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Questions and Answers

What are some physiological symptoms of sleep deprivation?

  • Decreased motivation (correct)
  • Decreased reflexes (correct)
  • Hallucinations
  • Fine-motor clumsiness (correct)

    • Sleep deprivation can result in increased sensitivity to pain.

    True

    What is the typical pattern of sleep cycles in humans?

    90-minute intervals with 3 to 5 cycles.

    Sleep Stage 2: Relaxation increases and sleep becomes ______.

    <p>deeper</p> Signup and view all the answers

    What are the optimal sleep hours for a toddler?

    <p>11-14 hours a day.</p> Signup and view all the answers

    Which individual would require the least amount of sleep?

    <p>A 70-year-old</p> Signup and view all the answers

    What are the side effects associated with antidepressants?

    <p>Drowsiness</p> Signup and view all the answers

    The side effects of midazolam include blurred vision.

    <p>True</p> Signup and view all the answers

    Which of the following is not a side effect of cyclobenzaprine?

    <p>Increased energy</p> Signup and view all the answers

    What is one adverse effect of benzodiazepines?

    <p>Drowsiness</p> Signup and view all the answers

    Spiritual distress can cause individuals to question their ______.

    <p>identities</p> Signup and view all the answers

    What activity can help explore one's personal spirituality?

    <p>Journaling thoughts specific to religious and spiritual beliefs.</p> Signup and view all the answers

    What should be included in the teaching session for a patient prescribed an antidepressant for insomnia?

    <p>Patient education about sleep hygiene.</p> Signup and view all the answers

    What is the Epworth Sleepiness Scale used for?

    <p>To determine a person's sleepiness during the day.</p> Signup and view all the answers

    What are common indicators of sleep deprivation observed in patients?

    <p>Irritability, disorientation, and slurred speech.</p> Signup and view all the answers

    Which of the following is a self-reported instrument that assesses sleep quality and disturbance over a 1-month period?

    <p>Pittsburgh Sleep Quality Index</p> Signup and view all the answers

    Nasal polyps are signs of a potential sleep problem.

    <p>True</p> Signup and view all the answers

    Polysomnography is also called a ______.

    <p>sleep study</p> Signup and view all the answers

    How many apneic or hypopneic episodes per hour indicates mild obstructive sleep apnea (OSA)?

    <p>Five to fifteen episodes per hour.</p> Signup and view all the answers

    Which medication is categorized as a sedative-hypnotic?

    <p>Zolpidem</p> Signup and view all the answers

    What should the nurse educate patients about when they are prescribed sleep medications?

    <p>Potential side effects and the importance of reporting them.</p> Signup and view all the answers

    What is insomnia?

    <p>Chronic difficulty in falling asleep, frequent awakenings, and/or poor sleep quality.</p> Signup and view all the answers

    What is considered optimal sleep duration for school-aged children?

    <p>9-11 hours</p> Signup and view all the answers

    What age group of children generally needs 8-12 hours of sleep at night?

    <p>School-aged children</p> Signup and view all the answers

    Obstructive sleep apnea affects women more than men.

    <p>False</p> Signup and view all the answers

    Sleep apnea is considered a _ disorder.

    <p>dyssomnia</p> Signup and view all the answers

    List two physical signs that indicate potential sleep problems.

    <p>Nasal polyps, deviated septum</p> Signup and view all the answers

    What are common symptoms of obstructive sleep apnea?

    <p>Daytime drowsiness</p> Signup and view all the answers

    What should patients avoid before bedtime to improve sleep?

    <p>Caffeine and nicotine</p> Signup and view all the answers

    Which medication class acts on GABA receptors to improve sleep onset and duration?

    <p>Sedative-hypnotics</p> Signup and view all the answers

    Excessive daytime sleepiness (EDS) is a common complaint in people experiencing _.

    <p>OSA</p> Signup and view all the answers

    What is a non-pharmaceutical option that can be effective for some patients to improve sleep?

    <p>Herbs like valerian and chamomile</p> Signup and view all the answers

    Sleep deprivation can only be acute.

    <p>False</p> Signup and view all the answers

    What is a common consequence of untreated sleep apnea?

