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2012-04-11 19:31:55
Foundations Sleep Alterations

Sleep Alterations
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  1. There are four adult clients who see the nurse for complaints of fatigue. The adult client at greatest risk is the one who gets:
    A. 6 hours of sleep
    B. 4.5 hours of sleep
    C. 10 hours of sleep
    D. 7 hours of sleep
    • C. 10 hours of sleep
    • Rationale: Data from over one million adult Americans revealed that the group that slept more than 8.5 hours each night had the greatest mortality.
  2. The nurse knows that the client understands education about promoting restful sleep when the client says:
    A. "I'll make a list of things to do the next day and put it by my bedside to look at before I go to bed.“
    B. "I bought some flannel sheets to help me stay warm at night.“
    C. I'll do push-ups before bedtime so I will be worn out and tired.“
    D. "I won't take my water pill anymore because it makes me get up in the night to go to the bathroom."
    • B. "I bought some flannel sheets to help me stay warm at night."
    • Rationale: A comfortable, quiet, and calm environment induces sleep. Mental and physical exercise stimulate the mind and body, preventing sleep. Diuretics taken earlier in the day will prevent nocturia.
  3. During a preschool screening, a parent asks how many hours of sleep a child of 3 years requires each night. What is the correct answer?
    A. 8-10 hours
    B. 14-16 hours
    C. 12-14 hours
    D. 10-12 hours
    • D. 10-12 hours
    • Rationale: Growing children require more sleep than adults. Toddlers need 10-12 hours per day. About 20-30% is REM sleep. Children of this age usually spend about 50% or a little less sleeping at night. Bedtime is disliked, but is facilitated with rituals.
  4. A client complains of inadequate sleep quantity and quality for the past month. The client wakes in the morning feeling tired. Which question provides the nurse with the best information about factors that may be contributing to this
    sleep problem?
    A. How old are you?
    B. What are you currently doing to improve your sleep?
    C. What has your spouse noticed when you sleep?
    D. What brought this on?
    • B. Disturbed Sleep Pattern, difficulty falling asleep related to fear
    • Rationale: Fear is the etiology of difficulty falling asleep. Insomnia is a type of sleep-pattern disturbance. The client does not complain of fatigue.
  5. Rest is a ______? (list at least 4)
    • A basic physiologic need
    • State where feel mentally relaxed, free from anxiety, and physically calm--Does not mean inactivity
    • Taking a walk, listening to music, sitting quietly
    • Allows body to repair cells, enhances removal of waste products
    • nRestores tissues to max functional ability before new activity
  6. Theories of need need for sleep include
    • To restore balance among different parts of CNS
    • To mediate stress, anxiety & tension
    • To help a person cope with physical and/or psychological stress of daily activities
  7. List the 3 Sleep Cycles
    • Circadian Rhythmn
    • Infradian Rhythm
    • Ultradian
  8. Define Ultradian (sleep cycle)
    Frequentshort cycles of sleep throughout 24 hours (normal finding in newborns, elderly)
  9. Define Circadian Rhythm
    • The Human body is designed to function on 24-hour sleep-wake cycle where individual gets 8 to 9 hours of sleep per night
    • Characterized by body temperature fluctuations & hormone secretory cycle (i.e. cortisol)
  10. Define Infradian Rhythm
    Sleep cycle that lasts longer than 24 hours in length where person needs more than 8 to 9 hours of sleep (often seen with teens)
  11. Sleep Stages are determined by what?
    • Brain waves – electroencephalogram(EEG)
    • Eye movements – electooculogram (EOG)
    • Degree of muscle tension – electromyogram (EMG)
  12. What are the first four Stages of sleep classifications?
    • First 4 stages are all classified as
    • Non-Rapid Eye Movement (REM) sleep
  13. What stage of sleep does REM sleep start?
    What dose REM sleep Stand for?
    • Fifth stage
    • Rapid Eye Movement
    • (REM) sleep
  14. The nurse is gathering a sleep history from a client who is
    being evaluated for obstructive sleep apnea. What common symptom will the
    client most likely report?
