RN 170B Exam 1 PDF

Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 1. Healthy Sleep There are many interventions the nurse can provide for a Habits: Sleep Hy- patient that do not involve medication. Many of these non- giene pharmacologic interventions are used to pro...

Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 1. Healthy Sleep There are many interventions the nurse can provide for a Habits: Sleep Hy- patient that do not involve medication. Many of these non- giene pharmacologic interventions are used to promote healthy sleep hygiene. Sleep hygiene includes a regular sleep schedule, exercise considerations, dietary choices, sleep environments, and bedtime routines. All of these can be managed at home as well as in an inpatient setting. 2. Sleep Schedule -Keeping a regular sleep schedule is one of the most im- portant aspects to achieving healthy sleep. This involves: *Going to bed at the same time each night and getting up at the same time every morning, including weekends. *Avoiding naps during the day, if possible. Naps disturb a normal sleep pattern. The exception would be for patients with a medically diagnosed sleeping disorder. *Adequate exposure to natural light during the day. Light helps regulate the circadian rhythm and maintain a healthy sleep-wake cycle. 3. Exercise -Aerobic exercise combined with resistance training is an important part of maintaining health. It can also promote high-quality sleep. Nonrapid eye movement (NREM) and rapid eye movement (REM) sleep are increased when a person is fatigued and relaxed from having performed physical activities. *High-intensity, vigorous exercise should be performed in the morning or late afternoon, at least 2 hours before bedtime. *Relaxing exercise like yoga and stretching can be done within the hours prior to bed. This will help initiate a healthy night's sleep. 4. Diet -Food and beverage choices can have a great effect on sleep. *Large, heavy, or spicy meals late in the evening can in- terfere with falling asleep and staying asleep. Conversely, going to bed hungry can make falling asleep difficult. *Complex carbohydrates and foods containing tryptophan can promote sleep. 1 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 *Caffeine and nicotine consumed too close to bedtime will cause problems falling asleep. *Alcohol can make falling asleep easier but will interfere with the sleep cycle. *Excessive fluids consumed too close to bedtime may cause a person to wake up to urinate. Therefore fluid consumption should be limited late in the evening. 5. Sleep Envior- -A comfortable and safe sleep environment promotes ment sleep. *Most people prefer a dark and quiet room. However, infants and older adults may prefer a small night-light. *Temperature preferences vary for each individual, and extra bedding or blankets should be provided to facilitate the desires of the patient. *The bed should provide support, and linens should allow freedom of movement. *Body alignment while sleeping should prevent muscle strain and discomfort. *A bed should be used for sleep and sex only. Watching television, listening to the radio, using a mobile device, etc. should not be done in bed 6. Bed Time Rou- -Almost everyone has a bedtime routine that helps facili- tine tate relaxation and mental preparedness for sleep. *Bedtime routines for children may include bathing, story time, music, snuggles, and the presence of a specific toy or comforting blanket. *Helpful and relaxing activities before bed may include reading, taking a warm bath, eating a light snack, aro- matherapy, or music. 7. Promoting Sleep RRouttine: Cluster care activities together to allow for 90 Hygiene in the In- to 120 minutes of uninterrupted sleep for the patient. This patient Setting allows the patient time to complete a full sleep cycle. Noise: The nurse can reduce noise for the patient by: *Drawing curtains and closing doors *Negotiating times to mute televisions and radios 2 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 *Limiting overhead pages *Lowering the volume of phone ringtones *Limiting staff conversations in the hallway *Conducting shift reports outside of the patient room, unless the facility requires bedside reports *Moving equipment quietly, paying attention to avoid other objects *Monitoring equipment frequently to prevent alarms Evening Care: Evening care, often referred to as h.s. ("hour of sleep") care, is important in an inpatient facility. This helps establish and maintain the bedtime routine for the patient. Evening care may include: *Oral care *Partial bathing *Skin care *Backrub *Linen maintenance *Toileting *Snacks or fluids 8. Nonpharmaco- -Insomnia: logic *Patients with insomnia may be placed on sleep restric- Interventions for tions, such as staying in bed only when asleep. Cogni- Sleep Disorders tive therapy for helping the patient to relax and change thought patterns is also beneficial for patients with insom- nia. -Hypersomnia *Nonpharmacologic intervention for a patient with hyper- somnia will be focused on correcting the underlying med- ical condition that is contributing to the hypersomnia. -Narcolepsy *Treatment for patients with narcolepsy should be focused on regular exercise, regular sleep routines, and light meals high in protein and vitamins. The patient should avoid alcohol, heavy meals, long-distance driving, and long periods of sitting. -Obstructive Sleep Apnea (OSA) *OSA treatments include improving sleep hygiene and 3 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 weight-loss efforts. A continuous positive airway pressure (CPAP) device may be prescribed by a polysomnographic specialist. It has a specialized mask that is worn during sleep that helps maintain pressure on the airway to keep it open. Patients may report skin irritation, discomfort, or a claustrophobic sensation when using the CPAP machine, but use should still be encouraged. -Restless Legs Syndrome (RLS) *Lifestyle changes like decreasing caffeine and alcohol consumption are helpful for patients with RLS. Walking, leg massages, and deep knee bends may also relieve symptoms. -Sleep Terrors *A consistent sleep schedule, along with proper sleep hygiene, is crucial for managing sleep terrors. Relaxation therapy and cognitive behavioral therapy can also be helpful. Hypnosis may be used in severe cases. 9. Which nonphar- Taking a warm bath macologic inter- Taking a warm bath is a relaxing activity that promotes ventions would healthy sleep. the nurse sug- gest to a patient Reading for 20 minutes for a healthy bed- Reading a book is a relaxing activity that helps the patient time routine? become physically calm. Aromatherapy Aromatherapy can provide a calm and relaxing physical experience for the patient and can be used as part of a healthy bedtime routine. 