What is the main difference between rest and sleep?

Sleep is accompanied by altered consciousness, while rest is not Signup and view all the answers

What is the purpose of NREM sleep?

To restore mental and physical function Signup and view all the answers

What is a characteristic of patients with Sleep-Related Breathing Disorder, specifically Obstructive Sleep Apnea (OSA)?

They report not having a restful sleep even though they are getting the amount of sleep they need. Signup and view all the answers

What is the term for excessive sleepiness during the day?

Hypersomnolence Signup and view all the answers

What is a common feature of sleep enuresis?

It occurs when the child is at least 5 years old. Signup and view all the answers

What is a type of Parasomnia characterized by dramatic or violent dreams?

REM sleep behavior disorder Signup and view all the answers

What is a characteristic of individuals with Sleep Apnea?

They have an occluded airway. Signup and view all the answers

What is a common complaint of patients with insomnia?

They have trouble falling asleep or staying asleep. Signup and view all the answers

What is a type of Parasomnia that involves eating and drinking while sleeping, but having no recollection of eating when waking up?

Sleep-related eating disorder Signup and view all the answers

What is a characteristic of Narcolepsy?

It is characterized by excessive sleepiness during the day. Signup and view all the answers

What is a type of Parasomnia that involves sleepwalking?

Somnambulism Signup and view all the answers

What is a document that records information about a person's sleep patterns?

Sleep diary Signup and view all the answers

What is the average sleep requirement for newborns and infants in a 24-hour period?

16-24 hours Signup and view all the answers

At what age do children typically stop taking naps during the day?

5 years old Signup and view all the answers

What is the recommended sleep duration for young adults?

7-9 hours Signup and view all the answers

What is the primary factor that can affect sleep patterns, according to the text?

All of the above Signup and view all the answers

What is the effect of a small protein snack combined with a healthy complex carbohydrate before bed on sleep?

It improves sleep Signup and view all the answers

What is the most common sleep disorder, according to the text?

Insomnia Signup and view all the answers

What is the primary indicator of sleep disturbances in older adults?

All of the above Signup and view all the answers

What is the recommended dietary habit to promote sleep, according to the text?

Eating a small protein snack with a healthy complex carbohydrate before bed Signup and view all the answers

What is the effect of psychological stress on sleep patterns, according to the text?

It affects sleep patterns Signup and view all the answers

What is the primary benefit of promoting relaxation and sleep through lifestyle and habits, according to the text?

It improves sleep quality Signup and view all the answers

What is the main goal of assessing pain quality?

To understand the severity and characteristics of the pain Signup and view all the answers

Which of the following is an example of a non-pharmacologic pain relief measure?

Using humor therapy Signup and view all the answers

What is the primary purpose of using a Numeric Sedation Scale?

To assess the patient's risk of respiratory depression Signup and view all the answers

Which population may require special attention to non-verbal cues when assessing pain?

Older adults and children Signup and view all the answers

What is the primary benefit of using patient-controlled analgesia (PCA) pumps?

Improved pain management Signup and view all the answers

What is the term for pain that is widespread and refers to pain that is more or less all over or at least in many areas?

Diffuse Signup and view all the answers

What is the medication administered intravenously to counteract the effects of opioid-induced somnolence?

Naloxone Signup and view all the answers

Which of the following is an example of a cultural and ethnic variable that can affect the pain experience?

All of the above Signup and view all the answers

What is the term for the process of assessing pain, including evaluating its onset, duration, and quality?

Pain assessment Signup and view all the answers

What is the primary benefit of using topical anesthesia for pain management?

Reduced risk of systemic side effects Signup and view all the answers

What is the primary purpose of a sleep diary?

To assess sleep disturbances Signup and view all the answers

Which type of pain is often described as burning, electric, tingling, or stabbing?

Neuropathic pain Signup and view all the answers

What is the term for pain that persists or recurs for more than 3 months?

Chronic pain Signup and view all the answers

What is an example of a behavioral response to pain?

Withdrawal Signup and view all the answers

What is the term for pain that occurs in an amputated limb?

Phantom pain Signup and view all the answers

What is the primary purpose of assessing pain in patients?

To develop an effective pain management plan Signup and view all the answers

What is the term for pain that is not classified as nociceptive or neuropathic in nature?

Nociplastic pain Signup and view all the answers

What is an example of a physiologic response to pain?

Increased blood pressure Signup and view all the answers

What is the term for pain that is initiated by actual or threatened damage to nonneural tissue?