    <p>Increased risk of diabetes</p> Signup and view all the answers

    What does the 'F' in the FICA assessment tool stand for?

    <p>Faith and Belief</p> Signup and view all the answers

    Which of the following questions is part of the FICA assessment?

    <p>Do you have spiritual beliefs that help you cope with stress?</p> Signup and view all the answers

    What does the 'O' in the HOPE assessment tool represent?

    <p>Organized religion</p> Signup and view all the answers

    Spirituality and religion are synonymous.

    <p>False</p> Signup and view all the answers

    What are the four dimensions of spiritual well-being?

    <p>Meaning and purpose, interpersonal relationships, unity with the environment, connectedness with God</p> Signup and view all the answers

    A liver profile typically includes serum levels of _______.

    <p>Albumin and Bilirubin</p> Signup and view all the answers

    What are the expected values for Alanine Aminotransferase (ALT)?

    <p>4-36 units/L</p> Signup and view all the answers

    What is included in sleep hygiene?

    <p>A regular sleep schedule, exercise considerations, dietary choices, sleep environments, and bedtime routines.</p> Signup and view all the answers

    Keeping a regular sleep schedule is important for achieving healthy sleep.

    <p>True</p> Signup and view all the answers

    What can interfere with falling asleep?

    <p>Large meals late in the evening</p> Signup and view all the answers

    Which exercise is recommended before bedtime?

    <p>Relaxing yoga or stretching</p> Signup and view all the answers

    What should be limited late in the evening to promote better sleep?

    <p>Fluid consumption.</p> Signup and view all the answers

    What is one intervention for promoting sleep hygiene in a patient setting?

    <p>Cluster care activities together</p> Signup and view all the answers

    What are some nonpharmacologic interventions for insomnia?

    <p>Cognitive therapy and sleep restrictions.</p> Signup and view all the answers

    Which nonpharmacologic intervention is suggested for a healthy bedtime routine?

    <p>Taking a warm bath</p> Signup and view all the answers

    What is an appropriate bedtime snack to promote sleep?

    <p>A piece of oat bran toast</p> Signup and view all the answers

    What category of sleep medications works on GABA receptors?

    <p>Sedative-hypnotics.</p> Signup and view all the answers

    Which disorder is the most common type of dyssomnia?

    <p>Insomnia</p> Signup and view all the answers

    Antidepressants can have a beneficial effect on sleep patterns when taken at a lower dose.

    <p>True</p> Signup and view all the answers

    What are some common symptoms of insomnia?

    <p>Difficulty falling asleep, excessive yawning, daytime drowsiness.</p> Signup and view all the answers

    What statement regarding common side effects would the nurse include?

    <p>Nervousness often occurs and improves within weeks.</p> Signup and view all the answers

    Study Notes

    Healthy Sleep Habits

    • Maintaining a regular sleep schedule is crucial for achieving healthy sleep.
      • This includes going to bed and waking up at the same time every day, even on weekends.
      • Avoid naps during the day, unless medically necessary.
      • Adequate exposure to natural light during the day helps regulate the circadian rhythm.

    Exercise and Sleep

    • Aerobic exercise combined with resistance training can promote high-quality sleep.
      • Perform high-intensity exercise in the morning or late afternoon, at least 2 hours before bedtime.
      • Relaxing exercises like yoga and stretching can be done closer to bedtime to help initiate sleep.

    Diet and Sleep

    • Food and beverage choices can significantly impact sleep.
      • Large, heavy, or spicy meals late in the evening can interfere with sleep.
      • Complex carbohydrates and foods containing tryptophan can promote sleep.
      • Avoid caffeine and nicotine close to bedtime.
      • Alcohol can make falling asleep easier but disrupts the sleep cycle.
      • Limit fluid intake late in the evening to prevent nighttime awakenings for urination.

    Sleep Environment

    • A comfortable and safe sleep environment is essential for promoting sleep.
      • Darkness and quiet are preferred by most people, but infants and older adults may benefit from a nightlight.
      • The bed should provide support, and linens should allow for freedom of movement.
      • Correct body alignment while sleeping prevents muscle strain and discomfort.
      • Use the bed for sleep and sex only, avoid watching television, listening to the radio, or using mobile devices in bed.