10. Which nonphar- Changing bed linens macologic inter- Changing the linens would help the patient relax and ventions would promote uninterrupted sleep. Soiled bedding may disturb the nurse pro- sleep. vide to an inpa- tient as part of Providing skin care evening care to Providing skin care by applying lotion to dry skin would promote uninterrupted sleep. Dry skin may itch and inter- 4 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 promote uninter- rupt a patient's sleep. rupted sleep? Providing oral care Providing oral care by brushing the patient's teeth would make him or her feel clean and promote uninterrupted sleep. Performing a partial bath Cleansing the face and hands helps most patients relax and provides mental preparation for sleep. 11. Which interven- Lower volume of telephone ringtones. tions would the The nurse would lower the volume of telephone ringtones nurse take to re- as they can disrupt a patient's sleep. duce noise and promote sleep Limit overhead pages to emergencies only at night. for a hospitalized The nurse would limit overhead pages to emergencies patient? only at night. Overhead pages are loud and may awaken the patient. Monitor equipment frequently. The nurse would monitor equipment frequently to prevent noise from alarm tones, which may disrupt a patient's sleep. Provide privacy by drawing curtains between patients. The nurse would provide privacy by drawing curtains between patients. Adjoining patients may stay up late or snore, which would disrupt a patient's sleep. 12. Which bedtime Piece of oat bran toast snack would be A piece of oat bran toast is a good snack choice to appropriate for promote sleep as it is a complex carbohydrate. Complex the nurse to offer carbohydrates promote sleep for some individuals. a patient to pro- mote sleep? 13. In cases where nonpharmacologic methods have not been effective in providing the patient with high-quality 5 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 Common Cate- sleep, medications may be prescribed or recommended. gories of Sleep Education for the patient is extremely important when Medications pharmacologic sleep aids are used. There are four com- mon categories of sleep medication: sedative-hypnotics, benzodiazepines, melatonin receptor agonists, and anti- depressants. 14. Common Cate- -Sedative-Hypnotics: work as facilitators against gam- gories of Sleep ma aminobutyric acid (GABA) receptors to inhibit brain Medications activity. They help improve the onset and duration of sleep. *Examples:Zolpidem (Ambien, Intermezzo), Zale- plon (Sonata), Eszopiclone (Lunesta) -Benzodiazepines: act as a central nervous system de- pressant by increasing the effect of GABA to reduce brain activity. *Examples: Alprazolam (Xanax),Lorazepam (Ativan), Ox- azepam, Temazepam (Restoril) -Melatonin Receptor Agonists: increase the body's uptake of melatonin. They mimic melatonin, which is a natu- rally occurring hormone produced by the pineal gland. *Examples: Ramelteon (Rozerem), Tasimelteon (Hetlioz), Agomelatine (Valdoxan, Melitor, Thymanax) -Antidepressant: can affect either the histamine or sero- tonin receptors to cause a sedative effect. *Examples: Doxepin (Silenor), Trazodone (Oleptro), Mir- tazapine (Remeron), Amitriptyline, Imipramine 15. Other Categories -Antihistamines can be effective for a night or two of restful of Sleep Medica- sleep, but should not be used long-term. Examples in- tions : Antihista- clude diphenhydramine (Benadryl) and doxylamine (Uni- mines som). Many are available over the counter. Drowsiness resulting from the use of antihistamines may last a long time and even into the following day. Other side effects include dizziness, confusion, and dry mouth and throat. -In addition to prescription and over-the-counter pharma- ceuticals, there are a number of other available options. Herbs like valerian and chamomile can be helpful for some patients. Melatonin supplementation can also be effective. 6 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 16. Which medica- -Benzodiazepines tions may be ef- *Benzodiazepines act as central nervous system depres- fective in manag- sants by increasing the effect of gamma aminobutyric ing sleep disor- acid (GABA) to reduce brain activity and initiate sleep. ders? -Antidepressants *Antidepressants taken at a lower dose needed for de- pression have a beneficial effect on sleep patterns. They are used to treat patients with sleep disorders. 17. Dyssomnias Dyssomnias are associated with trouble getting to sleep, staying asleep, or being excessively sleepy during wake times. 18. Parasomnias Parasomnias are associated with abnormal sleep behav- ior. 19. Insomnia -Definition: Difficulty falling asleep or staying asleep, sleeping lightly, or waking too early. Insomnia is the most common type of dyssomnia. -Causes: Insomnia is often caused by stress or lifestyle changes. It is 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 *Stress *Medical Record Cues *Obesity *Thick neck *Deviated septum or nasal polyps *Shortness of breath 20. Which disorder Insomnia is the most com- mon type of dys- Insomnia is the most common dyssomnia and is char- somnia? acterized by difficulty in falling asleep or staying asleep, sleep that is too light, or early morning awakenings. 7 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 21. Insomnie : Insomnia Nonpharmaco- Patients with insomnia may be placed on sleep restric- logic tions, such as staying in bed only when asleep. Cogni- Interventions for tive therapy for helping the patient to relax and change Sleep Disorders thought patterns is also beneficial for patients with insom- nia. 22. Which statement "Nervousness often occurs; however, this should improve regarding com- within several weeks." mon side ef- fects would the Nervousness is a common side effect associated with the nurse include in use of an antidepressant for insomnia. The nurse should a teaching ses- include this statement in the teaching session with the sion for a pa- patient. tient who is pre- scribed an an- tidepressant for insomnia? 23. Sleep-related hy- Diagnosis:Impaired Sleep (quantity) potheses/ Inter- Interventions: ventions to pro- *Patient education about sleep needs during various life mote rest and stages sleep *Patient education about sleep hygiene *Consultation with a sleep specialist *Patient adjustment of work schedule to allow for healthy sleep schedule *Patient education about stress management *A review of patient medications for potential sleep inter- actions Diagnosis: Impaired Sleep (quality) Interventions: *Patient education about sleep hygiene *Consultation with a sleep specialist *Patient adjustment of work schedule to allow for healthy sleep schedule *Patient education about stress management *A review of patient medications for potential sleep inter- actions 8 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 *Patient education about sleep journaling Diagnosis:Fatigue Interventions: *Patient education about sleep hygiene *Patient adjustment of work schedule to allow for healthy sleep schedule *Patient education about stress management *A review of patient medications for potential sleep inter- actions Diagnosis:Distorted Thinking Process Interventions: *Patient visit with a mental health professional *A review of patient medications for potential sleep inter- actions 24. The sleep his- -Sleep Pattern and Quality: tory assesmeny #Ask patients to give a