    A) Headache
    B) Early wakening
    C) Impaired reasoning
    D) Excessive daytime sleepiness
    D. The client will awake with a headache. The other options may exist, but headache is the most common complaint.
  15. The nurse incorporates what priority nursing intervention into a plan of care to promote sleep for a hospitalized client?
    A) Have client follow hospital routines.
    B) Avoid awakening client for nonessential tasks.
    C) Give prescribed sleeping medications at dinner.
    D) Turn television on low to late-night programming.
    B.) Hospitals and extended care facilities usually do not adapt care to an individual's sleep-wake cycle preferences. The nurse should attempt to avoid awakening sleeping clients for nonessential tasks to try and preserve their sleep cycles. The other options are incorrect.
  16. Very difficult to awaken a REM-sleeper; may have sense of paralysis at what stage of Sleep?
    Stage 5 REM
  17. Older adults are cautioned about the use of nonprescription
    sleeping medications because these medications can:
    A) Cause headaches and nausea.
    B) Be expensive and difficult to obtain.
    C) Cause severe depression and anxiety.
    D) Lead to further sleep disruption even when they initially seemed to be effective.
    • D.) Over-the-counter medications for sleep often cause more
    • problems than benefits. The other answers are incorrect.
  18. The client reports vivid dreaming to the nurse. Through
    understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs in which sleep phase?
    A) REM sleep
    B) Stage 1 NREM sleep
    C) Stage 4 NREM sleep
    D) Transition period from NREM to REM sleep
    A.) The dreams of REM sleep are vivid and elaborate. The other answers are incorrect.
  19. The nurse teaches a client taking phenytoin (Dilantin), an
    anticonvulsant, that this group of medications causes which symptom of a sleep problem?
    A) Nocturia.
    B) Increased daytime sleepiness.
    C) Increased awakening from sleep.
    D) Increased difficulty falling asleep.
    B.) The anticonvulsants can cause increased daytime sleepiness because they decrease REM sleep time. They do not cause nocturia, increased awakenings, or increased difficulty falling asleep.
  20. Which intervention is appropriate to include on a care plan for improving sleep in the older adult?
    A) Decrease fluids 2 to 4 hours before sleep.
    B) Exercise in the evening to increase fatigue.
    C) Allow the client to sleep as late as possible.
    D) Take a nap during the day to make up for lost sleep.
    • A.) By decreasing fluids 2 to 4 hours before sleep, it is less
    • likely that the client will awaken because of a need to urinate. Limiting naps during the day will help improve nighttime sleep. The client should sleep until the same time each morning. Exercising in the evening can make falling asleep more difficult.
  21. Describe the three defining characteristics of Stage 1 Sleep pattern (Non-REM).
    • Light sleep: person wakes easily, “floating” feeling
    • Rolling eye movements & relaxed muscles
    • Lasts only a few minutes
  22. How long dose Stage 2 of Non-REM Last?
    Lasts about 10-20 minutes
  23. Is a person hard to wake at stage 2 of the sleep cycle?
    Person in Non-REm still wakes easily
  24. Is the Sleep ijn stage 2 of the Non-REM deep, light or moderate?
    Light to moderate sleep
  25. Which stage is considered daydream state ?
    Stage 2 Non-REM
  26. During Stage 2 of non-REM the muscles are usually Stiff?
    (T or F)
    F - muscles are relaxed
  27. Transition to REM sleep begins in this stage
    Stage 2
  28. The eyes roll at what stage of sleep?
    Stage 1 and may roll in Stage 2 of Non-REM
  29. How long dose deep sleep last during stage 3 & 4 of non-REM?
    The pt is easily arroused at this time? T - F
    • Deep sleep lasting about 15 to 30 minutes
    • F - Pt is difficult to arouse;
  30. Snoring is common at which stage of sleep?
    Stages 3 & 4 Non-REM
  31. Enuresis (bedwetting) common with kids during which stage of sleep?
    Stage 3 & 4 Non-REM
  32. Is there eye movement in stage 3 & 4?
    No there is no eye movement in stage 3 & 4 Non-REM
  33. In stage 3 & 4 the muscles are very relaxed T or F?
    T- the muscles are very relaxed in stage 3&4 Non-REM
  34. There is no dreaming during stage 3 & 4 of no REM sleep? T or F
    F there is some realistic dreaming
  35. Describe the five defining characteristics of Stages 3&4 Sleep pattern (Non-REM )
    • Stages 3 & 4
    • Deep sleep lasting about 15 to 30 minutes
    • Difficult to arouse; some realistic dreaming
    • Snoring common
    • Enuresis (bedwetting) common with kids
    • No eye movement, muscles very relaxed
  36. At what stage of sleep do dreams occour?
    Stage 5 REM
  37. At what stage of sleep dose the characteristic rapid eye movements give the impression that the sleeper is following something with their gaze?
