Lpn fall 2008
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| Comfort | state in which a person is relieved of distress
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| Rest | waking state characterized by reduced activity & mental stimulation.
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| Sleep | state of arousable unconsciousness.
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| Environmental psychologists | specialists who study how the environment affects behavior & wellbeing have made pt rooms brighter and more colorful.
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| Walls | blue & colors with blue tints, such as mauve & light green, promote relaxation. Maybe integrated into wallpaper trim & decorative accessories such as framed pictures. The art often depicts country scenes & peaceful images.
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| Floors | b/c noise interferes with comfort, the hallways & work stations are carpeted in most agencies. The floors in pt rooms have tile or linoleum surfaces to facilitate the cleaning of spills.
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| Lighting | Adequate lighting, both natural & artificial, is important to the comfort, of pts & nursing personnel. Bright artificial light facilitates nursing care but is not conducive to pt comfort. Most pt rooms have multiple lights in various locations with adjust
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| Climate control | means mechanisms for maintaining temperature, humidity, & ventilation.
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| Room temperature | should be 68F to 74F (20C to 23C).
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| Humidity | amount of moisture in the air.
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| Relative humidity | ratio between the amount of moisture in the air & the greatest amount of water vapor the air can hold at a given temperature. (30% to 60% comfortable for most pts)
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| Thermoregulation | ability to maintain stable body temperature
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| Ventilation | movement of air include opening windows or using ceiling fans. Usually occurs thru a system of air ducts that circulate air in & out of each pt room.
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| Open windows | a safety hazard in hospitals & nursing homes.
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| Ceiling fans | spread infectious microorganisms.
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| Strong smell | ill pts usually find any strong smell disagreeable. Nurses should be conscientious about their own body & oral hygiene, refrain from wearing overpowering perfume, & avoid smelling of cigarette smoke.
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| Hospital beds | adjustable height & position of the head & knees can be changed either electronically or manually.
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| Unoccupied bed | changing linen when the bed is empty.
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| Hospital bed | may have removable headboards they facilitate resuscitation efforts it the pt experience respiratory or cardiac arrest. Removing the headboard gives the code team responders better access for airway intubation. Placing the headboard under the pts upper bo
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| Mattresses | are washed but not sterilized between uses, they are covered with a waterproof coating that withstands cleaning with strong antimicrobial solutions.
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| Mattress overlays | layers of foam or other devices placed on top of the mattress, used to promote comfort or to keep the skin intact.
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| Pillows | used to elevate a part of the body, relieve swelling, promote breathing, or help to maintain a therapeutic position.
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| Room equipment | Privacy curtain, overbed table, bedside stand, & chair.
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| Privacy curtain | preserves the pts dignity & modesty whenever it is necessary to examine or expose them for care. Also used to shield a pt from observation while using a urinal or bedpan.
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| Overbed table | makes it convenient for the pt to eat while in bed & to perform personal hygiene or other activities required on a flat surface.
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| Functions of sleep | Reducing fatigue, Stabilizing mood, Improving blood flow to the brain, Increasing protein synthesis, Maintaining the disease-fighting mechanisms of the immune system, promoting cellular growth & repair, & Improving the capacity for learning & memory stora
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| Sleep phases | Nonrapid eye movement (NREM), rapid eye movement (REM)
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| NREM | called slow wave sleep b/c electroencephalographic (EEG) waves appear as progressively slower oscillations also quiet sleep.
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| REM | called paradoxical sleep b/c EEG waves appear similar to those produced during periods of wakefulness, is the deepest stage of sleep also active sleep.
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| REM Phase | 20 min average lengthens toward am. Darting eye movements, hard to awake, vivid, colorful, emotional dreams, loss of muscle tone, jaw relaxes, tongue may fall to back of throat, v/s fluctuate, irregular respirations, pauses in breathing for 15-20 seconds
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| NREM Phase | 50-90 mins, deep, restful, dreamless sleep
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| Stage 1 | a few mins, light sleep, easily aroused, Gradual reduction in v/s.
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| Stage 2 | 10-20 mins deeper relaxation, can be awakened w/ effort.
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| Stage 3 | Early phase of deep sleep, snoring, relaxed muscle tone, little or no physical movement, & difficult to arouse.
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| Stage 4 | 15-30mins shortens toward am, Deep sleep, sleep-walking, sleep-talking, & bed-wetting may occur.