    Bedtime Routine

    • A consistent bedtime routine helps facilitate relaxation and mental preparedness for sleep.
      • Children's routines may include bathing, storytime, music, snuggles, and comfort objects.
      • Relaxing activities before bed include reading, warm baths, light snacks, aromatherapy, or music.

    Promoting Sleep Hygiene in the Inpatient Setting

    • Cluster care activities together to allow for uninterrupted sleep periods of 90-120 minutes.
    • The nurse can reduce noise by: - Drawing curtains and closing doors. - Negotiating times to mute televisions and radios. - Limiting overhead pages. - Lowering the volume of phone ringtones. - Limiting staff conversations in the hallway. - Conducting shift reports outside of the patient room. - Moving equipment quietly and carefully. - Monitoring equipment frequently to prevent alarms.

    Evening Care

    • Evening care, often referred to as "h.s." care, helps establish and maintain bedtime routines for patients.
    • Evening care may include: - Oral care. - Partial bathing. - Skin care. - Backrub. - Linen maintenance. - Toileting. - Snacks or fluids.

    Nonpharmacologic Interventions for Sleep Disorders

    • Insomnia: Sleep restrictions (staying in bed only when asleep) and cognitive therapy to promote relaxation and change thought patterns are helpful.
    • Hypersomnia: Nonpharmacologic interventions focus on correcting the underlying medical condition contributing to hypersomnia.
    • Narcolepsy: Regular exercise, sleep routines, and light meals high in protein and vitamins are recommended. Avoid alcohol, heavy meals, long drives, and prolonged sitting.
    • Obstructive Sleep Apnea (OSA): Improve sleep hygiene and weight loss efforts. Continuous positive airway pressure (CPAP) devices may be prescribed.
    • Restless Legs Syndrome (RLS): Decrease caffeine and alcohol consumption, engage in walking, leg massages, and deep knee bends.
    • Sleep Terrors: Maintain a consistent sleep schedule, practice proper sleep hygiene, and consider relaxation therapy, cognitive behavioral therapy, or even hypnosis in severe cases.

    Common Categories of Sleep Medications

    • Sedative-Hypnotics: Enhance the effects of gamma aminobutyric acid (GABA) receptors to inhibit brain activity. Improve sleep onset and duration.
      • Examples: Zolpidem (Ambien, Intermezzo), Zale-plon (Sonata), Eszopiclone (Lunesta).
    • Benzodiazepines: Act as central nervous system depressants by increasing GABA effects to reduce brain activity.
      • Examples: Alprazolam (Xanax), Lorazepam (Ativan), Oxazepam, Temazepam (Restoril).
    • Melatonin Receptor Agonists: Increase the body's uptake of melatonin, mimicking the naturally occurring hormone produced by the pineal gland.
      • Examples: Ramelteon (Rozerem), Tasimelteon (Hetlioz), Agomelatine (Valdoxan, Melitor, Thymanax).
    • Antidepressants: Can affect histamine or serotonin receptors to cause a sedative effect.
      • Examples: Doxepin (Silenor), Trazodone (Oleptro), Mirtazapine (Remeron), Amitriptyline, Imipramine.

    Other Categories of Sleep Medications: Antihistamines

    • Antihistamines can provide temporary sleep relief but should not be used long-term.
    • Examples: Diphenhydramine (Benadryl) and doxylamine (Unisom).
    • Drowsiness from antihistamines can last into the following day, causing side effects like dizziness, confusion, and dry mouth and throat.

    Other Sleep Medication Options

    • Herbs like valerian and chamomile can be helpful for some patients.
    • Melatonin supplementation can also be effective.

    Medications for Managing Sleep Disorders

    • Benzodiazepines: Act as central nervous system depressants to initiate sleep.
    • Antidepressants: Can improve sleep patterns when used at lower doses than for depression treatment.

    Dyssomnias

    • Dyssomnias are characterized by difficulty getting to sleep, staying asleep, or experiencing excessive sleepiness during waking hours.

    Parasomnias

    • Parasomnias are characterized by abnormal sleep behavior.