general description of their sleep will contain at patterns:What time do you normally go to bed?What time least the follow- do you normally wake up?How long does it usually take ing information: you to fall asleep?Do you use an alarm?How many hours do you usually sleep per night?Do you take naps?Do you feel tired during the day? #Have patients rate their sleep on a scale (e.g., 1 for worst night's sleep and 10 for best night's sleep). *Epworth Sleepiness Scale is a tool used to determine a person's sleepiness during the day. -Description of SLeep Problems: #If the patient describes a sleep problem, or one is sus- pected, ask open-ended questions. #The STOP-BANG sleep assessment may help deter- mine if the patient is at risk for obstructive sleep apnea (OSA), a condition in which the patient temporarily stops breathing during sleep as a result of upper airway col- lapse. #Ask the patient:What type of problem are you experi- encing?What signs and symptoms are you having?How long has this been occurring?Is it every day?How would you rate the severity of this issue?What changes have occurred in your life lately, and what effect did that have 9 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 on your sleep?How has your sleep problem affected your life? -Sleep Diary #For outpatient scenarios, a sleep diary can be a help- ful tool. Have the patient, bed partner, or parent com- plete a sleep-wake diary for about 2 weeks. It should include:Wake time, Sleep time, Physical activity and the times, Naps, Meal times, Caffeine and alcohol intake. *A sleep diary should not be used in an inpatient setting 25. The sleep his- -Physical Illness tory assesmeny #Ask about physical and psychological problems that can will contain at affect sleep. Symptoms like pain, nausea, shortness of least the follow- breath, etc. can interfere with sleep. ing information: *Any patient who is scheduled for surgery should be Continued asked about sleep apnea and screened using the STOP-BANG sleep tool to determine if there is undiag- nosed sleep apnea -Medications: #Review the patient's medication for information relating to sleep disturbances. Prescriptions, over-the-counter medications, and herbal supplements should be assessed. Some medications cause drowsiness, and others may cause insomnia or difficulty sleeping. Recreational drugs can also alter the patient's ability to get high-quality sleep -Current Life Events: *Any change in a person's lifestyle has the potential to affect the quality or quantity of sleep. *Job stress, shift work, loss of a family member, or the birth of a child are all events that can cause a disruption in sleep. #Ask the patient about social activities and recent travel, as those may also be affecting sleep. -Emotional and Mental status: *Anxiety, fear, and anger are emotions that can cause problems with sleep. 10 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 #Ask patients questions about their relationships, work, and stress 26. The sleep his- Bedttime Routines: tory assesmeny #Ask patients how they prepare for sleep. will contain at #Assess for beneficial habits like drinking chamomile tea least the follow- and turning down the lights during the hour before bed- ing information: time. Compare those with disruptive habits like strenuous Continued exercise right before bedtime or looking at an electronic device while lying in bed. #Ask patients about nocturia. Are they drinking a lot of fluids in the hours before bed? Are they getting up multiple times in the night to use the toilet? Bedtime Enviorment: #Ask patients to describe their perfect sleep conditions. Consider preferences on factors such as:Dark environ- ment or night light,Quiet or white noise, Room tempera- ture, Type of mattress, Number of pillows -Behaviors of Sleep DDeprivation #Observe the patient for irritability, disorientation, and slurred speech. These behaviors may be the result of sleep deprivation. The patient may or may not be aware that sleep is affecting his or her behavior. *Paranoia and delusions may result from long-term sleep deprivation. 27. If a sleep dis- The nurse will need to obtain information about the type turbance is pre- of problem, when it began, and its effects on the patient's sent, a focused daily activities. The patient may also be able to provide assessment will insight on possible causes of the sleep disturbance. Cop- be necessary ing mechanisms should be discussed to help the nurse determine the appropriate course of action. The problem may be one that the nurse can treat, or there may be a need for a referral to another health care professional. 28. Sleep Assess- -Epiwortth sleepiness scale: ment Instru- *The Epworth Sleepiness Scale is a self-reported ments eight-item questionnaire that can differentiate between sleep disorders and sleep deprivation.Epworth Sleepi- 11 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 ness Scale is a tool used to determine a person's sleepi- ness during the day. -Pittsburgh Sleep Quality Index: *The Pittsburgh Sleep Quality Index is a self-reported 19-item instrument that assesses sleep quality and sleep disturbance over a 1-month period. -Sleep Hygiene Index: *The Sleep Hygiene Index is a 13-item self-reported as- sessment that examines sleep hygiene behaviors. -STOP-BANG Screening Questionnaire: *The STOP-BANG questionnaire assesses the likelihood of obstructive sleep apnea based on eight factors. It may help determine if the patient is at risk for obstructive sleep apnea (OSA).Any patient who is scheduled for surgery should be asked about sleep apnea and screened using the STOP-BANG sleep tool to determine if there is undi- agnosed sleep apnea -Insomnia Severity Index -Part of the sleep assessment protocol may include the use of sleep instruments. These can be helpful in differ- entiating between sleep disorders and sleep deprivation and can assess sleep quality and sleep hygiene. 29. A physical as- Look for indicators on energy level, physical weakness, sessment of the or behavioral signs like yawning and slow speech. Oth- patient may re- er physical signs that might indicate impaired sleep are turn valuable in- obesity, thick neck, deviated septum or nasal polyps, and formation for de- shortness of breath. If the patient is hospitalized, the termining the nurse can observe the patient for muscle jerks, snoring, presence or ab- sleep apnea, or snorting during sleep. sence of sleep disturbances 30. Diagnostic Polysomnography, also called a sleep study, is the diag- Testing : nostic testing for sleep disorders. In polysomnography, Polysomnogra- the brain waves, oxygen level, heart rate, and breathing, phy as well as eye and leg movements, are recorded while the patient is asleep. For patients without sleep disturbances, the polysomnograph will show three nonrapid eye move- 12 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 ment (NREM) stages and one rapid eye movement (REM) stage in a 90-minute cycle. The polysomnograph will also provide an apnea-hypopnea index. This index is the total count of apneic or hypopneic episodes during a single hour (the number of times the patient stopped breathing properly). 