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Rest & Sleep
Taylors Fundamentals of Nursing Chapter 35 10th edition
| Term | Definition |
|---|---|
| Rest | when the body is in a decreased state of activity, with the consequent feeling of being refreshed. |
| Wakefulness | time of mental activity and energy expenditure |
| Sleep | -a state of rest accompanied by altered consciousness and relative inactivity -part of what is called the sleep–wake cycle -period of inactivity and restoration of mental and physical function |
| What are the two systems in the brainstem? | RAS and Bulbar synchronizing region (they work together to control the cyclic nature of sleep) |
| The RAS controls... | cortical activities related to a state of alertness |
| The RAS facilitates... | reflex and voluntary movements |
| The RAS extends... | upward through the medulla, the pons, the midbrain, and into the hypothalamus |
| The Bulbar synchronizing region is located where? | in the pons and medulla |
| Hypothalamus | control center of sleeping and waking (ex: people in coma has injury to the hypothalamus) |
| neurotransmitters that are involved with EXCITATION in the sleeping process | Norepinephrine and acetylcholine—in addition to dopamine, serotonin, and histamine |
| neurotransmitters that are involved with INHIBITION in the sleeping process | Gamma-aminobutyric acid (GABA) |
| What is a hormone that regulate the sleep–wake cycle and possibly circadian rhythms | Melatonin |
| sleep and wake states are also characterized by distinct hormonal patterns that exert... | that exert potential significant influences on metabolism and glucose homeostasis |
| What are the two major stages of sleep | NREM and REM |
| How many stages of NREM sleep are there? | 4 |
| NREM comprises about __% to __% of total sleep time | 75%-80% |
| Throughout the stages of NREM sleep, the parasympathetic nervous system dominates, and decreases in... | decreases in pulse, respiratory rate, blood pressure, metabolic rate, and body temperature |
| It is more difficult to arouse a person during... | REM sleep |
| In normal adults, the REM state consumes __% to __% of a person’s nightly sleep time | 20%-25% |
| During REM sleep increase occur in... | the pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase |
| skeletal muscle tone and deep tendon reflexes are depressed during... | REM sleep |
| REM sleep is essential to... | mental and emotional equilibrium and play a role in learning, memory, and adaptation. |
| What Stage of sleep? -between wakefulness and sleep -in a relaxed state but still aware of the surroundings -Involuntary muscle jerking -This stage lasts only minutes. -The person can be aroused easily. -constitutes about 5% of total sleep. | NREM Stage 1 |
| What stage of Sleep? -The person falls into a stage of sleep. -The person can be aroused with relative ease. -This stage constitutes 50% to 55% of sleep. | NREM Stage 2 |
| What stage of sleep? -The depth of sleep increases, and arousal becomes increasingly difficult. -This stage composes about 10% of sleep. | NREM Stage 3 |
| What stage of sleep? -greatest depth of sleep/delta sleep. -Arousal is difficult. -Slow brain waves -Pulse and RR decrease -BP decrease -Muscles are relaxed. -Metabolism slows and the body temperature is low. -constitutes about 10% of sleep. | NREM Stage 4 |
| What stage of sleep? -Eyes dart back and forth -Small muscle twitching (ex:face) -Large muscle immobility/paralysis -Respirations irregular/apnea -Rapid or irregular pulse | REM |
| What stage of sleep? -Blood pressure increases or fluctuates -Increase in gastric secretions -Metabolism increases; body temperature increases -Encephalogram tracings active -arousal from sleep difficult -Constitutes about 20% to 25% of sleep | REM |
| REM sleep enters from _____ _ of NREM sleep and re-enters NREM sleep at ______ _ | REM sleep enters from stage II of NREM sleep and re-enters NREM sleep at stage II |
