Chapter 41_Sleep

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nursedgm87
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238728
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Chapter 41_Sleep
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2013-10-04 13:59:57
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Sleep Fundamentals Nursing
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Sleep needs-nursing
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  1. How is sleep regulated?
    Sleep is regulated by a sequence of physiological states integrated by central nervous system activity
  2. What are the steps of the sleep cycle?
    Presleep period+ 4 to 5 complete sleep cycles (NREM+one REM) per night
  3. What is REM sleep?
    Rapid eye movement sleep
  4. What are the stages of sleep?
    Stages 1, 2, 3, 4, and rapid eye movement (REM)
  5. What are circadian rhythms?
    Often referred to as the "body clock", circadian rhythm is a 24-hour cycle that rules us all. This internal body clock is affected by external forces, such as sun rise and time zones.
  6. What are the 2 main purposes of sleep?
    • -Physiological and psychological restoration
    • -Maintenance of biological functions
  7. When do dreams occur?
    -Dreams occur in both Non-REM and REM sleep but the ones we will remember because they're more vivid are the ones we have during REM sleep
  8. Which types of diseases and/or illnesses are more susceptible to affect our quality/amount of sleep?
    • -Respiratory (Sleep apnea or cold)
    • -Cardiovascular (Chest pain or poor blood circulation)
    • -Musculoskeletal (could be a sprained ankle=pain)
    • -Nocturia (needing to urinate during sleep time)
  9. What are some symptoms of sleep apnea?
    • -Stop breathing during sleep for at least 10 seconds
    • -You never feel rested
    • -Often wake up with headaches
  10. What is the best way to diagnose sleep apnea in a person?
    -When the person is married, the spouse is the best witness because they see it happen and they hear them snore loud
  11. What is hypersomnolence?
    -Excessive sleeping
  12. Insomnia is often related to...
    -Stress
  13. What is narcolepsy?
    Chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern.
  14. Which 3 nocturnal habits are considered parasomnias (undesirable motor and verbal responses)?
    • -Talking and walking in your sleep
    • -Braxism (gritting your teeth)
    • -Enuresis (bed wetting)
  15. True or False? Shift work will not affect the amount of sleep you usually get nor will it disrupt your sleeping patterns.
    False
  16. True or False? Sleep deprivation is considered a sleep disorder.
    True
  17. Quick Quiz! During rounds on the night shift, the nurse notes that a patient stops breathing for 1 to 2 minutes several times during the shift. What is this condition called?
    A. Cataplexy
    B. Narcolepsy
    C. Sleep apnea
    D. Insomnia
    C. Sleep apnea
    (this multiple choice question has been scrambled)
  18. Rest is crucial and everyone benefits from it. What are these benefits? (3)
    • -Mental relaxation
    • -Freedom from anxiety
    • -State of mental, physical, and spiritual activity
  19. Quick Quiz! A 4 year old pediatric patient resists going to sleep. What action should the nurse take in order to assist this patient?
    A. Add a daytime nap to the plan of care  
    B. Allow the child to sleep longer in the morning
    C. Maintain the patient's home sleep routine
    D. Offer the patient a bedtime snack that includes milk
    C. Maintain the patient's home sleep routine
    (this multiple choice question has been scrambled)
  20. The younger a person is, the (more, less) she sleeps and as the person gets older the (more, less) she needs sleep.
    • Younger=more sleep
    • As the person is getting older =less sleep

    We don't need to know how long each categories of people sleep but it's a good way to see that as people are getting older, the less they get or need sleep each night.

    • -Neonate=16h
    • -Infant=10-12h+naps=14h+
    • -Toddlers=12-14h with naps
    • -Preschoolers=13h
    • -School aged children=9 to 10h
    • -Adolescents=Varies
    • -Young adults=6 to 8.5h
    • -Middle and older adults=Decline in total number of hours
  21. What are the 7 factors affecting sleep?
    • -Drugs and substances
    • -Lifestyle
    • -Usual sleep pattern
    • -Emotional stress
    • -Environment
    • -Exercise and fatigue
    • -Food, drinks and caloric intake
  22. What are the most susceptible drugs and substances that may affect a person's sleep?
    • -Hypnotics
    • -Diuretics
    • -Antidepressants
    • -Alchohol
    • -Caffeine
    • -Narcotics
    • -Beta-blockers
    • -Anticonvulsants
    • -Anti-parkinsonians