    Insomnia

    • Definition: Difficulty falling asleep or staying asleep, sleeping lightly, or waking too early. The most common type of dyssomnia.
    • Causes: Often caused by stress or lifestyle changes. More common in women and increases in prevalence with age.
    • Patient Observation Cues: Symptoms of sleep deprivation, dark circles around puffy eyes, excessive yawning, daytime drowsiness, and stress.
    • Medical Record Cues: Obesity, thick neck, deviated septum or nasal polyps, and shortness of breath.

    Insomnia as the Most Common Dyssomnia

    • Insomnia is the most common dyssomnia, characterized by difficulty falling or staying asleep, light sleep, or early awakenings.

    Nonpharmacologic Interventions for Insomnia

    • Patients with insomnia may benefit from sleep restrictions (staying in bed only when asleep) and cognitive therapy to promote relaxation and change thought patterns.

    Common Side Effects of Antidepressants for Insomnia

    • Nervousness is a common side effect of antidepressant use for insomnia. The nurse should include this information in patient education.

    Sleep Disorders Diagnosis & Interventions

    • Impaired Sleep (Quantity) - Patient education about sleep needs during various life stages, sleep hygiene, and stress management. Consultation with a sleep specialist. Work-schedule adjustments to allow for healthy sleep. Medication review for potential sleep interactions.
    • Impaired Sleep (Quality) - Patient education about sleep hygiene and stress management. Consultation with a sleep specialist. Work-schedule adjustments to allow for healthy sleep. Medication review for potential sleep interactions. Patient education about sleep journaling.
    • Fatigue - Patient education about sleep hygiene and stress management. Work-schedule adjustments to allow for healthy sleep. Medication review for potential sleep interactions.
    • *Distorted Thinking Process - Patient visit with a mental health professional. Medication review for potential sleep interactions.

    Sleep History Assessment

    • Sleep Pattern and Quality - Ask patients about their typical bedtime, wake-up time, sleep duration, and daytime sleepiness. Assess their sleep quality on a scale (1-10). Use the Epworth Sleepiness Scale to evaluate daytime sleepiness.
    • Description of Sleep Problems - For patients with reported sleep problems or those suspected of having them, ask open-ended questions about the type of problem, symptoms, duration, severity, and any recent life changes that may have impacted sleep. Utilize the STOP-BANG questionnaire to assess for obstructive sleep apnea (OSA).
    • Sleep Diary - In outpatient settings, use a sleep diary to record wake time, sleep time, physical activity, nap times, meal times, caffeine/alcohol intake, and more for a couple of weeks. Avoid using them with inpatients.

    Sleep History Assessment Continued

    • Physical Illness - Assess for any physical or psychological conditions that could impact sleep, including pain, nausea, or shortness of breath. Screen patients scheduled for surgery for OSA using the STOP-BANG tool.
    • Medications - Review the patient's medication list (prescriptions, over-the-counter, and herbal supplements) for potential side effects that may cause sleep disturbances. Include recreational drugs in the medication review.
    • Current Life Events - Assess for any recent lifestyle changes, like job stress, shift work, grief, or new family additions, that could be disrupting sleep. Consider social activities and travel as well.
    • Emotional and Mental Status - Ask questions about relationships, work, and stress levels to assess for anxiety, fear, or anger which can disrupt sleep.

    Sleep History Assessment Continued

    • Bedtime Routines - Assess the patient's bedtime routine, including any beneficial habits (like chamomile tea and dimming lights) and disrupting habits (like excessive exercise before bed or using electronic devices in bed). Ask about nocturia (waking up to urinate during the night).
    • Bedtime Environment - Ask patients to describe the ideal sleep environment, including preferences for darkness, quiet, temperature, mattress type, and pillow arrangement.

    Observing Sleep Deprivation

    • Observe for signs of irritability, disorientation, and slurred speech, which can result from sleep deprivation.
    • Long-term sleep deprivation can lead to paranoia and delusions.

    Sleep Disturbance Assessment

    • Gather information about the type, onset, and impact of the sleep problem.
    • Discuss coping mechanisms to guide the treatment plan.
    • Determine if the nurse can treat it or if a referral to a specialist is necessary.

