Sleep, Rest & Physical Activity PDF

# Sleep & Rest ## The Sleep Cycle - **Stage 1 (Interim between consciousness and sleep)**: Occurs after 5-15 minutes - **Stage 2 (Move to Stage after 5-15 minutes)**: Heart rate slows. Brain does less complicated tasks. - **Stage 3 (After another 15 minutes. Move into non-REM sleep, the Delta stage...

# Sleep & Rest ## The Sleep Cycle - **Stage 1 (Interim between consciousness and sleep)**: Occurs after 5-15 minutes - **Stage 2 (Move to Stage after 5-15 minutes)**: Heart rate slows. Brain does less complicated tasks. - **Stage 3 (After another 15 minutes. Move into non-REM sleep, the Delta stage)**: Body temperature & BP decreases. Body makes repairs. - **Stage 5 REM (Increase in eye movement, heart rate, breathing, BP & temperature)**: Movement into REM sleep approx 90 minutes after first feeling sleepy. ## Advantages of Rest and Sleep - Promotes general health and well-being. - Helps to recover from illness. - Sleep has a restorative function and aids in the healing process. - Increases ability to learn, concentrate, and recall knowledge. - Helps person to be socially adaptable. - Sound sleep helps to overcome fatigue. - Recuperates the energy and strength. - Reduces tiredness, body ache, headache, nausea, and discomfort. - REM sleep helps for brain restoration and cognitive restoration. REM sleep is associated with changes in cerebral blood flow, increased cortical activity, increased oxygen consumption, and epinephrine. ## Beneficial Effects of Physical Activities - Maintains the muscle tone, joint mobility. - Attains physical fitness. - Prevents and corrects deformities like foot drop. - Maintains bone density and prevents osteoporosis. - Stimulates blood circulation and prevents venous stasis. - Reduces workload on the heart. - Helps to reduce oedema. - Prevents varicose veins. - Improves lung ventilation. - Improves appetite and digestion. - Prevents constipation and flatulence - Promotes exertion of wastes from the body. - Sharpens muscular and mental co-ordination. - Facilitates relaxation and sleep. - Improves memory power. - Physical health is useful for every walk of life. - Restores a sense of relaxation and equilibrium. ## Exercises The function of most of the muscles is to produce the movements of body parts. A few muscles function mainly to stabilize bones so that other skeletal muscles can execute a movement more effectively. Hence, our human body should have the support of both the muscles and joints in order to maintain good body alignment. ### Definition: Exercise: A type of physical activity involving the muscles, performed to maintain or improve physical fitness. Exercise is the performance of physical activities for improvement of health, or for the correction of physical deformity. ### Beneficial Effects of Exercise on Different Body Systems #### Musculo Skeletal System - Maintains and increases the muscle tone. - Maintans joint mobility (Prevents stiff joints). ## Maintaining Body Mechanics #### Measures to Maintain Good Body Posture: - Maintain a position that puts pelvis in a balanced position. - Keep the object close to the body to prevent strain on the muscles. - Provide a - wide base of support by keeping the feet apart for better balance. - flex the knees and hips to take an object instead of bending the back. - Sit close to the table while writing something. - Stand close to the area if something has to be picked up from above head. - If an object has to be taken to another place roll, push, or slide it, if possible, instead of lifting the object. - Posture should be with a natural gesture. #### To Pick Up an Object from the Floor: - It is best to squat with the back straight. #### For Lifting Weight: - Stand close to the object - with both feet placed firmly and wide apart. - bend the knees slightly and hold the weight close to the body to prevent strain on the muscles. - flex the knees and hips to take an object instead of bending the back. - Avoid lifting weight. If possible, push or pull the weight than lifting. #### Frequently It is Necessary to Move a Patient: - Keep the patient in good alignment and protect from injury while being moved. #### Guidelines for Moving and Lifting Patients: - Know the patient's medical diagnosis, capabilities, and any movements that are restricted. Put braces or any device the patient wears before helping. - Place carefully the stretcher or wheel chair before moving or lifting the patient. - Ensure the support of another nurse. - Explain to the patient what you plan to do. - Encourage the use of patient’s capacity to assist you in moving. - If the patient is in pain administer the prescribed analgesic in advance of the transfer to allow the patient to participate in the move comfortably. - Elevate the bed as necessary so that you’re working at a height that’s comfortable and safe for you. - Remove any obstacles that may make moving and lifting inconvenient. ## Position and Posture Maintenance Positioning a patient in proper body alignment and changing the position regularly and systematically are essential aspects of nursing practice. When positioning patients in bed, the nurse can do a number of things to ensure proper alignment and promote patient comfort and safety. #### Measures To Ensure Patient Comfort and Safety: - Make sure the mattress is firm and support natural body curvatures. - Ensure that the bed is clean and dry. Wrinkled or damp sheets increase the risk of pressure sore formation. #### Patient Positioning: - Patient positioning is vital to a safe and effective surgical procedure. - Proper patient positioning depends on the type and length of procedure, anesthesia access to the patient, devices required and other factors. - Safely positioning the patient is a team effort. #### Goals of Proper Patient Positioning: - Maintain the patient’s airway and circulation throughout the procedure. - Prevent nerve damage. - Allow surgeon accessibility to the surgical site as well as for anesthetic administration. - Provide comfort and safety to the patient. - Prevent soft tissue or musculoskeletal and other patient injury. ## Supine Position - The patient rests on the back. - The relationship of the body part is essentially the same as in standing alignment except that the body is in the horizontal plane. - Pillows, trochanter rolls and hand rolls or arm splints are used to increase comfort and reduce injury to skin or the musculoskeletal system. #### Uses: - Comfortable position for many of the patients. - Ideal for the examination of head, neck, chest, abdomen and extremities, for monitoring the vital signs and peripheral pulses. - For surgery of the anterior part of the body and it is the best position after the surgery. #### Complications: - Flexion contractures, foot drop, pressure sores, etc. can occur if not attended well. #### Preventing Complications: - Provide a firm supportive mattress; use a bed board if necessary. - Place pillows under the upper shoulders, the neck, and the hands so that the head and the neck are held in the correct position. ## Prone Position - The patient lies on the abdomen and the head is turned to one side. - Pillow may be placed under the head. - Hands can be held in a comfortable position. - Place a small pillow under the face on the side. - Place a small cushion under the patient between the end of the rib cage and the upper abdomen to facilitate easy breathing. #### Uses: - For the examination of posterior trunk, spines, and rectum. - For surgeries of the back. - To relieve pressure on areas such as sacrum, scapula, and heel. - Used after anesthesia to prevent aspiration. ## Lateral Position (Side-Lying Position) - The patient is resting on the side with the major portion of body weight on the dependent hip and shoulders. - A 30 degrees lateral position is recommended for patients at risk for pressure ulcers. #### Uses: - A comfortable position for many patients. - Relieves pressure on bony prominences. - Used for giving enema, for inserting suppositories, and for checking rectal temperature. ## Sims' Position - The patients weight in the anterior ilium, humorus, and clavicle. - The patient lies on his left with left arm drawn behind the back. - The right arm may be in any position. - The right thigh is flexed against the abdomen. - Place a pillow under the head with the left cheek resting on it. - Keep another pillow under the upper flexed leg from the groin to the foot. #### Uses: - Used for vaginal examination and rectal examination. - To relieve pressure in the buttocks, scapula, and heels. ## Fowler's Position - An upright position with the patient in a sitting position in the bed with legs resting on the bed. - The patients back is supported on a back rest. - Some beds can be adjusted to provide this position. - The knees may be raised on a knee pillow. - The arms are supported on pillows. #### Types: - **High Fowler's:** When the head is in 75-90 degrees. - **Semi Fowler's:** When the head is in 40-45 degrees. - **Low Fowler's position:** When the head is in 30 degrees. #### Actions to Prevent Complications in Long Term Patients: - Place a pillow under the head and the neck to prevent lateral flexion of the neck. - Place a pillow under the upper arm, lower arm should be flexed and positioned comfortably. - Provide hand wrist splint if necessary. - Use one or two pillows as needed to support the leg from the groin to the foot. - Ensure that the shoulders are aligned with the hips. ## Lithotomy Position - The patient lies on her back with the legs well separated and thighs well flexed on abdomen. - The buttocks are brought to the edge of the bed with legs resting on straps. - The areas assessed in this position are female genitalia and genital tract. - This position provides maximal exposure of genitalia and facilitates insertion of a vaginal speculum. #### Uses: - Used in case of vaginal examination and for the collection of a Pap smear for diagnostic purposes. - The position during delivery for many women. - The position also can be used for surgical procedures involving genitourinary systems. #### Limitations: - Lithotomy position is embarrassing and uncomfortable, so examiner minimizes time that patient spends in it. - Patient should be kept well draped. ## Knee Chest Position (Genu Pectoral Position) - The patient lies on the bed in such a way that the knees and the chest rest on the bed. - The head is turned to one side. - A small pillow can be placed under the chest. - The weight of the patient rests on chest and knees only. - The knees are flexed and thighs are at right angle to legs. #### Uses: - For the examination of rectum and vagina. - Used as post-partum exercise. ## Trendelenburg’s Position - The head of the bed is lowered, and the foot raised in a straight incline. - The patient lies on his back. - Beds are now available with electric control systems to lower the head end or the foot end. - When the head end of the bed is raised it is known as reverse Trendelenburg’s position. #### Uses: - To promote venous circulation in certain patients. - To provide postural drainage from base of lung lobes. - To facilitate venous return for patients with poor peripheral perfusion. - It is used in Operation Theater for the examination or for surgery in the pelvic organs. ## Dorsal Recumbent Position - The patient lies on his back with knees flexed and legs separated. - The feet rest on the bed. - A pillow is placed under the head. #### Uses: - For the examination of vagina and rectum. - For catheterization. - For doing procedures in the rectum, vulva, and vagina. ## Restraints These are protective devices employed to prevent a patient from harming himself or others, to immobilize a part, to restrict the activity, and to promote a feeling of security in patients. #### Purposes: - To prevent injuries to patients. - To provide safety and protection - To prevent patient falling from the bed or chair. #### Restraints: - Should be applied smoothly without obstructing the blood circulation, maintaining normal anatomical position. - Should be released every two hours. #### Note: - If numbness, loss of sensation, or cyanosis is noted remove it immediately. - The restraints are made up of linen, canvas, leather, plastic, metal, or wood. ## Hazards of Restraints: - Tissue damage under the restraints due to constant friction. - Development of pressure sores. - Development of hypostatic pneumonia due to immobility. - Ischemia or nerve damage due to constrictive restraints. - Foot drop and wrist drop. - Asphyxia and aspiration pneumonia in patients who are in supine position and have altered levels of consciousness and vomiting. - Psychic injury; where the patient feels that he is punished. ## Splints and Casts A splint is a rigid support made from metal, plaster, or plastic. It’s used to protect, support, or immobilize an injured or inflamed part of the body. - **Splints:** Used to immobilize musculoskeletal and nerve injuries, support healing, and to prevent further damage. - **Casts and splints:** Support and protect injured bones and soft tissue. Casts and splints hold the bones in place while they heal. They also reduce pain, swelling, and muscle spasm. #### Splints and Casts: - Are applied following surgery. ## Splints or “Half-Casts” - Provide less support than casts. - Can be adjusted to accommodate swelling from injuries easier than enclosed casts. - The health care provider will decide the type of support that is best for the patient. #### Purposes: - To support body parts - To correct deformity - To provide stabilization - To apply traction - To provide first aid for fracture limb - To provide an erect posture for weight bearing areas - To manage strains and strains