    And from a personal point of view and I swear to god or whatever I can swear on, that my ADHD meds (which are in the class of central nervous system stimulants), if not taken at a certain time, its possible that I may not fall asleep at all or that I fall asleep very late at night.
  23. What are the most susceptible lifestyle patterns that may affect a person's sleep?
    • -Work schedule
    • -Social activities
    • -Routines
  24. What are the most susceptible emotional stresses that may affect a person's sleep?
    • -Worries (could be related to any kind of worries but most people worry about work and money)
    • -Physical health
    • -Death
    • -Losses
  25. In order to have a high quality night of sleep, which factors eliminated from the room's environment?
    • -Noises should be reduced to a minimum
    • -Darkness should be promoted (it has been proven that lighting affects your sleep quality and that it has become worse with cell phones charging, laptops charging and emitting light or any kind of electronics near your body when you sleep)
    • -A routine should be installed (going to bed around the same time every night and getting up around the same time every morning)
  26. True or False? It's good for your sleep if you go for a run (or workout) right before going to bed.
    False
  27. In order to be able of going to bed at a reasonable time at night, any caffeinated beverages should be avoided after what time of the day?
    5 pm
  28. When a nurse questions a patient about his sleep history, what are the 7 questions she might be likely to ask him? These questions will help the nurse to get the bigger picture concerning the factors that may influence her patient's sleep.
    • -Description of sleeping problems
    • -Usual sleep pattern
    • -Physical/psychological illness
    • -Current life events
    • -Bedtime routines
    • -Bedtime environment
    • -Behaviors of sleep deprivation
  29. When the nurse has questioned her patient's sleeping history, what is she able to do with all this information that she has gathered?
    -She is able to write a diagnosis in the patient's chart in order to inform the physician about the patient's situation. She's also able to make a care plan in order to help the patient to get better sleep, setting priorities  and collaborate with him.

    • Examples of diagnosis:
    • -Anxiety
    • -Ineffective breathing patterns
    • -Compromised family coping
    • -Disturbed sensory perception
    • -Sleep deprivation
  30. A patient with sleeping issues is being discharged today and going back home. Which home health promotion elements may the nurse implement to this leaving patient? (8)
    • She will promote:
    • -Environmental controls (temperature, noise, light)
    • -Bed time routines
    • -Safety
    • -Comfort
    • -Establishing periods of rest and sleep
    • -Stress reduction
    • -Avoid bedtime snacks that are high in calories (or sugar)
    • -Pharmacological approaches
    •      -Promoting sleep in older adults
    •      -Sleep hygiene
  31. What is the name of the device that could be suggested by a physician for a patient with sleep apnea issues?
    -CPAP (continuous positive airway pressure)
  32. A patient with sleeping issues is hospitalized. Which acute care elements may the nurse implement in order for her patient to get a better sleeping pattern? (5)
    • She will promote:
    • -Environmental controls (climate, curtains closed for privacy, decrease light, decrease noise)
    • -Comfort
    • -Establishing periods of rest and sleep
    • -Safety
    • -Stress reduction
  33. Quick Quiz! A patient suffers from a sleep pattern disturbance. What is the most important nursing intervention to promote adequate sleep?
    A. Plan to have activities during the night for this patient
    B. Encourage the patient to exercise immediately before sleep.
    C. Administer a sleep aid 2 hours before bedtime
    D. Reorganize the treatment and vital signs schedule at night
    D. Reorganize the treatment and vital signs schedule at night
    (this multiple choice question has been scrambled)
  34. Which 2 classes of medications are the most common in order to treat sleeping disorders?
    • -Hypnotics (Temazepam trade name is Restoril or Melatonin)
    • -Sedatives (Lorazepam trade name is Ativan or Oxazepam trade name is Serax)
  35. 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
    A. Headache
    (this multiple choice question has been scrambled)
  36. The nurse incorporates what priority nursing intervention into a plan of care to promote sleep for a hospitalized client?
    A. Give prescribed sleeping medications at dinner
    B. Have the client follow hospital routines
    C. Avoid awakening the client for nonessential tasks
    D. Turn the television on low to late-night programming
    C. Avoid awakening the client for nonessential tasks
    (this multiple choice question has been scrambled)
  37. Older adults are cautioned about the use of nonprescription sleeping medications because these medications can:
    A. Be expensive and difficult to obtain
    B. Lead to further sleep disruption even when they initially seemed to be effective.
    C. Cause headache and nausea
    D. Cause severe depression and anxiety
    B. Lead to further sleep disruption even when they initially seemed to be effective.
    (this multiple choice question has been scrambled)
  38. 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. Stage 4 NREM sleep
    B. Rapid eye movement (REM) sleep
    C. Stage 1 NREM sleep
    D. Transition period from NREM to REM sleep
    B. REM sleep
    (this multiple choice question has been scrambled)
  39. The nurse teaches a client taking phenytoin (Dilantin), an anticonvulsant, that this group of medications causes which symptom of a sleep problem?
    A. Increased difficulty falling asleep
    B. Increased awakening from sleep
    C. Nocturia
    D. Increased daytime sleepiness
    D. Increased daytime sleepiness
    (this multiple choice question has been scrambled)
  40. Which intervention is appropriate to include on a care plan for improving sleep in the older adult?
    A. Exercise in the evening to increase fatigue
    B. Decrease fluids 2 to 4 hours before sleep
    C. Take a nap during the day to make up for lost sleep
    D. Allow the patient to sleep as late as possible
    B. Decrease fluids 2 to 4 hours before sleep
    (this multiple choice question has been scrambled)
  41. Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching?
    A. "I won't put the baby to bed with a bottle."
    B. "My grandmother told me that babies sleep better on their stomachs."
    C. "For the first few weeks we're putting the cradle in our room."
    D. "I know I'll have to get up during the night to feed the baby when he wakes up."
    B. My grandmother told me that babies sleep better on their stomachs."
    (this multiple choice question has been scrambled)
  42. The nurse is developing a plan of care for a client experiencing narcolepsy. Which intervention is appropriate to include on the plan?
    A. Encourage patient to take one or two 20-minute naps during the day
    B. Have patient limit fluid intake 2 hours before bedtime
    C. Instruct the patient to increase carbohydrates in the diet
    D. Preserve energy by limiting exercise to morning hours
    A. Encourage client to take one or two 20-minute naps during the day
    (this multiple choice question has been scrambled)
  43. What nursing measure promotes sleep in school-aged children?
    A. Offer a glass of hot chocolate before bedtime
    B. Encourage evening exercise
    C. Make sure that the room is dark and quiet
    D. Encourage quiet activities prior to bedtime
    D. Encourage quiet activities prior to bedtime
    (this multiple choice question has been scrambled)
  44. To validate the suspicion that a married male client has sleep apnea, the nurse first:
    A. Schedule the client for a sleep test
    B. Question the spouse if she is awakened by her husband's snoring
    C. Ask the client if he experiences apnea in the middle of the night
    D. Place the client on a continuous positive airway pressure device
    B. Question the spouse if she is awakened by her husband's snoring
    (this multiple choice question has been scrambled)
  45. When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:
    A. Anticonvulsants
    B. Antidepressants
    C. Opioids
    D. Non-steroidal anti-inflammatory drugs
    E. Adjuvants
    C. Opioids
    (this multiple choice question has been scrambled)
  46. The nurse finds a client sleepwalking down the unit hallway. An appropriate intervention the nurse implements is:
    A. Blocking the hallway with chairs and seating the client
    B. Lightly tapping the client on the shoulder and leading him or her back to bed.
    C. Quietly approaching the client and then loudly calling his or her name
    D. Asking the client what he or she is doing and calling for help
    B. Lightly tapping the client on the shoulder and leading him or her back to bed.
    (this multiple choice question has been scrambled)
  47. The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises.
    A. Second
    B. First
    C. Third
    D. Fourth
    B. First
    (this multiple choice question has been scrambled)
  48. Which of the following medications are the safest to administer to adults needing assistance in falling asleep?
    A. Hydroxyzine
    B. Chloral hydrate
    C. Phenoarbital
    D. Triazolam
    D. Triazolam (Benzodiazepines class)
    (this multiple choice question has been scrambled)
  49. The nurse is providing health teaching for a client using herbal compounds such as valerian for sleep. What points need to be included?
    A. Can cause urinary retention
    B. Should not be used indefinitely
    C. May cause diarrhea and anxiety
    D. May interfere with prescribed medications
    E. Over time they can lead to further sleep problems
    F. Are not regulated by Health Canada
    • B. Should not be used indefinitely
    • D. May interfere with prescribed medications
    • E. Over time they can lead to further sleep problems
    • F. Are not regulated by Health Canada
  50. The nurse recognizes that a client is experiencing insomnia when the client reports...
    A. Difficulty staying asleep
    B. Extended time to fall asleep
    C. Feeling tired after a night's sleep
    D. Falling asleep at inappropriate times
    • A. Difficulty staying asleep
    • B. Extended time to fall asleep
    • C. Feeling tired after a night's sleep
  51. The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS), the best position in which to place the baby after nursing is...
    A. Prone
    B. Supine
    C. Fowler's
    D. Side lying
    • B. Supine
    • D. Side lying
  52. To assist an adult client to sleep better, the nurse recommends which of the following?
    A. Eating a large meal one hour before bedtime
    B. Performing mild exercises 30 minutes before going to bed
    C. Drinking a glass of wine just before retiring to bed
    D. Consuming a small glass of warm milk at bedtime
    D. Consuming a small glass of warm milk at bedtime
    (this multiple choice question has been scrambled)

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