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| Newborns sleep reqs | 16-20 hrs/day 50%
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| 3mths-1yr reqs | 14-15 hrs/day 35%
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| Toddler reqs | 12 hrs/nite plus 1-2 naps
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| Preschool reqs | 9-12 hrs/nite
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| 5-6yrs reqs | 11 hrs/nite
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| 11yrs reqs | 9 hrs/nite
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| Adolescent reqs | 7-9 hrs/nite 25%
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| Adult reqs | 7-9 hrs/nite 20-25%
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| Elderly reqs | 7-9 hrs/nite 13%-15%
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| Light | daylight & darkness influence the sleep-wake cycle. Without bright light, the pineal gland secretes melatonin.
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| Circadian rhythm | Phenomena that cycle on a 24hr basis. Drowsiness & sleep correlate w/ setting sun & nite, wakefulness corresponds w/ sunrise & daylight.
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| Melatonin | hormone that induces drowsiness & sleep.
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| Light | triggers suppression of melatonin secretion.
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| Activity | exercise increases fatigue & the need for sleep. When physical activity occurs just before bedtime, has a stimulating rather than relaxing effect.
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| Environment | people sleep best in there usual environment, they develop a preference for a particular pillow, mattress, & blankets.
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| Sleep-promoting-factors1 | darkness, dim light, consistent sleep schedule, secretion of melatonin.
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| Sleep-promoting-factors2 | familiar sleep environment, optimal warmth & ventilation, performance of sleep rituals, sedative, hypnotic drugs, depression, relation.
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| Sleep-promoting-factors3 | satiation, proteins containing L-tryptophan, excessive alcohol consumption, comfort, quiet, effortless breathing.
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| Sleep-suppressing-factors1 | sunlight, bright light, inconsistent sleep schedule, suppression of melatonin, noise, difficulty breathing.
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| Sleep-suppressing-factors2 | strange sleep environment, cold, hot, stuffy room, disturbance of sleep rituals, stimulant drugs.
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| Sleep-suppressing-factors3 | depression, anxiety, worry activity, hunger, thirst, protein-deficient diets, metabolisms of alcohol, pain, nausea, full bladder.
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| Sleep rituals | habitual activities performed before retiring induce sleep (ex: eating a light snack, watching TV, reading & performing hygiene.
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| L-tryptophan | found in protein foods such as milk & dairy products. The recommendation to drink warm milk to induce sleep may have been an anecdotal observation of its Hypnotic effect.
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| Hypnotic | sleep-producing.
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| Alcohol | a depressive drug that promotes sleep but tends to reduce normal REM & deep sleep stages of NREM sleep. As alcohol is metabolized, stimulating chemicals that were blocked by the sedative effects of the alcohol surge forth from neurons, causing early awake
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| Caffeine | beverages containing caffeine, a central nervous system stimulant, cause wakefulness.
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| Sleep disturbances | ex ulcers can be more painful during the nite b/c hydrochloric acid increases during REM sleep. Conditions worsened by lying flat in bed, such as some cardiac, respiratory, & musculoskeletal disorders, contribute to sleeplessness.
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| Sedatives/tranquilizers | produce relaxing & calming effect promote rest, precursor to sleep
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| Stimulants | drugs that excite structures in the brain to cause wakefulness.
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| Drug tolerance | diminished effect from the drug at its usual dosage range.
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| Questionnaires | nurses can gather data during interviews; pts can answer the questions independently in the form of self-report.
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| Sleep diary | a daily account of sleeping & waking activities.
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| Nocturnal polysomnography | a diagnostic assessment technique in which a pt is monitored for an entire nite sleep to obtain physiologic data.
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| Multiple sleep latency test | assessment of daytime sleepiness.
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| Insomnia | means difficulty falling asleep, awakening frequently during the nite, or awakening early. It results in feeling unrested the next day.
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| Hypersomnia | sleep disorder characterized by feeling sleepy despite getting normal sleep. 2 conditions are narcolepsy & sleep apnea/hypopnea.
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| Narcolepsy | sudden onset of daytime sleep, short NREM periods before the 1st REM phase, & pathologic manifestations of REM sleep.
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| Hyper somnolence | which is excessive sleeping for long periods.
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| Sleep paralysis | person cannot move for a few mins just before falling asleep or awakening.
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| Cataplexy | sudden loss of muscle tone triggered by an emotional change such as laughing or anger.
