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Presentation on theme: "L ULLABY AND G OOD N IGHT …. Lisa B. Flatt, RN, MSN, CHPN."— Presentation transcript:


2 R EST VS. S LEEP 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) RestSleep

3 T YPES OF S LEEP 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 Rapid Eye Movement (REM) Non-rapid Eye Movement (NREM)

4 H OW LONG DO THEY LAST ? N OT L ONG 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 C IRCADIAN R HYTHM – N OT TO BE CONFUSED WITH C ICADAS 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 H OW WELL DO YOU SLEEP ? W HAT 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 A GE AND D EVELOPMENTAL L EVEL – THE NEED FOR SLEEP AgeHours/dayOther Newborns %REM mostly St III and IV NREM Infants12-22Light sleep, end of 1 st year 14 of 24 hrs with 1-2 naps Toddlers %REM, 1 nap, bedtime resistance Preschoolers %REM,less St I NREM, consistency, may need naps School-age8-1220% REM Adolescents8-1220% REM Young adult7-8 Middle-age adult6-8St IV decreases, aroused more easily Older adultAwaken more frequently, longer to get back to sleep

8 P REFERENCES 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 W HAT KIND OF SHAPE ARE YOU IN ? Illnesses – require more sleep Altered health status Obesity – difficulty breathing Nocturia Activity level Ineffective breathing

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

11 ….. A ND MORE …… Anxiety Stress Depression Beta blockers Sedatives Narcotics Diuretics Amphetamines Bronchodilators Decongestants Steroids PsychiatricMedications

12 Disturbing my Sleep! Primary 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 meds; 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 _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 patients 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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