| What is the complete Sleep Cycle? | NREM Stage 1> NREM Stage 2> NREM Stage 3> NREM Stage 4>NREM Stage 3> NREM Stage 2>REM>NREM Stage 2 |
| Most people go through ____ or ____ cycles of sleep each night and each cycle last about 90-110 minutes. | 4 or 5 |
| more deep sleep occurs in | delta stage (NREM stages III and IV) in the first half of the night |
| What is the standard average of sleep in a night for an adult | 7 to 8 hours |
| infants require __ to __ hours of sleep each day (including naps) | 12 to 16 |
| toddlers require __ to __ hours of sleep each day (including naps) | 11 to 14 |
| preschoolers require __ to __ hours of sleep each day (including naps) | 10 to 13 |
| school age (ages 6-12) require __ to __ hours of sleep each day | 9 to 12 |
| teenagers require __ to __ hours of sleep each day | 8 to 10 |
| What are the factors that affect sleep? | Developmental Considerations (age, obesity) Motivation (desire) Culture (routines) Lifestyles and habits (exercise, diet, smoking) Environmental Factors (noise) Psychological Stress (stress) Illness Medications |
| Drugs that can affect sleep include... | benzodiazepines amphetamines antidepressants Diuretics antiparkinsonian drugs some antidepressants antihypertensives steroids decongestants caffeine asthma medications |
| Illness associated with Sleep disturbances | -GERD (awaken at night with heartburn) -Coronary artery disease -Epilepsy -Liver failure and encephalitis (insomnia) -Hypothyroidism (cold at night and joint or muscle pain that disrupts sleep) -ESRD- RLS |
| Insomnia | -difficulty falling asleep, intermittent sleep, or maintaining sleep -People with a history of depression |
| Hypersomnia | extreme sleepiness through day, even though sleeping 10 or more hours a night |
| Narcolepsy | chronic neurologic disorder characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. Some may experience cataplexy |
| What are the central disorders for hypersomnolence? | Idiopathic Hypersomnia and Narcolepsy |
| Parasomnias | episodes or behaviors that occur during arousals from REM sleep or partial arousals from NREM sleep that disturb the patient or others Most common in children ex: sleep walking/somnambulism, night terrors, etc |
| How is sleep apnea determined? | -The absence of breathing [apnea] -Diminished breathing efforts [hypopnea] -Respiratory related arousals accompanied by sleepiness, insomnia, snoring -nocturnal respiratory disturbance -Observed apnea and associated health disorders |
| Cataplexy? | the sudden, involuntary loss of skeletal muscle tone lasting from seconds to 1 or 2 minutes |
| Circadian Rhythm sleep-wake disorders | chronic or recurrent pattern of sleep–wake rhythm disruption primarily caused by an alteration in the internal circadian timing system and associated distress or impairment, lasting for a period of at least 3 months ( except jet lag) |
| Restless Leg Syndrome (RLS) | -involuntary movement of the legs when the body is at rest -a common sleep-related neurologic disorder that affects approximately 7% to 10% of the people in the United States, including children and adults -aka Willis–Ekbom disease (WED) |
| Treatments for Dysomnia | -Sedatives -Hypnotics -Cognitive behavioral Therapy |
| How to Assess sleep (ADPIE) | -The nature of the problem -The cause of the problem -signs and symptoms -When did it begin and how often it occurs -How the problem affects everyday living -The severity -How the patient is coping with the problem |
| Assess sleep characteristics | -Restlessness -Sleep posture -Sleep activities -Snoring -Leg jerking |
| Nursing Interventions for sleep | -Prepare a restful environment. -Promote bedtime rituals. -Offer appropriate bedtime snacks and beverages. relaxation and comfort. -respect normal sleep–wake patterns. -Use medications to produce sleep. -Teach about rest and sleep. |
| Screenings that assess sleep disturbances | Epworth Sleepiness Scale Pittsburgh Sleep Quality Index (PSQI) STOP-Bang Questionnaire (OSA) Stanford Sleepiness Scale |
Created by:
Pclark21
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