Nociceptive pain Signup and view all the answers

What is an example of a somatic pain?

Cutaneous pain Signup and view all the answers

Study Notes

Rest, Sleep, and Wakefulness

Rest refers to a decreased state of activity, with a feeling of being refreshed.
Sleep is a state of rest accompanied by altered consciousness and relative inactivity, part of the sleep-wake cycle.
Wakefulness is a time of mental activity and energy expenditure.

Stages of Sleep

A normal sleep cycle consists of four stages of NREM (non-rapid eye movement) sleep.
The stages are consecutive, then reversed, and finally enter REM (rapid eye movement) sleep.
The cycle repeats, with the person re-entering NREM sleep at stage II.

Circadian Cycle

The circadian cycle is a biological clock that exists in all humans.
The body prepares for sleep at night by decreasing body temperature and releasing melatonin.

Developmental Patterns of Sleep

Newborns and infants: 16-24 hours of sleep in a day, in 4 hour increments.
Toddlers: 11-14 hours of sleep at night, with 2 naps in the day.
Preschoolers: 10-13 hours of sleep per night, with a similar REM sleep pattern to adults.
School-aged children: 9-12 hours of sleep, with sleep peaking during times of physical growth.
Teenagers: 8-10 hours of sleep, but often only 7-7.5 hours due to lifestyle factors.
Young adults: 7-9 hours of sleep, with decreased REM sleep.
Middle-aged adults: total sleep time decreases, with decreased stage 4 sleep and increased time spent awake.
Older adults: average 7-8 hours of sleep, with less sound sleep and decreased stage 4 sleep.

Factors Affecting Rest and Sleep

Developmental considerations (e.g., age-related sleep patterns).
Motivation (e.g., staying awake for a party or event).
Culture (e.g., cultural orientation towards privacy and quiet).
Lifestyle and habits (e.g., working shifts, organizing priorities).
Environmental factors (e.g., sleeping in a new environment affects REM and non-REM sleep).
Psychological stress (e.g., affecting sleep patterns).
Illness (e.g., GERD, insomnia, thyroid disorders).
Medications (e.g., diuretics, timed medications).

Lifestyle and Habits

Activity and exercise increase fatigue and promote relaxation followed by sleep.
Dietary habits:
- Amino acid L-tryptophan promotes sleep.
- Small protein snack with a complex carbohydrate before bed improves sleep.
- Large quantities of alcohol limit REM and delta sleep.
- Caffeine blocks adenosine, leading to difficulty falling asleep.
Avoid exercising less than 2 hours before bed.
Avoid smoking and nicotine, associated with poor sleep.

ICSD Classification of Sleep Disorders

The ICSD classification includes various sleep disorders, including insomnia.

Insomnia

Signs and symptoms: difficulty falling asleep, intermittent sleep, or difficulty maintaining sleep.
30-35% of adults in the US complain of insomnia.
Often associated with depression, disruptions in circadian rhythms, and recent weight gain.

Obstructive Sleep Apnea (OSA): characterized by 5 or more predominant obstructive respiratory events.
Symptoms: absence of breathing, irregular snoring, and gasping for air.
Treatment: CPAP machine.

Central Disorders of Hypersomnolence

Idiopathic Hypersomnia: excessive sleep, particularly during the day.
Narcolepsy: excessive daytime sleepiness, frequent overwhelming urges to sleep.

Parasomnias

Disruptive sleep-behaviors, including:
- Somnambulism (sleepwalking).
- REM sleep behavior disorder (RBD).
- Sleep terrors (occurring in deepest stages of sleep).
- Nightmare disorder (frightening dreams, more common in children).
- Sleep enuresis (bedwetting, more common in males).
- Sleep paralysis (brief state of immobility upon waking).
- Sleep-related eating disorder (eating while asleep, with no recollection upon waking).

Pain Management

Patient pain assessments should include:
- Verbalization and description of pain.
- Onset and duration of pain.
- Etiology (cause) or mechanism of injury.
- Location of pain.
- Quality, character, and intensity of pain.
- Aggravating or causal factors.
- Alleviating or relieving factors.
- Effect on function.
- Pain management goal.
Pharmacologic pain relief measures:
- Analgesic administration.
- Opioid (e.g., morphine).
- Adjuvant (e.g., Gabapentin).
- Nonopioid (e.g., Tylenol, Motrin).
Complementary health approaches and integrative health care:
- Distraction.
- Humor.
- Music.
- Imagery.
- Mindfulness practice.
- Cutaneous stimulation.
- Acupuncture.
- Hypnosis.
- Biofeedback.
- Healing/therapeutic touch.
- Animal-assisted intervention.