31. Diagnostic Test- The following scale is used for diagnosing a potential case ing : Obstruc- of OSA: tive Sleep Apnea 30 indicates severe OSA 32. Diagnostic Test- Is a diagnostic tool for assessing potential narcolepsy. ing : The multi- Narcolepsy is a neurologic disorder in which the brain ple sleep latency is unable to regulate the sleep-wake cycle and has an test uncontrollable desire to sleep. During this test, the pa- tient's brain waves, heartbeat, and eye movements are recorded during several 20-minute daytime naps. The readings during the short naps will indicate if the patient entered REM sleep quickly. 33. Which sleep in- Pittsburgh Sleep Quality Index strument is used to assess sleep The Pittsburgh Sleep Quality Index is a self-reported quality and dis- 19-item instrument that assesses sleep quality and sleep turbance over a disturbance over a 1-month period. 1-month period? 34. Which physical -Nasal polyps signs indicate *Nasal polyps are signs of a potential sleep problem and potential sleep may lead to obstructive sleep apnea. problems? -Deviated septum *A deviated septum or nasal obstruction is a sign of a po- tential sleep problem and a causative factor in obstructive sleep apnea because airflow is decreased. -Shortness of breath *Shortness of breath is a sign of a potential sleep problem and a causative factor in sleep apnea. 13 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 35. A person suffer- 5 to 15 ing from mild ob- Five to fifteen episodes per hour indicates mild OSA. structive sleep apnea (OSA) would have how many apneic or hypopneic episodes per hour? 36. Nursing Consid- If a patient is being prescribed a sleep medication, the erations nurse should take precautions. The nurse should lower the bed to the lowest position and ensure the handrails are in place, the night-lights are on, and the call light is within the patient's reach. The patient should not consume any alcohol products while using sleep medications. Before administering sleep medication, the nurse should review the potential side effects with the patient. The patient must know to report any side effects. Older adults are more susceptible to the sedative effects of sleep medications and their side effects. 37. Match the med- Sedative-hypnotic: Zolpidem ication pre- Benzodiazepine: Alprazolam scribed for sleep Melatonin receptor agonist: Ramelteon with the corre- Antidepressant: Amitriptyline sponding cate- gory. 38. Insomnia -insomnia is a symptom that patients experience when they have chronic difficulty in falling asleep, frequent awakenings from sleep, and/or a short sleep or non- restorative sleep. It is the most common sleep-related complaint, with up to 30% of adults suffering from the problem. It is commonly experienced by individuals di- agnosed with depression.People with insomnia expe- rience EDS and insufficient sleep quantity and quality. However, frequently a patient gets more sleep than is realized. Insomnia often signals an underlying physical or 14 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 psychological disorder. It occurs more frequently in and is the most common sleep problem for women. 39. Insomnia Con- People experience transient insomnia because of situa- tiued: tional stresses such as family, work, or school problems; jet lag; illness; or loss of a loved one. Insomnia sometimes recurs, but between episodes a patient is able to sleep well. However, a temporary case of insomnia caused by a stressful situation can lead to chronic difficulty in getting enough sleep, perhaps because of the worry and anxiety that develop about getting sleep. Insomnia is often associated with poor sleep hygiene, or practices that a patient associates with sleep. If the condition continues, the fear of not being able to sleep is enough to cause wakefulness. During the day people with chronic insomnia feel sleepy, fatigued, depressed, and anxious. Treatment is symptomatic, including im- proved sleep-hygiene measures, biofeedback, cognitive techniques, and relaxation techniques. Behavioral and cognitive therapies have few adverse effects and show evidence of sustained improvement in sleep over time 40. School Aged -Optimal sleep is 9-11 hours at night. Children - Sleep (idk) Or 9-year-old Throughout the School-aged children need 8-12 hours of sleep a night. Life Cycle -Children in this age group rarely nap. 41. School Aged The amount of sleep needed varies during the school Children years. A 6-year-old averages 11 to 12 hours of sleep nightly, whereas an 11-year-old sleeps about 9 to 10 hours (Hockenberry et al., 2019). The 6- or 7-year-old usually goes to bed with some encouragement or by do- ing quiet activities. The older child often resists sleeping because the child is unaware of fatigue or has a need to be independent. When children experience sleep prob- lems, it often causes sleep disruption in parents 42. Promoting Sleep -Reassure patient in a calm and supportive manner. In A School Aged -Review healthy bedtime routines with parents; correct Child any deficiencies. 15 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 -Educate parents on techniques for helping the child re- lax. 43. Obstructive Sleep apnea is a condition in which the person temporar- Sleep Apnea ily stops breathing (apnea) or experiences diminished breathing (hypopnea) while asleep. The most common type is obstructive sleep apnea. Sleep apnea affects men more than women, and prevalence increases with age. It is Considdered a Dysomnia -Causess: The upper airway collapses despite respiratory efforts. -Patient Observation Cues: *Daytime drowsiness *Excessive yawning *Dark circles around puffy eyes *Recessed chin *Male *Older age *Medical Record Cues *Obesity *Thick neck *Deviated septum or nasal polyps *Shortness of breath *Family history of OSA 44. The following - 30 indicates severe OSA OSA: 45. Nursing diag- Encourage patient to establish a bedtime routine and a nosis: Impaired regular sleep pattern. Sleep - Interven- -Instruct patient to avoid caffeine and nicotine before bed- tions time. -Help patient identify ways to eliminate stressful concerns about work before bedtime (e.g., taking time before actual sleep to read a light novel). -Adjust environment; have patient control noise, temper- 16 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 ature, and light in the bedroom. -Teach patient how to perform muscle relaxation before bedtime; include demonstration. 