Fundamentals of Nursing: Chapter 38 Rest and Sleep PDF

CHAPTER 38 UNIT 4 PHYSIOLOGICAL INTEGRITY SLEEP DURATION SECTION: BASIC CARE AND COMFORT Sleep averages vary with the developmental stage, with Rest and...

CHAPTER 38 UNIT 4 PHYSIOLOGICAL INTEGRITY SLEEP DURATION SECTION: BASIC CARE AND COMFORT Sleep averages vary with the developmental stage, with Rest and Sleep infants and toddlers averaging 9 to 15 hr/day. This CHAPTER 38 declines gradually throughout childhood, with adolescents averaging 9 to 10 hr/day and adults 7 to 8 hr/day. Adequate amounts of sleep and rest promote COMMON SLEEP DISORDERS health. Too little sleep leads to an inability Insomnia to concentrate, poor judgment, moodiness, The most common sleep disorder, this is the inability irritability, and increased risk for accidents. to get an adequate amount of sleep and to feel rested. It might mean difficulty falling asleep, difficulty Chronic sleep loss can increase risks of obesity, staying asleep, awakening too early, or not getting depression, hypertension, diabetes mellitus, refreshing sleep. Acute insomnia lasts a few days possibly due to heart attack, and stroke. personal or situational stressors. Chronic insomnia lasts a month or more. Some people have intermittent insomnia, sleeping well SLEEP CYCLE for a few days and then having insomnia for a few days. The sleep cycle consists of three stages of non-rapid Women and older adults are more prone to insomnia. eye movement (NREM) sleep and a period of rapid eye movement (REM) sleep. Typically, people cycle through Sleep apnea the stages of sleep in various patterns several times. REM More than five breathing cessations lasting longer than sleep accounts for 20% to 25% of sleep time. 10 seconds per hour during sleep, resulting in decreased arterial oxygen saturation levels. Stage 1 NREM Sleep apnea can be a single disorder or a mixture of Very light sleep the following. Only a few minutes long ◯ Central: Central nervous system dysfunction in the Muscle relaxation respiratory control center of the brain that fails to Loss of awareness of surroundings trigger breathing during sleep. Vital signs and metabolism beginning to decrease ◯ Obstructive: Structures in the mouth and throat relax Awakens easily during sleep and occlude the upper airway. Feels relaxed and drowsy Narcolepsy Stage 2 NREM Sudden attacks of sleep that are often uncontrollable Deeper sleep Often happens at inappropriate times and increases the 10 to 20 min long risk for injury Vital signs and metabolism continuing to slow Requires slightly more stimulation to awaken Hypersomnolence disorder Increased relaxation Excessive daytime sleepiness lasting at least 3 months Impairs social and vocational activities Stage 3 NREM Increased risk for accident or injury related to sleepiness Slow wave sleep or delta sleep Vital signs decreasing More difficult to awaken ASSESSMENT/DATA COLLECTION Psychological rest and restoration Ask about sleep patterns, history, and any Reduced sympathetic activity recent changes. Identify the usual sleep requirements. REM Ask about sleep problems (type, manifestations, timing, Vivid dreaming seriousness, related factors, aftereffects). About 90 min after falling asleep, recurring Use a linear or visual scale with “best sleep” on one every 90 min end and “worst sleep” on the opposite end and ask for a Longer with each sleep cycle sleep rating on a 0 to 10 scale. Average length 20 min Check for common factors that interfere with sleep. Varying vital signs Very difficult to awaken Cognitive restoration FUNDAMENTALS FOR NURSING CHAPTER 38 Rest and Sleep 217  FACTORS THAT INTERFERE WITH SLEEP CLIENT EDUCATION Physiologic disorders: Can require more sleep or disrupt Exercise regularly at least 2 hr before bedtime. sleep (sleep apnea, nocturia) Establish a bedtime routine and a regular sleep pattern. Arrange the sleep environment for comfort. Current life events: Traveling more, change in work hours Limit alcohol, caffeine, and nicotine at least 4 hr Emotional stress or mental illness: Anxiety, fear, grief before bedtime. Limit fluids 2 to 4 hr before bedtime. Diet: Caffeine consumption, heavy meals before bedtime Engage in muscle relaxation if anxious or stressed. Exercise: Promotes sleep if at least 2 hr before bedtime, For narcolepsy otherwise can disrupt sleep Exercise regularly. Fatigue: Exhausting or stressful work makes falling Eat small meals that are high in protein. asleep difficult. Avoid activities that increase sleepiness (sitting too long, warm environments, drinking alcohol). Sleep environment: Too light, the wrong temperature, or Avoid activities that could cause injury should the client too noisy (children, pets, loud noise, snoring partner) fall asleep (driving, heights). Medications: Some can induce sleep but interfere Take naps when drowsy or when narcoleptic events with restorative sleep. Others (bronchodilators, are likely. antihypertensives) cause insomnia. Take prescribed stimulants. Substance use: Nicotine and caffeine are stimulants. For hypersomnolence disorder Caffeine and alcohol tend to cause night awakenings. Maintain a regular sleep-wake schedule. Provide ample sleep opportunities. Take prescribed stimulants. NURSING ACTIONS Help clients establish and follow a bedtime routine. Limit waking clients during the night. Promote a quiet hospital environment. Help with personal hygiene needs or a back rub prior to sleep to increase comfort. Consider continuous positive airway pressure (CPAP) devices for clients who have sleep apnea. Consult the provider about trying sleep‑promoting over‑the‑counter products (melatonin, valerian, chamomile). As a last resort, suggest that the provider prescribe a pharmacological agent. Medications of choice for insomnia are benzodiazepine‑like medications, which include the sedative‑hypnotics zolpidem, eszopiclone, and zaleplon. Adjust inpatient routines when possible to conform with clients’ home routines (bathing, bedtime). 218 CHAPTER 38 Rest and Sleep CONTENT MASTERY SERIES  Application Exercises Active Learning Scenario 1. A nurse in a provider’s office is caring for a client A nurse on a medical unit is collecting data from a client who who states that, for the past week, “I have felt reports a persistent inability to sleep. Use the ATI Active tired during the day and cannot sleep at night.” Learning Template: Basic Concept to complete this item. Which of the following responses should the UNDERLYING PRINCIPLES: List at least three common nurse ask when collecting data about the client’s factors that might be interfering with the client’s sleep. difficulty sleeping? (Select all that apply.) A. “Have your working hours changed recently?” NURSING INTERVENTIONS: List at least three B. “Do you feel confused in the late afternoon?” strategies the nurse can implement to help the client sleep while in the hospital. C. “Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day?” D. “Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep?” E. “Tell me about any personal stress you are experiencing.” 2. A nurse is talking with a client about ways to help sleep and rest. Which of the following recommendations should the nurse give to the client to promote sleep and rest? (Select all that apply.) A. Practice muscle relaxation techniques. B. Exercise each morning. C. Take an afternoon nap. D. Alter the sleep environment for comfort. E. Limit fluid intake at least 2 hr before bedtime. 3. A nurse is caring for a client who has been following the facility’s routine and bathing in the morning. However, at home, the client always takes a warm bath just before bedtime. Now the client is having difficulty sleeping at night. Which of the following actions should the nurse take first? A. Rub the client’s back for 15 min before bedtime. B. Offer the client warm milk and crackers at 2100. C. Allow the client to take a bath in the evening. D. Ask the provider for a sleeping medication. 4. A nurse is preparing a presentation at a local community center about sleep hygiene. When explaining rapid eye movement (REM) sleep, which of the following characteristics should the nurse include? (Select all that apply.) A. REM sleep provides cognitive restoration. B. REM sleep lasts about 90 min. C. It is difficult to awaken a person in REM sleep. D. Sleepwalking occurs during REM sleep. E. Vivid dreams are common during REM sleep. 5. A nurse is instructing a client who has narcolepsy about measures that might help with self‑management. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. “I’ll add plenty of carbohydrates to my meals.” B. “I’ll take a short nap whenever I feel a little sleepy.” C. “I’ll make sure I stay warm when I am at my desk at work.” D. “It’s okay to drink alcohol as long as I limit it to one drink per day.” FUNDAMENTALS FOR NURSING CHAPTER 38 Rest and Sleep 219  Application Exercises Key Active Learning Scenario Key 1. A. CORRECT: Job changes, including roles and working Using the ATI Active Learning Template: Basic Concept hours, can affect the quality and quantity of sleep. UNDERLYING PRINCIPLES B. Chronic sleep deprivation or lack of rapid eye movement Illness sleep can cause confusion, but sleep difficulties for 1 week should not result in confusion. Current life events (travel, change in work hours) C. CORRECT: Caffeinated drinks act as a Emotional stress or mental illness (anxiety, fear) stimulant and can interfere with sleep. Caffeine consumption D. CORRECT: Periods of apnea warrant a prompt Heavy meals before bedtime referral for diagnostic sleep studies. Exercise within 2 hr of bedtime E. CORRECT: Emotional stress is a common Sleep environment that is noisy, too light, or the wrong temperature cause of short‑term sleep problems. Medications that cause insomnia NCLEX® Connection: Basic Care and Comfort, Rest and Sleep NURSING INTERVENTIONS Help clients establish and follow a bedtime routine. 2. A. CORRECT: Relaxation techniques, especially muscle Limit waking clients during the night. relaxation, can help promote sleep and rest. Promote a quiet hospital environment. B. CORRECT: Following an exercise routine regularly, at least Assist with personal hygiene needs. 2 hr prior to bedtime, can help promote rest and sleep. Offer a back rub. C. Napping during the day can keep some people from getting Request a prescription for a sleep medication from the provider. the sleep they need during their usual sleeping hours. D. CORRECT: For example, rather than trying to NCLEX® Connection: Basic Care and Comfort, Rest and Sleep sleep with a restless pet at the foot of the bed, move the pet to another sleep area. E. CORRECT: Limiting fluids for a few hours before bedtime helps minimize getting up to urinate. NCLEX® Connection: Basic Care and Comfort, Rest and Sleep 3. A. Rubbing the client’s back can help promote sleep, but there is another option to try first. B. Offering the client warm milk and crackers can help promote sleep, but there is another option to try first. C. CORRECT: When providing care, first use the least restrictive intervention. Of these options, allowing the client to follow their usual bedtime routine represents the least change, so it is the first intervention to try. D. Asking for a prescription for sleep medication can help induce sleep, but there is another option to try first. NCLEX® Connection: Basic Care and Comfort, Rest and Sleep 4. A. CORRECT: Cognitive and brain tissue restoration occur during REM sleep. B. REM sleep lasts an average of 20 min. It typically begins about 90 min after falling asleep. C. CORRECT: In this stage, awakening is difficult. Awakening is relatively easy in stages 1 and 2 of non‑REM sleep. D. Sleepwalking and sleep talking tend to occur during stage 3 of non‑REM sleep. E. CORRECT: Dreaming does occur in other stages, but it is less vivid and possibly less colorful. NCLEX® Connection: Physiological Adaptation, Pathophysiology 5. A. Clients who have narcolepsy should eat light, high‑protein meals. B. CORRECT: Clients who have narcolepsy should take short naps to reduce feelings of drowsiness. C. Clients who have narcolepsy should avoid sitting for prolonged periods in warm environments. D. Clients who have narcolepsy should avoid ingesting any substance that could increase drowsiness (alcohol). NCLEX® Connection: Basic Care and Comfort, Rest and Sleep 220 CHAPTER 38 Rest and Sleep CONTENT MASTERY SERIES