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Lullaby and Good Night….

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Presentation on theme: "Lullaby and Good Night…."— Presentation transcript:

1 Lullaby and Good Night….
Lisa B. Flatt, RN, MSN, CHPN

2 Rest vs. Sleep Calm state Relaxation Physical activity
No physical activity Altered state of consciousness Perception and reaction are decreased Varying levels of reaction (dog barking, lawn mower, smoke detector)

3 Types of Sleep Rapid Eye Movement (REM) Non-rapid Eye Movement (NREM)
25% of sleep in young adults Recurs every 990 minutes and lasts 5-30 minutes Increases as you become more rested Active dreaming, remembered dreams, difficulty awakening, depressed muscle tone, irregular heart, respiratory rates and muscle movements, increased brain activity Most sleep is non-REM slow-waves 4 Stages I:last few minutes; drowsy, relaxed, eyes roll side to side; RR and HR decrease II: minutes, eyes still; HR, RR and T decrease III: HR, RR, T decrease; MS relaxes; decreased reflexes; snoring IV: deep sleep; HR and RR drop to 20-30% waking rate; some dreaming, eye rolling; decreased BP; blood vessels dilate; MS relax; decreased BMR; increased GI activity

4 How long do they last? Not Long enough!
REM – recurs every 990 minutes, lasts 5-30 minute NREM - about one hour in adults Stage II and III – minutes total Stage IV – 30 minutes Cycle REM, St I,II and III then IV – then III, II and REM cycle4-6 times every 7-8 hours Each cycles lasts about 70 minutes If you wake up, start all over again! More rested, cycles last longer, less time in Stages II and IV and NREM Different developmental levels, different time lengths

5 Circadian Rhythm – Not to be confused with Cicadas
24 hour – Daily cycle, all living things do it! Biorhythms – humans only. These are controlled with light and darkness, gravity and electromagnetic stimuli. Infants as young as 6 months have circadian rhythms very much like adults!

6 How well do you sleep? What to assess and consider……
Age and developmental level Individual preferences Physical condition Cultural, spiritual and religious practices Living conditions and socioeconomic status Environmental factors Psychological factors Medications

7 Age and Developmental Level – the need for sleep
Hours/day Other Newborns 16-18 50%REM mostly St III and IV NREM Infants 12-22 Light sleep, end of 1st year 14 of 24 hrs with 1-2 naps Toddlers 10-12 20-30%REM, 1 nap, bedtime resistance Preschoolers 11-12 20-30%REM,less St I NREM, consistency, may need naps School-age 8-12 20% REM Adolescents Young adult 7-8 Middle-age adult 6-8 St IV decreases, aroused more easily Older adult Awaken more frequently, longer to get back to sleep

8 Preferences Sleep patterns Lifestyle
Work schedule and changes – sleep pattern changes Caffeine Alcohol – speeds up REM sleep Smoking – nicotine is a stimulant Vigorous exercise at ‘wrong times’ – releases endorphins

9 What kind of shape are you in?
Illnesses – require more sleep Altered health status Obesity – difficulty breathing Nocturia Activity level Ineffective breathing

10 And more…… Cultural, Spiritual, Religious Socieeconomic, Living conditions, Environmental Co-sleeping (babies and young children sleeping with parents) Sanitation Safety Noise Temperature extremes ventilation

11 ….. And more…… Anxiety Stress Depression Beta blockers Sedatives
Psychiatric Medications Anxiety Stress Depression Beta blockers Sedatives Narcotics Diuretics Amphetamines Bronchodilators Decongestants Steroids

12 Disturbing my Sleep! Primary Sleep Disorders Secondary Sleep Disorders
Narcolepsy – excessively sleepy during day; could be in middle of driving, talking, etc..; starts with REM Unknown, possible genetic defect Insomnia – unable to fall asleep; psychological (anxiety, etc); pain; nocturia; environmental (lights, etc.); chemical (medicine, caffeine, etc.) Full assessment needed, usually no med’s; modification of habits, etc. Secondary Sleep Disorders Hypersomnia – excessive sleeping during the day, r/t CNS damage, kidney, liver or metabolic disorders Sleep apnea – periods of apnea during sleep; last 10 sec – 2 min; x/night; tired during day; middle-aged overwt males and post-menopausal women Parasomnia-behaviors that interfere with sleep Sleep deprivation – decrease in amount, consistency and quality of sleep

13 Sleep Apnea Three types Causes Treatments
_Obstructive – tongue, tonsils_ __Central Apnea- chest movement, air flow stops, respiratory center defect in brain__ __Mixed – both combined_____ Causes ___remove and hopefully correct__________ ___modify reasons as above__________ Treatments __CPAP_____ __BiPAP____________ ___Surgery, adjust body habitus, sleep sitting up____

14 Parasomnia- behaviors
Somnambulism - ___sleep walking______ Sleeptalking - ___holler out, tell secrets_______ Nocturnal enuresis - __pee at night___ Nocturnal erections - ___speaks for itself_____ Bruxism - ___teeth grinding____

15 Assessment Medications Age Activity - patterns Diet Alcohol/drugs
Disease process - labs Sleep patterns Stress, anxiety, depression

16 Nursing Diagnosis Insomnia R/T ____anxiety, stress, depression
Impairment of normal sleep pattern R/T _____shift work, SOB, ________ Sleep deprivation R/T _____fan running at night for wife to sleep, dementia, nightmares, narcolepsy, sleep walking, idiopathic CNS disease_______

17 Plan Collaborate with team to get an ideas on how to promote sleep
Assess sleep pattern daily Client will verbalize plan to sleep at night, wake in am Reduce environmental noise Monitor fluid intake after 6PM Instruct family on sleep patterns and disease

18 Interventions Provide Calm environment by closing door at night
Rub lotion on back before bed at 10PM Turn off tv at 8pm Administer sleeping pill by 9pm Keep sleep log Educate family on need to give diuretic before 4pm

19 Evaluation 6 of 7 nights closed door before 9PM
Did not rub patient’s hairy back at all Wife turned off tv at night before 11pm Gave extra sleeping pills and benadryl to keep patient off call light 7 of 7 nights Sleep log kept by nurse first two days, family kept last 5 days (instructed not to hit patient with sleep log) Wife took patients diuretic related to her swollen ankles – discuss this with social work

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