46. Promote Sleep Instruct patient to try to exercise daily, preferably in the Teaching Inter- morning or afternoon, and to avoid vigorous exercise in ventions the evening within 2 hours of bedtime. Caution patient against sleeping long hours during weekends or holidays to prevent disturbance of normal sleep-wake cycle. Explain that, if possible, patients should not use the bed- room for intensive studying, snacking, television watch- ing, or other nonsleep activity besides sex. Encourage patients to try to avoid worrisome thinking when going to bed and to use relaxation exercises. If patient does not fall asleep within 30 minutes of going to bed, advise to get out of bed and do some quiet activity until feeling sleepy enough to go back to bed. Recommend that patients limit caffeine to morning cof- fee and limit alcohol intake (more than one to two drinks a day interrupts sleep cycle). Recommend that patients discontinue use of electronic devices about 30 minutes before going to bed. Ask patient to examine environment. Instruct that use of earplugs and eyeshades may be helpful. Instruct patient to avoid heavy meals 3 hours before bedtime; a light snack may help. 47. Obstructive The most common form is obstructive sleep apnea Sleep Apnea (OSA), which is a cessation or stopping of airflow despite the effort to breathe. It occurs when muscles or soft struc- tures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, and nasal airflow diminishes (hypopnea) or stops (apnea). The person tries to breathe because chest and abdominal movements continue, which often results in loud snor- ing sounds. When breathing is partially or completely diminished, the person becomes sufficiently hypoxic and must awaken to breathe. Structural abnormalities such 17 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 as a deviated septum, nasal polyps, narrow lower jaw, or enlarged tonsils sometimes predispose a patient to OSA. It is estimated that 9% to 21% of women and 24% to 31% of men in the United States are affected by OSA. However, a large majority of people are undiagnosed and untreated 48. Obstructive -Obesity and hypertension are major factors in OSA. Sleep Apnea Smoking, increasing age (greater than 65 years old), Contiued heart failure, alcohol, nasopharyngeal structural abnor- malities, large neck circumferences, and menopause are increased risks for OSA. Some research indicates that there may be a link between OSA and occupations in which the individual is exposed to and breathes in sol- vents -Excessive daytime sleepiness (EDS) is a common com- plaint in people experiencing OSA and CSA. Other common symptoms of OSA include fatigue, morning headaches, irritability, depression, difficulty in concentrat- ing, and a decrease in sex drive (Kryger et al., 2017). Untreated sleep apnea increases the risk of hyperten- sion, diabetes mellitus, heart disease, and heart failure. Lifestyle changes, including a weight-reduction program in people who are obese, improved sleep hygiene, bilevel positive airway pressure (BPAP or BiPAP), continuous positive airway pressure (CPAP), surgery, hypoglossal nerve stimulation, and oral repositioning devices for the jaw and tongue, are treatment options for OSA 49. Obstructive OSA causes a serious decline in arterial oxygen satura- Sleep Apnea tion level. Patients are at risk for cardiac dysrhythmias, Contiued right-sided heart failure, pulmonary hypertension, angina attacks, stroke, and hypertension. Patients with sleep apnea rarely achieve deep sleep. OSA affects quality-of-life issues such as concentration, social interactions, libido, and sexual activity and often is an em- barrassment to a patient. Treatment includes therapy for underlying cardiac or respiratory complications and any 18 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 emotional problems that occur because of the symptoms of this disorder. 50. A person suffer- 5 to 15Five to fifteen episodes per hour indicates mild ing from mild ob- OSA. structive sleep apnea (OSA) would have how many apneic or hypopneic episodes per hour? 51. Sleep Medica- -Sedative-Hypnotics: work as facilitators against gamma tions/ Patient Ed- aminobutyric acid (GABA) receptors to inhibit brain activ- ucation ity. They help improve the onset and duration of sleep. -Patient Teaching(Side Effects and Considera- tions):Sedative-hypnotics have a related risk for abuse and dependence. As such, they are listed as controlled substances. Side Effects: *Next-day hangover effect *Residual drowsiness *Dizziness *Ataxia *Parasomnia *Vivid dreams -Examples:Zolpidem (Ambien, Intermezzo), Zaleplon (Sonata), Eszopiclone (Lunesta)----Benzodiazepines: act as a central nervous system depressant by increasing the effect of GABA to reduce brain activity. -Patient Teaching(Side Effects and Considera- tions):Long-term use of benzodiazepine medications fur- ther disrupts sleep and may cause additional problems. -The use of benzodiazepines must be tapered off to limit dangerous withdrawal symptoms. -Examples: Alprazolam (Xanax),Lorazepam (Ativan), Ox- azepam, Temazepam (Restoril)- 19 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 52. Sleep Medica- -Melatonin Receptor Agonists: increase the body's uptake tions/ Patient Ed- of melatonin. They mimic melatonin, which is a naturally ucation Contin- occurring hormone produced by the pineal gland. ued -Patient Teaching(Side Effects/ Considerations):Mela- tonin receptor agonists show no evidence of abuse, de- pendence, or withdrawal and have been approved for long-term use in adults. -Examples: Ramelteon (Rozerem), Tasimelteon (Hetlioz), Agomelatine (Valdoxan, Melitor, Thymanax) -Antidepressant: can affect either the histamine or sero- tonin receptors to cause a sedative effect. -Patient Teaching(Side Effects/ Considerations): The use of antidepressants as a sleep aid is an "off-label" use; that is, the medication is being used in a manner that has not been given Food and Drug Administration (FDA) ap- proval. When prescribed as a sleep aid, antidepressants are prescribed at a lower dose. One of the main side effects of certain antidepressant medications is drowsi- ness. Other side effects include: headache, nervousness, and decreased sexual desire. These side effects usually subside within a few weeks. Examples: Doxepin (Silenor), Trazodone (Oleptro), Mir- tazapine (Remeron), Amitriptyline, Imipramine 53. Other Categories -Antihistamines can be effective for a night or two of of Sleep Medica- restful sleep, but should not be used long-term. Exam- tions/ Pt Educa- ples include diphenhydramine (Benadryl) and doxylamine tion (Unisom). Many are available over the counter. Drowsi- ness resulting from the use of antihistamines may last a long time and even into the following day. Other side effects include dizziness, confusion, and dry mouth and throat.-In addition to prescription and over-the-counter pharmaceuticals, there are a number of other available options. Herbs like valerian and chamomile can be helpful for some patients. Melatonin supplementation can also be effective. 54. Nursing Con- -Before administering sleep medication, the nurse should ssiderations review the potential side effects with the patient. The 20 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 patient must know to report any side effects. Older adults are more susceptible to the sedative effects of sleep medications and their side effects. -The patient should not consume any alcohol products while using sleep medications. 55. Which physical -Nasal polyps signs indicate Nasal polyps are signs of a potential sleep problem and potential sleep may lead to obstructive sleep apnea. problems? -Deviated septum A deviated septum or nasal obstruction is a sign of a po- tential sleep problem and a causative factor in obstructive sleep apnea because airflow is decreased. -Shortness of breath Shortness of breath is a sign of a potential sleep problem and a causative factor in sleep apnea. 