    Sleep Assessment Instruments

    • Epworth Sleepiness Scale - An eight-item self-reported questionnaire differentiating sleep disorders from sleep deprivation.
    • Pittsburgh Sleep Quality Index - A 19-item self-reported questionnaire that assesses sleep quality and disturbances over a month.
    • Sleep Hygiene Index - A 13-item self-reported assessment evaluating sleep hygiene behaviors.
    • STOP-BANG Screening Questionnaire - Used to assess OSA risk based on eight factors. Strongly consider screening patients scheduled for surgery.
    • Insomnia Severity Index - A standardized measure to assess insomnia severity.
    • Sleep Assessment Protocol - May include using sleep instruments to distinguish sleep disorders from sleep deprivation and assess sleep quality and hygiene.

    Physical Assessment for Sleep Problems

    • Assess energy level, physical weakness, and behavioral signs like yawning and slow speech.
    • Physical signs that could indicate sleep impairment include obesity, thick neck, deviated septum or nasal polyps, and shortness of breath.
    • If hospitalized, observe for muscle jerks, snoring, sleep apnea, or snorting during sleep.

    Diagnostic Testing: Polysomnography

    • This diagnostic test, also known as a sleep study, is the gold standard for sleep disorders.
    • Records brain waves, oxygen levels, heart rate, breathing, eye movements, and leg movements during sleep.
    • In individuals without sleep disturbances, polysomnography shows three nonrapid eye movement (NREM) stages and one rapid eye movement (REM) stage in a 90-minute cycle.
    • It also provides an apnea-hypopnea index to determine the number of apneic or hypopneic episodes per hour (times the patient stopped breathing properly).

    Diagnostic Testing: Obstructive Sleep Apnea

    • An apnea-hypopnea index (AHI) of 30 indicates severe obstructive sleep apnea (OSA).

    Diagnostic Testing: Multiple Sleep Latency Test

    • This tool assesses for narcolepsy.
    • Narcolepsy is a neurological disorder characterized by the brain's inability to regulate sleep-wake cycles and uncontrollable sleepiness.
    • Records brain waves, heartbeat, and eye movements during various 20-minute daytime naps.
    • Identifies narcolepsy if REM sleep onset occurs quickly during the naps.

    Assessment Instrument: Pittsburgh Sleep Quality Index

    • A 19-item self-reported questionnaire that evaluates sleep quality and disturbances over a month.

    Physical Signs of Potential Sleep Problems

    • Nasal Polyps - Potential sleep problem and cause of OSA, due to decreased airflow.
    • Deviated Septum - Potential sleep problem and cause of OSA, due to decreased airflow.
    • Shortness of Breath - Potential sleep problem and sign of sleep apnea.

    Obstructive Sleep Apnea

    • Individuals with mild OSA experience five to fifteen apneic or hypopneic episodes per hour.

    Nursing Considerations: Sleep Medication

    • If a patient is prescribed sleep medication, lower the bed to the lowest safe position and ensure handrails are in place, nightlights are on, and the call light is within reach.
    • Emphasize avoiding alcohol while on sleep medications.
    • Review potential side effects and emphasize reporting any side effects.
    • Older adults are more susceptible to the sedative effects of sleep medications and their side effects.

    Medications for Sleep

    • Sedative-Hypnotic - Zolpidem
    • Benzodiazepine - Alprazolam
    • Melatonin Receptor Agonist - Ramelteon
    • Antidepressant - Amitriptyline

    Insomnia

    • A common sleep-related complaint with up to 30% of adults experiencing it.
    • Frequent difficulty falling asleep, frequent awakenings, short or non-restorative sleep.
    • Often associated with depression.
    • Individuals with insomnia experience excessive daytime sleepiness (EDS) and insufficient sleep quantity and quality, but often get more sleep than they realize.
    • It frequently signals an underlying physical or psychological disorder and is more prevalent in women.

    Insomnia Continued

    • Transient Insomnia - Temporary insomnia caused by situational stressors such as family problems, school problems, work problems, jet lag, illness, grief, or death of a loved one.
    • Recurrent Insomnia - Episodes of insomnia occur, but patients are able to sleep well between those episodes.
    • **Chronic Insomnia - ** A temporary case of insomnia due to stress can develop into chronic insomnia, often due to worry and anxiety about sleep.
    • Poor Sleep Hygiene - Frequently associated with Insomnia. The anxiety and worry about not being able to sleep become a self-fulfilling prophesy.
    • Chronic Insomnia During the Day - Individuals experience fatigue, sleepiness, depression, and anxiety.
    • Treatment - Symptomatic treatment may include improved sleep hygiene, biofeedback, cognitive techniques, relaxation techniques, behavioral therapy, and cognitive therapy. Behavioral and cognitive therapies have few side effects and show sustained sleep improvement over time.

    School-Aged Children: Sleep

    • Optimal Sleep - 9-11 hours at night (6-year-olds: 11-12 hours; 11-year-olds: 9-10 hours).
    • Napping - Rare for this age group.

    Promoting Sleep in School-Aged Children

    • Reassurance - Calmly reassure the child in a supportive manner.
    • Bedtime Routines - Review healthy bedtime routines with parents and correct any deficiencies.
    • Relaxation Techniques - Educate parents on how to help their children relax.

    Obstructive Sleep Apnea

    • Sleep Apnea - A condition where the person temporarily stops breathing (apnea) or experiences diminished breathing (hypopnea) while asleep.
    • Obstructive Sleep Apnea - The most common type of sleep apnea.

    REM Sleep

    • Occurs approximately 90 minutes after sleep begins
    • Characterized by rapid eye movements, fluctuating heart rate and respirations, and increased blood pressure
    • Muscle tone decreases during REM sleep
    • Gastric secretions increase during REM sleep
    • Arousal is very difficult during REM sleep
    • Vivid, colorful dreaming is most likely to occur during REM sleep
    • Duration of REM sleep increases with each sleep cycle and averages 20 minutes

    Narcolepsy

    • Treated with stimulants or wakefulness-promoting agents like modafinil, armodafinil, methylphenidate, or sodium oxybate
    • Antidepressants are also prescribed to suppress cataplexy and other REM-related symptoms

    Sleep Through the Life Cycle

    • Newborns: Sleep 14-17 hours a day in 2-4 hour blocks after feeding
    • Infants: Sleep 12-15 hours at night and take naps during the day
    • Toddlers and Preschoolers: Sleep 11-14 hours a day with a nap
    • School-aged Children: Sleep 9-11 hours at night
    • Adolescents: Sleep 8-10 hours at night
    • Adults: Sleep 7-9 hours at night
    • Older adults: Sleep 7-8 hours at night
    • A 70-year-old would require the least amount of sleep

    Antidepressants

    • One of the main side effects of certain antidepressants is drowsiness
    • Other side effects include headache, nervousness, and decreased sexual desire

    Midazolam

    • Side effects include retrograde amnesia, euphoria, confusion, headache, slurred speech, paresthesia, tremors, weakness, hypotension, tachycardia, blurred vision, nystagmus, diplopia, loss of balance, nausea, vomiting, increased salivation, urticaria, pain, pruritus at injection site, rash, coughing, dyspnea
    • Adverse effects include cardiac arrest, apnea, bronchospasms, laryngospasm, respiratory depression
    • Black Box Warning: May cause severe respiratory depression, respiratory arrest, and apnea. Initial doses in older adults should be conservative. Do not administer by rapid IV injection in neonates as it may cause severe hypotension or seizures.

    Cyclobenzaprine

    • Side effects include feelings of euphoria, lightheadedness, headache, slurred speech, dizziness, drowsiness, fatigue, confusion, and muscle weakness. These may be experienced early in treatment but many are transient and will subside over time.
    • Other side effects include weight gain, dry mouth, diarrhea, constipation, GI upset, sexual difficulties in males, tachycardia, hypotension
    • Severe adverse reactions include angioedema, myocardial infarction, seizures, and ileus.