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| Hypnogogic hallucinations | dreamlike auditory or visual experiences while dozing or falling asleep.
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| Automatic behavior | performance of routine tasks w/o full awareness or later memory of having done them.
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| Apnea | absence of breathing
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| Hypopnea | hypoventilation
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| Sleep apnea/hypopnea syndrome | combination of hypopnea & apnea. Sleeper stops breathing or breathing slows for 10 secs or longer 5 or more times per hour.
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| Apneic/Hypopneic periods | ventilations decreases & blood oxygenation drops. Accumulation of carbon dioxide & the fall in oxygen cause brief periods of awakening throughout the nite. Pts will feel tired after sleeping or worse symptoms may cause heart attack, stroke, or sudden deat
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| Hypoxia | decreased cellular oxygenation of heart, brain, & other organs.
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| Reduce apneic episodes | sleeping in other than supine position, losing weight, & avoiding substances that depress respirations such as alcohol or sleeping meds.
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| Severe cases (apneic) | pts may wear Cpap machine (keeps the alveoli inflated at all times), surgery on the tonsils, uvula, pharynx, tongue or epiglottis.
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| Sleep-wake cycle disturbance | results from a sleep schedule that involves daytime sleeping & interferes w/ biologic rhythms. May occur among shift workers, jet travelers, & those diagnosed w/ seasonal affective disorder a cyclical mood disorder linked to diminished exposures to sunlig
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| Shift work | the indoor lighting to which most shift workers are exposed is not bright enough to suppress melatonin; therefore they fight to stay awake.
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| Microsleep | unintential sleep lasting 20 to 30 secs.
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| Shift workers | more prone to errors & accidents from sleepiness. Most people who work nite shifts never completely adapt to the reversal of day & nite activities no matter how long the pattern is.
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| Jet travel | may have difficulty falling or staying asleep. More transient than shift work, may take 1 day for each time zone that is crossed when traveling east, less when west.
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| Photoperiod | # of daylight hours person is accustomed to
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| Jet lag | emotional & physical changes experienced when arriving in a different time zone.
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| Seasonal affect disorder1 | hyper somnolence, lack of energy when awake, increased appetite accompanied by cravings for sweets, & weight gain.
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| Seasonal affect disorder2 | symptoms begin during darker winter mths & disappear as daylight hours increase in the spring. Results from excessive melatonin.
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| Phototherapy | technique for suppressing melatonin by stimulating light receptors in the eye. Usually relieves symptoms w/in 3 to 5 days, but symptoms tend to recur in the same amt of time if a pt abruptly discontinues phototherapy.
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| Parasomnias | conditions associated w/ activities that cause arousal or partial arousal, usually during transitions in NREM periods of sleep.
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| Parasomnias examples | Somnambulism (sleep-walking), Nocturnal enuresis (bedwetting), sleep-talking, Nightmares, & night terrors, Bruxism (grinding of teeth), RLS may be the most disabling parasomnia.
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| Restless legs syndrome | movement typically in the legs but occasionally in the arms or other body parts to relieve disturbing skin sensations, also known as myoclonus.
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| Nursing diagnoses for sleep | fatigue, impaired bed mobility, disturbed sleep pattern, sleep deprivation, relocation stress syndrome, risk for injury, impaired gas exchange.
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| Progressive relaxation | therapeutic exercise in which a person actively contracts then relaxes muscle groups to break the worry-tension cycle that interferes w/ relaxation.
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| Massage | stroking the skin, promotes 2 desired outcomes, it relaxes tense muscles & improves circulation.
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| Components of phototherapy1 | initiates a schedule of full-spectrum light exposure beginning in Oct to Nov. Removes eyeglasses or contact lenses that have ultraviolet filters.
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| Components of phototherapy2 | sits w/in 3 ft of the artificial light for aprox. 2 hrs soon after awakening from sleep. Glances @ light periodically but may engage in other activities such as reading or handiwork.
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| Components of phototherapy3 | Repeats the exposure to light after sundown (to stimulate extending the daylight hrs) up to a cumulative time of 3-6 hrs a day. Continues the pattern of light exposure until spring.
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| Sundown syndrome | early-morning confusion associated w/ inadequate sleep or the effects of sedative & hypnotic medications.
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| Characteristics of sundown syndrome | alert & oriented during the day, onset of disoriented as the sun sets, disorganized thinking, restlessness, agitation, preservation (ruminating over the same repetitive thought) & wandering.
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