56. Sleep depriva- Many patients experience sleep deprivation because of tion. a sleep disorder. It can be acute or chronic and results from insufficient or disrupted sleep. Causes include ill- ness (e.g., fever, difficulty breathing, or pain), emotion- al stress, medications, environmental disturbances (e.g., frequent interruptions in sleep during nursing care, noisy neighbors or pets), and variability in the timing of sleep as a result of shift work. Sleep disorders such as sleep apnea or insomnia can cause sleep deprivation. With sleep deprivation, there is a decrease in the quantity or quality of sleep and/or an inconsistency in the timing of sleep. When sleep becomes interrupted or fragmented, changes in the normal sequencing of the sleep cycles occur. Cumulative sleep deprivation develops over time. Individuals respond to sleep deprivation differently. Pa- tients experience a variety of physiological and psycho- logical symptoms. The severity of symptoms is often relat- ed to the duration of sleep deprivation. The most effective treatment for sleep deprivation is to eliminate or correct the environmental factors and patient care activities that 21 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 disrupt the sleep pattern. Nurses play an important role in identifying treatable sleep-deprivation problems. Evi- dence suggests that both chronic sleep deprivation and long sleep duration are associated with obesity, type 2 diabetes mellitus, poor memory, depression, digestive problems, and the development of cardiovascular disease 57. Sleep Physiological Symptoms: deprivation. Ptosis, blurred vision Physiologi- Fine-motor clumsiness cal/Psychologi- Decreased reflexes cal Sympttoms Slowed response time Decreased reasoning and judgment Decreased auditory and visual alertness Cardiac arrhythmias Psychological Sympttoms: Confused and disoriented Increased sensitivity to pain Irritable, withdrawn, apathetic Agitated Hyperactive Decreased motivation Excessive sleepiness 58. Sleep Depriva- -Any significant loss of sleep, resulting in problems in tion concentration and irritability. and is considered a primary sleep disorder- Dyssomnia. -Causes of sleep deprivation include: *Recreational drug abuse *Hospitalization *Certain medications *Stress *Light or noise *Lifestyle changes -Patient Observation Cues *Hallucinations *Disorientation *Paranoia *Delusions 22 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 *Drowsiness *Headache *Nausea *Increased sensitivity to pain *Frequent accidents or injuries *Medical Record Cues *Increased blood pressure *Hormonal imbalance 59. Sleep Stages There are two main cycles of sleep: nonrapid eye move- ment (NREM) and rapid eye movement (REM). NREM has three stages. NREM and REM sleep typically alter- nate in 90-minute intervals, with the normal sleep pattern being 3 to 5 cycles. 60. Sleep Stage 1: -Lightest level of sleep, between sleep and wakefulness NREM1 -Vital signs and metabolism begin to decrease/slow down -Easy arousal by external stimuli, such as noise -Feeling of drowsiness -Lasts a few minutes -May occur during the day as "resting my eyes" 61. Sleep Stage 2: -Relaxation increases NREM2 -Sleep becomes deeper -Snoring may occur -Relatively easy arousal-Physiologic functions continue to slow -Accompanied by occasional small muscle jerks-Lasts 10-20 minutes 62. Sleep Stage 3: -Deepest stage of sleep, called slow-wave or delta wave NREM3 sleep for the type of brain waves seen during this type of sleep -More difficult arousal and rare movement-Muscles re- laxed -Vital signs decrease but regular rhythms/patterns main- tainedRestorative processes (such as the release of growth hormone) occur -Sleepwalking (somnambulism) and nocturnal enuresis may occur 23 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 -Strong stimuli needed for arousal -Amount of time spent in slow-wave sleep depends on how long since a person slept -Lasts approximately 30-60 minutes 63. Sleep Stages: -Occurrence of vivid, colorful dreaming (less vivid dream- REM ing may occur in other stages) -Starts approximately 90 minutes after sleep is initiated -Autonomous response causes rapid eye movements, fluctuating heart rate and respirations, and increased blood pressure -Muscle tone decreased -Gastric secretions increased -Very difficult arousal -Duration of REM sleep increases with each sleep cycle and averages 20 minutes 64. Medications To -Patients diagnosed with narcolepsy are treated with Prevent Nar- stimulants or wakefulness-promoting agents such as colepsy modafinil, armodafinil, methylphenidate, or sodium oxy- bate, which only partially increase wakefulness and re- duce sleep attacks -Patients also receive antidepressant medications that suppress cataplexy and the other REM-related symp- toms. 65. Sleep Through- -Newborn: out the Life Cycle # 14-17 total hours a day is optimal. *Optimal sleep pattern for a newborn is in 2-to-4-hour blocks after a feeding. -Infant: #Optimal sleep pattern for an infant is 12-15 hours at night with naps during the day. -Toddler & Preschooler: #Optimal sleep pattern is 11-14 hours a day with a nap to restore energy. *Amount of sleep will vary with growth spurts. -School Age Child: #Optimal sleep is 9-11 hours at night. 24 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 -Adolescent: #Optimal sleep is 8-10 hours at night. -Adult: #Optimal sleep is 7-9 hours at night. -Older Adult: #Optimal sleep is 7-8 hours at night. 66. Which individ- 70-year-old ual would require the least amount A 70-year-old would require the least amount of sleep; of sleep? older adults sleep approximately 6 hours per night. 67. Antiddepres- One of the main side effects of certain antidepressant sants side medications is drowsiness. Other side effects include: effects headache, nervousness, and decreased sexual desire. 68. The side effects Retrograde amnesia, euphoria, confusion, headache, of midazolam slurred speech, paresthesia, tremors, weaknes, Hypoten- sion, 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 Midazolam 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. 69. The side effects Feelings of euphoria, lightheadness, headache, slurred of cyclobenza- speech, dizziness, drowsiness, fatigue, confusion, and prine muscle weakness. These may be experienced early in treatment; however, many are transient and will subside over time, weight gain, dry mouth, diarrhea, constipation, GI upset, sexual difficulties in males, Tachycardia, hy- 25 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 potension Severe adverse reactions include angioedema, myocar- dial infarction, seizures, and ileus. 