    Anticonvulsants

    • Common side effects include headaches, fatigue, dizziness, blurred vision, nausea, weight gain or loss, mood changes

    Sedative-Hypnotics

    • Side effects include: next-day hangover effect, residual drowsiness, dizziness, ataxia, parasomnia (sleepwalking, sleep talking), vivid dreams

    Benzodiazepines

    • Mechanism of Action: Increase the effect of GABA to reduce brain activity. Depress CNS activity. Affect hypothalamic, thalamic, and limbic systems of the brain. Do not suppress REM sleep as much as barbiturates. Do not increase the metabolism of other drugs.
    • Effects: Calming effect on the CNS. Useful in controlling agitation and anxiety. Reduce excessive sensory stimulation, inducing sleep, and inducing skeletal muscle relaxation.
    • Class: Sedative-hypnotics or anxiolytics.
    • Indications: Sedation, sleep induction, skeletal muscle relaxation, anxiety relief, anxiety-related depression, treatment of acute seizure disorders, treatment of alcohol withdrawal, agitation relief, balanced anesthesia, moderate or conscious sedation.
    • Contraindications: Drug allergy, narrow-angle glaucoma, pregnancy
    • Adverse Effects: Mild and infrequent including headache, drowsiness, dizziness, cognitive impairment, vertigo, lethargy, fall hazard for older adults, "hangover" effect or daytime sleepiness
    • Toxicity and Overdose: Somnolence (drowsiness/sleepiness), confusion, coma, diminished reflexes. Do not cause hypotension and respiratory depression unless taken with other CNS depressants. Treatment is symptomatic and supportive, flumazenil can be used as an antidote.
    • Commonly Used Benzodiazepines: Alprazolam (Xanax), Lorazepam (Ativan), Oxazepam, Temazepam (Restoril), Diazepam (Valium), Midazolam (Versed)
    • Non-Benzodiazepine Hypnotics: Eszopiclone (Lunesta), Ramelteon (Rozerem), Zolpidem (Ambien)
    • Long-term Use: Can further disrupt sleep and cause additional problems
    • Withdrawal: Benzodiazepines must be tapered off to limit dangerous withdrawal symptoms.

    Spiritual Distress

    • Definition: A disruption in the life principle that pervades a person's entire being and transcends the person's biologic and psychosocial nature. It causes people to question their identities and leads to doubt, loss of faith, and feelings of aloneness or abandonment.

    • Causes: Illness, loss, grief, major life changes, conflict between beliefs and health regimens, inability to practice usual rituals.

    • Situations Associated with Spiritual Distress: Acute illness, Chronic illness, Terminal illness, Near-death experience.

    • Nurses' Role: Maintain spiritual sensitivity and observe spiritual or religious needs of patients. Be prepared to answer questions about one's own spiritual beliefs.

      Activities that can help explore personal spirituality

    • Journaling thoughts related to religious and spiritual beliefs

    • Identifying the most important beliefs

    • Considering opposing beliefs and challenging oneself with questions

    • Attending an environment of a different belief at least once

    • Learning from others with different beliefs

    • Aligning behaviors to personal beliefs

    Open Conversations for Spiritual Distress

    • Importance: Allows for a patient-centered approach in assessing health care needs and gives the patient an opportunity to seek guidance and support.
    • Open-ended Questions:
      • "What changes have occurred since learning of your illness?"
      • "What does this illness mean in regard to your current lifestyle?"
      • "Do you have any new concerns or questions related to the illness?"
      • "What have you used in the past to help cope with stressful situations?"
    • Initiating a Conversation: A nurse can share their own story of what led to their religious and spiritual beliefs.

    FICA Assessment Tool

    • Purpose: Guides healthcare providers with spiritual assessment questions.
    • Questions:
      • Faith & Belief: "Do you consider yourself spiritual or religious?" "Do you have spiritual beliefs that help you cope with stress and difficult times?" If the patient responds "no," ask "What gives your life meaning?"
      • Importance: "Do your spiritual beliefs influence how you take care of yourself, your health, or your medical decisions?"
      • Community: "Are you part of a spiritual community or do you belong to a church, temple, or mosque that provides you support?"
      • Address: "How would you like me, your health care provider, to address these issues in your health care?"

    HOPE Assessment Tool

    • Purpose: Addresses the general concepts of hope within the patient.
    • Components:
      • H: Sources of hope: Where the patient finds comfort and support
      • O: Organized religion: Does the patient identify with an organized religion?
      • P: Personal beliefs on spirituality: What are the patient's personal beliefs?
      • E: Effects of spiritual beliefs on medical decisions and end-of-life issues: How do the patient's beliefs impact their medical and end-of-life decision making?

    ICNP Nursing Analysis During Spiritual Distress

    • Relevant Cues:
      • Spiritual Distress: Chronic illness, expressions of hopelessness, statements indicating concern over the recent inability to pray.
      • Moral Distress: Cultural conflict between medical treatment and religious beliefs, expressions of concern about rejection by the religious community, hesitation in accepting blood transfusions
      • Decisional Conflict: Unclear personal beliefs, questioning of personal beliefs while making decisions, delayed decision making.

    Spirituality and Religion

    • Distinction: Spirituality is a broad term that focuses on the meaning of life, death, and existence. Religion is an organized, structured method of practicing faith.
    • Importance for Health: Strong spiritual health has been shown to decrease pain levels, increase quality of life, lower anxiety associated with chronic conditions, and even prolong years of survival.
    • Nurses' Role: Be knowledgeable of how others practice their faith and embrace their spirituality.

    Overview of Spirituality

    • Definition: The expression of meaning and purpose in life.
    • Commonality: It exists in everyone, regardless of their religious beliefs.
    • Personal Nature: A highly personal individual experience.

    Spirituality

    • Awareness of inner self and purpose beyond self
    • Spirituality is separate from organized religion
    • Provides hope and energy during difficult times
    • Florence Nightingale believed in spiritual health as integral to hospital environments

    Dimensions of Spirituality

    • Meaning and purpose in life, interpersonal relationships, connection to environment, and a higher power
    • Leads to feelings of contentment from within and is linked to quality of life
    • Spiritually healthy individuals experience joy, forgiveness, acceptance of hardship and mortality, and enhanced quality of life

    Concepts Associated with Spirituality

    • Self-transcendence: Connecting to inner self, leading to a sense of connection to others and the world
    • Connectedness: Feeling connected to oneself, others, and a higher being, providing hope, faith and peace
    • Inner Strength: An energy source inspiring motivation, encouragement, and a positive outlook during stress
    • Faith and Hope: Maintaining inner peace despite distress, providing calm and positive emotions
    • Meaning/Purpose in Life: Identifying purpose during both positive and negative life events

    Statements aligning with Spirituality

    • Spirituality expresses meaning and purpose in life
    • Spirituality can give people hope during difficult times
    • Spirituality exists regardless of religious beliefs
    • Spirituality is a personal experience

    Liver Profile

    • Set of liver function tests including albumin, bilirubin, and four liver enzymes: ALT, ALP, AST, and GGTP
    • Performed on a venous blood sample
    • Reasons for prescription: Screen or monitor for liver disease
    • Albumin and bilirubin levels reflect the liver's protein production and waste product clearance
    • Enzyme levels measure liver disease as damaged cells release enzymes

    Interpretation of Abnormal Liver Profile Values

    • Elevated levels of all values except albumin indicate liver disease
    • Albumin levels are decreased in liver disease

    Liver Panel Expected Value Ranges

    • Bilirubin (total): 0.3-1.0 mg/dL
    • Albumin: 3.5-5 g/dL
    • Alanine Aminotransferase (ALT): 4-36 units/L
    • Alkaline Phosphatase (ALP): 30-120 units/L
    • Aspartate Aminotransferase (AST): 0-35 units/L
    • Gamma-Glutamyl Transpeptidase (GGTP): 8-38 units/L for females and males over 45 years, 150 units/L for females and 174 units/L for males

    Cardiac Marker Information

    • Creatine Kinase-MB (CK-MB):
      • Expected values: 3%
      • Begins to rise: 4 hours
      • Peak: 18 hours
      • Returns to normal: 2 days
    • Myoglobin:
      • Expected values: ---
      • Begins to rise: 6 hours
      • Peak: 18 hours
      • Returns to normal: 2-3 days

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