Types of Pain

Acute pain: rapid onset, varying in intensity from mild to severe.
Chronic pain: maladaptive pain that persists or recurs for more than 3 months.
Localization: pain localized to the place of injury.
Somatic pain: scattered pain in tendons, ligaments, bones, blood vessels, and nerves.
Visceral pain: produced by a disease, often occurring as organs stretch abnormally.
Cutaneous/superficial pain: pain in the skin.
Referred pain: pain referred to a different area than the source of the pain.

Duration of Pain

Acute pain: rapid in onset, varies in intensity and duration.
Chronic pain: persists or recurs for more than 3 months.

Analgesic Administration

Opioid administration: example, morphine.
Adjuvant administration: example, Gabapentin.
Nonopioid administration: example, Tylenol, Motrin.

Pain Treatment in Special Populations

Children.
Older adults.
Nonverbal cues are important in assessing pain in these populations.

Additional Methods for Administering Analgesics

Patient-controlled analgesia (PCA) pumps.
Epidural analgesia and peripheral nerve blocks.
Topical anesthesia.### Protein Intake
RDA for adults is 0.8 g/kg of body weight, which accounts for 10% to 35% of total calorie intake
Protein intake is extremely important for all patients, especially those recovering from surgery or trauma, as it is essential for generating new cells and wound healing

Vitamins

Organic compounds needed by the body in small amounts, but do not provide calories
Required for metabolism of carbohydrates, protein, and fat
Can be classified into two categories:
- Water-soluble: C, B-complex vitamins; not stored in body, need to be taken daily
- Fat-soluble: A, D, E, K; absorbed through the intestinal wall directly into bloodstream

Food Intake

Can be categorized into two components:
- Decreased (anorexia, loss of appetite)
- Increased (obesity, BMI ≥30)

Diets

Modified consistency diets:
- Clear liquid: Jello, carbonated beverages, apple juice
- Pureed: Pudding
- Mechanically altered: Items that can be blended
Types of nutritional therapy:
- TPN (total parenteral nutrition): bypasses gastrointestinal tract, administered through central vein
- PPN (peripheral parenteral nutrition): for clients with inadequate oral intake, requires supplementation through peripheral vein
- PEG (percutaneous endoscopic gastrostomy): surgically placed gastrostomy tube
- PEJ (percutaneous endoscopic jejunostomy): surgically placed jejunostomy tube

Pain

The process of pain transmission:
- Action potential propelled along neuron by exchange of ions through nerve cell membrane
- Sodium rushes in, potassium rushes out, changing charge on membrane surface
Gate theory: explains why mechanical and electrical interventions or heat and pressure may provide effective pain relief

Factors Affecting Pain Experience

Cultural and ethnicity variables
Family, biologic sex, gender, and age variables
Religious beliefs and spirituality
Environment and support people
Anxiety and other stressors
Past pain experience

Pain Assessment

Patient's verbalization and description of pain
Onset and duration of pain
Etiology (cause) or mechanism of injury, if known
Location of pain
Quality, character, and intensity of pain
Aggravating or causal factors
Alleviating or relieving factors
Effect on function
Pain management goal

Pain Relief Methods

Pharmacologic measures:
- Analgesic administration (e.g., morphine)
- Adjuvant therapy (e.g., gabapentin)
- Nonopioid therapy (e.g., Tylenol, Motrin)
Nonpharmacologic measures:
- Distraction
- Humor
- Music
- Imagery
- Mindfulness practice
- Cutaneous stimulation
- Acupuncture
- Hypnosis
- Biofeedback
- Healing/therapeutic touch
- Animal-assisted intervention

Sleep and Rest

Factors affecting rest and sleep:
- Developmental considerations
- Motivation
- Culture
- Lifestyle and habits
- Environmental factors
- Psychological stress
- Illness
- Medications
Circadian rhythm: biological clock that exists in all humans
Sleep disorders:
- Insomnia: difficulty falling asleep or staying asleep
- Sleep apnea: characterized by five or more obstructive respiratory events per hour
- Narcolepsy: excessive daytime sleepiness and frequent overwhelming urges to sleep
- Central disorders of hypersomnolence: excessive sleepiness and sleep episodes

Sleep Diary

Records:
- Time patient retires
- Time patient tries to fall asleep
- Approximate time patient falls asleep
- Time of awakening in morning
- Presence of stressors affecting sleep
- Record of food, drink, or medication affecting sleep
- Record of physical and mental activities
- Record of activities performed 2 to 3 hours before bedtime

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Description

Test your knowledge on the sleep requirements for different age groups of children, from newborns to teenagers. Learn about the recommended hours of sleep and nap patterns for each stage of development. Identify the changes in sleep patterns as children grow and mature.