70. Side Effectss Of Anorexia, dry mouth, blurred vision, constipation, gyneco- Antidepressants mastia, sexual dysfunction, altered blood glucose lev- el, urinary retention, agitation, anxiety, ataxia, cognitive impairment, sedation, headache, insomnia, skin rash, photosensitivity, weight changes, orthostatic hypoten- sion, blood dyscrasias with clozapine, Dizziness, dyskine- sias, nausea, syncope, hypotension, Drowsiness, abnor- mal dreams, dry mouth, constipation, increased appetite, asthenia (muscle weakness),Anxiety, dizziness, drowsi- ness, headache, mild GI disturbance, sexual dysfunc- tion, asthenia, tremor,Dizziness, drowsiness, headache, GI upset, anorexia, hepatotoxicity,Dizziness, headache, sedation, nausea, blurred vision, tachycardia 71. Side Effectss Of Headaches. Anticonvulsants Fatigue. Dizziness. Blurred vision. Nausea. Weight gain or loss. Mood changes. nausea, abdominal pain, dizziness, sleepiness, irritability, anxiety or mood changes. 72. Sedative-Hyp- Next-day hangover effect notics Side Residual drowsiness Effects Dizziness Ataxia Parasomnia Vivid dreams 73. Benzodi- -Action: Benzodiazepines act as a central nervous system azepines, Class, depressant by increasing the effect of GABA to reduce Indication, Side brain activity, Depress CNS activity, Affect hypothalamic, effects thalamic and limbic systems of the brain, Do not suppress 26 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 rapid eye movement (REM)sleep as much as barbiturates do, Do not increase metabolism of other drugs -Drugs Effects: Calming effect on the CNS, Useful in controlling agitation and anxiety, Reduce excessive sen- sory stimulation, inducing sleep, Induce skeletal muscle relaxation -Class: sedative-hypnotics or anxiolytics (meddication that relieves anxiety) -Indications: Sedation, Sleep induction, Skeletal mus- cle relaxation, Anxiety relief, Anxiety-related depression, Treatment of acute seizure disorders, Treatment of al- cohol withdrawal, Agitation relief, Balanced anesthesia, Moderate or conscious sedation Contraindications: Drug allergy, Narrow-angle glaucoma, Pregnancy Adverse Effectss: Mild and infrequent, Headache, Drowsi- ness, Dizziness, Cognitive impairment, Vertigo, Lethargy, Fall hazard for older adults, "Hangover" effect or daytime sleepiness Toxcicity and Overdose: Somnolence(drowsi- nesss/sleepiness), Confusion, Coma, Diminished reflex- es, Do not cause hypotension and respiratory depres- sionunless taken with other CNS depressants, Treatment symptomatic and supportive, Flumazenil as an antidote -Five benzodiazepines commonly used as sedative-hyp- notic drugs: Alprazolam (Xanax), Lorazepam (Ati- van), Oxazepam, Temazepam (Restoril), Diazepam (Valium), Midazolam (Versed),Temazepam (Resto- ril),Nonbenzodiazepine:Eszopiclone (Lunesta),Non- benzodiazepine:Ramelteon (Rozerem),Nonbenzodi- azepine:Zolpidem (Ambien) -Long-term use of benzodiazepine medications further disrupts sleep and may cause additional problems. -The use of benzodiazepines must be tapered off to limit dangerous withdrawal symptoms. 74. Spiritual Dis- When illness, loss, grief, or a major life change occurs, tress people often use spiritual resources to help them cope and search for meaning. Spiritual needs and concerns 27 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 usually develop when people fail to use their spiritu- al resources during these times. Spiritual distress is "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 to feel doubt, lose faith, and feel alone or abandoned. Individuals often question their spiritual values or the meaning of life, raising questions about their way of life, purpose for living, and source of meaning. Spir- itual distress also occurs when there is conflict between a patient's beliefs and prescribed health regimens or when patients face the inability to practice usual rituals. -Acute illness, Chronic illness, Terminal illness, Near-death experience. 75. Spiritual Dis- it is imperative when providing nursing care that the nurse tress maintains spiritual sensitivity and is observant of any spiri- tual or religious needs of the patient. Spiritual distress can occur during times of impaired health or when learning of a life-changing health diagnosis. The patient may be experiencing a "why me?" moment and could be facing extreme changes and difficulties in his or her life. This spiritual distress may be expressed as pain, insomnia, anger, depression, stoicism, sadness, or even the need for excessive attention. During times of spiritual distress, an individual will reflect on his or her spirituality and turn toward the things in life that provide peace, hope, and strength. Or sometimes, those without a spiritual source or inner connectedness may begin to feel hopeless or saddened or may even sink into a severe depressive state. As a nurse, being cognizant of spiritual distress and being present when a patient exhibits a spiritual need will strengthen the nurse-patient relationship. Sometimes, observation of the patient's surroundings can provide clues to his or her spirituality such as scriptures, religious jewelry, prayer objects, or even recognizing in day-to-day conversations where the patient may have expressed spiritual beliefs. 28 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 76. Activities that Journaling thoughts specific to religious and spiritual be- can help ex- liefs plore one's per- Identifying which beliefs one finds most important sonal spirituality Considering opposing beliefs and challenging oneself include: Spiritual with questions Distress Being open to attending, at least once, an environment of a different belief Learning from others with beliefs that differ from one's own Aligning one's behaviors to follow personal beliefs Nurses must be able to recognize their own cultural bias- es and be prepared to answer difficult questions regard- ing their own spiritual beliefs when initiating a conversa- tion. Being distinctly aware of one's own specific spiritual beliefs is essential, as miscommunication can occur if the patient addresses the nurse's beliefs with challenging questions. 77. The Importance Open-ended questions to help identify spiritual needs of Open Conver- include the following sations For Spir- What changes have occurred since learning of your ill- itual Distress ness? 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? A nonconfrontational way of introducing the topic of spir- ituality with a patient may be for the nurse to tell her own story of what led to her religious and spiritual beliefs. This initial dialogue allows the nurse to ask questions related to hope, expectations, concerns, and fears the patient may be currently experiencing. This open conversation allows for a patient-centered approach in assessing health care needs and gives the patient an opportunity to seek guid- ance and support for those needs. 78. 29 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 FICA Assess- FICA as a well-designed instrument based on the ques- ment Tool tions asked, ease of remembrance, and time needed to complete the questionnaire. -Faith and 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 re- sponds "no," then consider asking, "What gives your life meaning?" -Importance: "Do your spiritual beliefs influence how you take care of yourself, your health, or your medical deci- sions?" -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?" 