    Stage 5 REM
  38. Very low Muscle tone (except respiratory muscles) is common what stage of sleep?
    Stage 5 REM Sleep
  39. sporadic muscle twitching occours in which stage of sleep?
    Stage 5 REM Sleep
  40. How long dose Stage 5 REM sleep last?
    it lasts about 10-20 minutes
  41. What sleep pattern prevents people from reaching REM sleep often?
    • Insomniacs rarely make it to REM
    • stage of sleep.
  42. Insomniacs rarely make it to what stage of sleep?
    REMstage of sleep
  43. What type of mechenisim are food, drugs, other substances and exercise considered?
  44. What are common factors that affecting sleep?
    Name 4 out of the 7
    • Drugs/Substances
    • Lifestyle
    • Usual Sleep Patterns
    • Emotional Stress
    • Environment
    • Exercise & Fatigue
    • Food and Caloric Intake
  45. What substance shortens sleep onset & ability to arouse easily?
  46. What should be avoided close to bedtime because it may delay sleep becasue it has a half-life of 1 to 2 hrs.
  47. Exercise increases REM and N-REM sleep so why should it be avoided at least 2 hours before bedtime?
    It can cause wakefulness
  48. Having to urinate throughout the night is what?
  49. Why does consuming caffeine close to bed disrupts sleep patterns?
    • Caffeine has a long half-life, and it can delay or disrupt non-REM sleep.
    • NO caffeine after 3pm (what I've heard FYI) :-)<
  50. How does nutrition effect sleep patterns?
    too much or too little food before bedtime; L-Tryptophan foods (tryptophan is an amino acid the body uses to make serotonin, the neurotransmitter that slows down nerve traffic so your brain isn't so busy) induce sleep.
  51. Sleep apnea, Orthopnea, Colds are examples of whcih type of sleep distrubance (system)?
    Respiratory –
  52. Unstable angina would effect sleep how?
    Chest pain, Heart ache (pain) + Cardiac Disease +
  53. What disease process causes decrease in stage 4 sleep?
  54. What are some environmental factors that might effect sleep?
    light, noise, room temperature, unfamiliar environment
  55. What are fourdisease processes/or emotional factors that can effect sleep?
    • Hypertension
    • Restless Leg Syndrome
    • Pain: affects sleep onset & duration
    • Mood: depression & anxiety affect sleep
    • Respiratory – Sleep apnea, Orthopnea, Colds
    • Cardiac Disease – Unstable angina
    • Hypothyroidism – causes decrease instage 4 sleep
  56. Types of Drugs that affect Sleep
    1. Which provide short therm help with sleep?
    2. Which affect non - REM sleep?
    3. Which affect REM Sleep?
    4. What drug effects sleep due to causing Nocturia?
    • 1. Hypnotics, barbiturates – provide short term help only
    • 2. Antidepressants and Stimulants - affect REM sleep
    • 3. Alcohol, Caffeine – affect non-REM sleep
    • 4. Diuretics – having to go to the BR frequently disrupts sleep
  57. nMore factors

    in normal sleep pattern (affects of menopause, illness, pain)

    Stress; depression

    factors (unfamiliar environment; homelessness)

    night or rotating shifts

    in time zones
  58. Sleep Requirements for a Neonate is what?
    10-23 hrs
  59. Sleep Requirment for an Infants (over 3 months)
    10-12 hrs plus naps
  60. Sleep Requirments for a Toddler (2 yrs)
    1 to 2 naps plus 10-12 hrs at night
  61. Pre-schooler requires how much sleep a night?
    10-11 hrs
  62. How much sleep do adolescent require a night?
    8-9 hrs
  63. 6-9.5 hrs of sleep is required for what class of people?
  64. Why do Older adults nap frequent during the day?
    poorerquality of sleep – explains reason for frequent napping during day
  65. How many time a night do we shift positions?
    20 to 40 per night is the norm
  66. What increases with age where sleep is concerned?
    Nightawakenings: 1 to 2 per night; increases with agen
  67. What is :unusual in the US except in very young & older persons?
  68. A sleep disorder where there is difficulty initiating or maintaining sleep; "want of sleep" but cannot forsome reason (ie. menopausal)
  69. When does Parasomnias occur?
    during deepest sleep
  70. A specific type of Parasomnias that happens 1 to 2x's a night where the person appears awake but unconscious of surroundings.
    Sleepwalking (somnambulism)
  71. Most common in preschoolers - sudden awakening, wide-eyed stare and screaming;difficult to arouse and calm, but once they are calmed they have no recall
    Night terrors
  72. What is grinding of teeth during sleep; generally related to anxiety called?
  73. Cessation of breathing for a time during sleep; with multiple nighttime awakenings is known as what?
    Sleep apnea
  74. Central Sleep Apnea is defined by what?
    a delay in signal from brain to breathe; cessation of airflow & respiratory movements due to affects on brain respiratory center
  75. Obstructive Sleep apnea is defined how?
    How is it treated?
    lack of airflow due to occlusion or obstruction of pharynx during sleep; more common in men &/or obese persons – treated surgically or using CPAP machine.
  76. When a person has Central and Obstrcutive Sleep Apnea is is referred to as what?
  77. Excessive daytime sleepiness, but not deprivation. Fall asleep at inappropriate times, may experience short term sleep paralysis.
  78. Catoplexy is what?
    short term sleep paralysis.
  79. How much of lost REM sleep is ever recovered?
    Only 2/3
  80. What can sleep deprivation affect?
    affects coordination, reaction time & judgment
  81. What are the clinical manifistations of Sleep Deprivation?
    Symptoms: HA, anxiety, decreased pain threshold, GI upset, vertigo, irritability, delayed wound healing
  82. What is the definition of Sleep Deprivation?
    • sleep lossng <6hrs per night
    • Possible total sleep >8 hrs with frequent interruptions (phone calls, baby crying,etc.)
  83. Sleep deprivation puts you at a greater risk for what disease process/other?
    • Diabetes Type II
    • Obesity
  84. Sleep history consist of what type of things? list 3
    rituals, timing, environment
  85. What should be utilized when doing an assessment for clients?
    What should be asked?
    • Utilize nursing history - Ask sleep patterns, usual
    • habits—sleep uninterrupted 6-8 hours
    • Sleep history: rituals, timing, environment
    • Sleeping problems:
    • Physical or Psychological illnesses
    • Current Life Events
    • Emotional/Mental Status
  86. Who should you ask question to when assessing sleep patterns?
    Clients are best source of information but families/partners have insight, too
  87. Should you ask open ended or detailed questions first when enquring about sleep problems?
    Sleeping problems: open ended questions then focused questions
  88. Which of the folloing would you not take note of when assess for sleep complications?
    Sleep Medications
    Inability to concentrate
    Hallucinations after extended periods of sleeplessness
    Sleep Medications
  89. What are some physical signs of sleep deprivation or complications?
    Physical: frequent yawning, dark circles under eyes, increased BP, pulse & RR
  90. What are some behavioral signs of sleep deprivation or compliactions?
    Behavioral – mood alterations, agitation, confusion
  91. What Diagnostic/Lab tests could be done to determine sleep complications?
    Diagnostic tests: sleep studies in sleep lab, homemonitoring, monitoring hormone levels
  92. Sleep Pattern Disturbance – change in quantity or quality of rest pattern that causes discomfort or interferes with desired lifestyle
    Sleep Deprivation – prolonged periods of time withoutsustained, natural sleep; periodic states of relative unconsciousness
    Fatigue – overwhelming, sustained sense ofexhaustion and decreased capacity for physical and mental work