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Questions and Answers

What is the primary difference between rest and sleep?

What is the sequence of stages in a normal sleep cycle?

What is the role of the circadian cycle in sleep preparation?

What is wakefulness characterized by?

What happens after the person enters REM sleep?

What is the purpose of sleep?

What is the recommended sleep duration for newborns and infants in a 24-hour period?

At what age do most children typically stop taking naps during the day?

What is the average sleep requirement for teenagers?

What percentage of REM sleep is typically observed in young adults?

Which of the following factors can affect sleep patterns?

What is the recommended dietary habit to promote sleep?

What is the most common sleep disorder?

What is the circadian rhythm?

What is the effect of exercise on sleep patterns?

Which of the following is associated with poor sleep?

What is a common complaint of patients with insomnia?

What is characterized by 5 or more predominantly obstructive respiratory events?

Which disorder is characterized by excessive sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep?

What is a characteristic of Circadian Rhythm Sleep-Wake Disorders?

What is a type of Parasomnia that involves dramatic or violent dreams while experiencing vivid dreams?

What is a type of Parasomnia that occurs when a person eats and drinks while sleeping but has no recollection of eating when they wake up?

What is a common feature of sleep terrors?

What is a condition in which a person is unable to move when waking up from a nap or sleep?

What is a common feature of patients with Obstructive Sleep Apnea (OSA)?

What is a document that records information about a person's sleep patterns?

What is pain?

What type of pain is localized to the place of injury?

What is the characteristic of chronic pain?

What type of pain is produced by a disease and often occurs when organs stretch abnormally?

What is the difference between acute and chronic pain?

What type of pain is an example of a heart attack?

What is the primary action to take when a patient reaches a score of 4 on the Numeric Sedation Scale?

Which of the following age groups may require special attention to non-verbal cues when assessing pain?

What is the purpose of patient-controlled analgesia (PCA) pumps?

What is the medication administered intravenously to counteract the effects of opioid-induced somnolence?

What is the primary benefit of using epidural analgesia and peripheral nerve blocks for pain management?

What is the primary advantage of topical anesthesia in pain management?

What is a characteristic of chronic pain?

What is the term for pain that is not classified as nociceptive or neuropathic in nature?

What is an example of a behavioral response to pain?

What is the term for pain that occurs in an amputated limb?

What is a factor that can affect the pain experience?

What is a type of pain that is initiated by actual or threatened damage to nonneural tissue?

What is a type of pain that is often described as burning, electric, tingling, or stabbing?

What is a goal of patient pain assessments?

What is an example of a nonopioid analgesic?

What is a potential side effect of opioid analgesic administration?

What is the primary indicator of abdominal fat?

Which of the following proteins is complete?

What is the process by which dietary protein is broken down into amino acids?

What is the recommended WHR for females?

What is the function of pancreatic enzymes in protein digestion?

What is the primary component of all body structures?

What is the recommended daily protein intake for adults?

What is the purpose of TPN nutritional therapy?

What is the difference between fat-soluble and water-soluble vitamins?

What is the typical pH range of an aspirate from the stomach?

What is the purpose of the gate theory in pain management?

What is the characteristic of vitamin A deficiency?

What is the purpose of a PEG tube?

What is the difference between anorexia and obesity?

What is the purpose of a PEJ tube?

What is the action potential of pain signals?

What is the primary function of sleep?

What is the characteristic of wakefulness?

What is the sequence of events in a normal sleep cycle?

What is the role of the circadian cycle in sleep preparation?

What is the main difference between rest and sleep?

What is the purpose of NREM sleep?

What is a characteristic of patients with Sleep-Related Breathing Disorder, specifically Obstructive Sleep Apnea (OSA)?

What is the term for excessive sleepiness during the day?

What is a common feature of sleep enuresis?

What is a type of Parasomnia characterized by dramatic or violent dreams?

What is a characteristic of individuals with Sleep Apnea?

What is a common complaint of patients with insomnia?