79. HOPE assess- Like the FICA, the HOPE assessment tool uses a short ment tool acronym that is easy to remember and can guide health care providers with spiritual assessment questions. This tool addresses the general concepts of hope within the patient, whether there is an organized religion in the pa- tient's community environment, what their personal spir- itual beliefs are, and lastly what impact their beliefs may have on medical and end-of-life decision making. -H: Sources of hope; where the patient finds comfort and support -O: Organized religion -P: Personal beliefs on spirituality -E: Effects of spiritual beliefs on medical decisions and end-of-life issues 80. ICNP Nursing Relevant Cues: Analysis Dur- Spiritual Distress: Chronic illness, expressions of hope- ing Spiritual Dis- lessness, statements indicating concern over the recent tress inability to pray -Moral Distress: Cultural conflict between medical treat- ment and religious beliefs, expressions of concern about rejection by religious community, hesitation in accepting 30 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 blood transfusion -Decisional Conflict: Unclear personal beliefs, question- ing of personal beliefs while making decisions, delayed decision making 81. Spiritualiity and Spirituality and religion are often terms that are used inter- Religion changeably, but in actuality, they are unique yet comple- mentary concepts. Spirituality is a broad term that focuses on the meaning in life, death, and existence. Religion, on the other hand, is an organized, structured method of practicing faith in which an individual expresses his or her spirituality. Both spirituality and religion are important parts of health and wellness as 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 after diagnosis with a terminal illness. To understand the impact both spiritual- ity and religion have on a patient's health, nurses must appreciate and be knowledgeable of how others practice their faith and embrace their spirituality. 82. Overview of Spir- Spirituality is not synonymous with religion. There is no ituality single agreed-upon definition of spirituality, and the de- finition continues to evolve over time. Spirituality is the expression of meaning and purpose in life. It exists in everyone, regardless of their religious beliefs, and is a highly personal individual experience. It is an awareness of one's inner self and a realization that there is a greater purpose than oneself. Spiritual issues may include questions such as: "What is my purpose in life?" or "Why is there evil and suffering?" A person can consider him- or herself spiritual without belonging to an organized religion. Spirituality gives peo- ple hope and the energy needed when facing difficult situations in life. Florence Nightingale believed that spiri- tuality is an energy force that is a necessity for a healthy hospital environment. She believed it is just as important to care for someone's spiritual health as it is to care for his or her physical health. As a professional nurse, it is 31 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 important to understand the difference between religion and spirituality so that we can provide the appropriate support to our patients during their times of need. 83. Dimensions of Spiritual well-being includes four dimensions: meaning Spirituality and purpose of one's own life, interpersonal relationships with others, a sense of unity with the environment, and a connectedness with God or a higher power. The concept of spiritual well-being is defined as feelings of contentment coming from the inner self and has been shown to be related to quality of life Those who experience spiritual well-being feel connect- ed to others and can find meaning or purpose in their lives. Those who are spiritually healthy experience joy, can forgive themselves and others, accept hardship and mortality, and report an enhanced quality of life. Spiritual well-being shows the positive aspects of spirituality and is associated with positive health outcomes of decreased pain, stress, and negative emotions; lower risk of depres- sion and suicide; and improved tolerance of the physical and emotional stressors of disease and illness 84. Concepts Asso- There are five distinct but overlying concepts that help ciated with Spiri- define spirituality: tuality -Self-Transcendence: Connecting to one's inner self, which then allows an individual to feel a connection with other beings and the world around him or her. -Connectedness: Being connected to oneself, connected to others, and connected to a higher being. Connected- ness allows an individual to find hope, faith, and peace during difficult times or increased stress. -Inner Strength: An energy source that inspires motivation and encouragement and provides a positive outlook dur- ing times of stress. -Faith and Hope: Even during times of great distress, there is still a peace that provides calm and positive emotions -Meaning/Purpose in Life: With spirituality, a purpose in 32 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 life can be identified during times of both positive and negative life events. 85. Which state- -Spirituality is the expression of meaning and purpose in ments align with life. the concept of *Spirituality is the expression of meaning and purpose in spirituality? life. It can give people hope when facing a difficult time in their lives. -Spirituality exists regardless of religious beliefs. *Spirituality exists in everyone, regardless of their reli- gious beliefs, and is a highly personal individual experi- ence. -Spirituality is a personal experience. *Spirituality is a highly personal individual experience and can evolve and change over a person's lifetime. 86. Liver Profile/ -A liver profile is a set of liver function tests that typically Reasons For Pre- include serum levels of: scribing /Inter- *Albumin pretation of Ab- #Bilirubin normal Valuess *Four liver enzymes:Alanine aminotransferase (ALT), Al- kaline phosphatase (ALP), Aspartate aminotransferase (AST), Gamma-glutamyl transpeptidase (GGTP) -A liver profile is performed on a sample of venous blood. -Reasons for Prescribing *To screen for or monitor liver disease *Levels of albumin and *bilirubin indicate how well the liver is making protein and clearing *bilirubin, which is a waste product. The enzyme levels are measures of liver disease because the enzymes are released from damaged liver cells. -Interpretation of Abnormal Values *All values, except albumin, are elevated in liver disease. Albumin is decreased. 87. - #Bilirubin (total): *0.3-1.0 mg/dL 33 / 105  Exam #1 170B Watkins Study online at https://quizlet.com/_fywvh5 LIver Panel - -Albumin: Expected Value *3.5-5 g/dL Ranges 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): *Males and females >45 yr: 8-38 units/L *Females 150 units/L Males: >174 units/L Begins to Rise (h): 6 Peak (h): 18 Returns To Normal (days): 2-3 Marker:CK-MB Expected Values: 3% Begins to Rise (h): 4 Peak (h): 18 Returns To Normal (days): 2 Marker: Myoglobin Expected Values: