Nursing A ConceptBased Approach to Learning VOLUME ONE
Nursing: A Concept-Based Approach to Learning VOLUME ONE EDITION VOLUME ONE|| SECOND EDITION MODULE 7 Health, Wellness, and Illness Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health • Professional definitions of health § Presence or absence of disease § "State of being well and using every power the individual possesses to the fullest extent" (Florence Nightingale) § "Dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible" (ANA) Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Wellness and Well-Being • State of well-being § § § Self-responsibility Ultimate goal Dynamic, growing process Daily decision making Whole being of individual Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Holism • Concerned with the individual as a whole, not as an assembly of parts • Consider the relationship of individuals to the environment and to others • Interventions are directed toward restoring overall harmony Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The seven components of wellness. From Wellness: Concepts and Applications, 7 th ed. (p. 4), by D. J. Anspaugh, M. H. Hamrick, and F. D. Rosato, 2009, New York, NY: Mc. Graw-Hill. Reprinted with permission. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
An Illness–Wellness Continuum • Health and illness/disease can be seen as opposite ends of a health continuum § Individuals move back and forth day by day § No distinct boundary § Perceptions of self, others' perceptions affect placement on continuum Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Illness and Disease • Illness § Highly personal state § Diminished physical, emotional, intellectual, social developmental or spiritual functioning § May or may not be related to disease • Acute Illness • Short duration and severe • Chronic Illness • Persists longer than 6 months • Disease § Alteration in body functions § Reduction of capacities § Shortening of normal life span Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Illness Behavior • Involves how people monitor their bodies and define and interpret their symptoms • Internal variables § Perception of illness and nature of illness • External variables § Visibility of symptoms, social group, cultural background, economics, and accessibility to health care Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Effects of Illness • Reaction § § § Anxiety: #1 response Regression Anger Guilt Depression/sadness Dependancy Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Effects of Illness on the Client and Family/Caregiver • Brings changes § Behavioral and emotional § Self-concept and body image § Lifestyle • Loss of autonomy • Often means change in lifestyle Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Caregiver’s Concerns Assess the family for the existence of caregivers who provide daily or respite care for older adult family members. Assess for caregiver burden. Caregivers are most often spouses or middle-aged children. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion • Healthy People 2020: Improving the Health of Americans § Four major goals 1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death 2. Achieve health equality, eliminate disparities, and improve the health of all groups Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion, continued • Healthy People 2020: Improving the Health of Americans § Four major goals 3. Create social and physical environments that promote good health for all 4. Promote quality of life, healthy development, and healthy behaviors across all life stages Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nurse's Role in Health Promotion, • Health risk appraisal, wellness assessment § Teach about risk factors § Motivate to reduce specific risks, develop positive health habits • Lifestyle and behavior change § Requires participation of individual § Geared toward enhancing quality of life, extending life span Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Screening Guidelines Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Infants • Additional Protective Measures Failure to thrive Infant colic Crying Child abuse including shaken baby syndrome § Sudden infant death § § Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Box 21 -5 Health Promotion Guidelines for Toddlers Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Toddlers • Additional Protective Measures § Visual problems § Respiratory and ear infections (second hand smoke) § Dental caries Learn through exploration and imitation Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Pre. Schoolers • Additional Protective Measures § Visual problems § Respiratory tract and ear infections • Communicable disease • Congenital abnormalities correction Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for School-Age Children • Additional Protective Measures § Cholesterol screening § Urine for glucose § Communicable diseases § Stress management § Sleep habits • Additional Play and Social Interaction § Organized group activities § Parental expectations § Parental responsibilities Begin to form beliefs about health Influenced by parents and caregivers Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Adolescents • Additional Protective Measures § Infectious disease: meningitis, STD’s § Cardiovascular disease § Neglect/abuse • Additional Safety Concerns § § Teen pregnancy Addiction (tobacco, drugs, alcohol) Mental health: schizophrenia, depression, suicide Homosexuality • Additional Nutrition and Exercise Guidelines § Calcium, vitamin D to prevent osteoporosis § Increased sleep needs Image and weight issues can lead to anorexia or steroid use Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Box 22 -2 (continued) Health Promotion Guidelines for Young Adults Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Young Adults § Additional Protective Measures § Diabetes screening § Calcium and vitamin D to prevent osteoporosis § Additional Safety Concerns § § § § Injury and violence Suicide (leading cause of death) Hypertension Substance abuse (including smoking) Sexually transmitted infections (STI) Eating disorders Certain malignancies (testicular cancer (age 15 -35), breast cancer and cervical cancer) Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Middle Aged Adults • Additional Safety Concerns § Injuries (MVA, occupational) § Cancer (#1 cause of death) • Cancer of the lung, prostate, and colon (men) • Lung cancer followed by cancer of the breast then colon (women) § Cardiovascular disease (#1 cause of death) § Obesity § Diabetes § Alcoholism § Mental health alterations • Anxiety • Depression Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Middle Aged Adults • Additional Health Tests and Screening § Mammogram age 35 baseline § Screening for diabetes (glucose) § Screening for colorectal (stool for guiac; sigmoidoscopy age 50), cervical, uterine, and prostate cancer (PSA age 55) § Screening for osteoporosis § Skin assessment § Medication assessment Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Health Promotion for Older Adults • Additional Health Tests and Screening: § bone mineral, ekg, thyroid, chemistry, and skin assessment • Safety: polypharmacy ü Acute care settings pose risks for adverse events: Delirium, dehydration, malnutrition, health care–associated infections, urinary incontinence, falls Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Variables Influencing Health • External variables § Lifestyle choices § Healthy or unhealthy activities Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Variables Influencing Health, continued • Internal variables § Biological • Genetic factors § Psychological • Presence of mental illness § Cognitive • Disorders of cognition such as autism spectrum disorder Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment • Health history and physical examination § § Existing problems Age Safety assessment Nutritional assessment • Physical fitness assessment § Muscle endurance § Flexibility, body composition § Cardiorespiratory endurance Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment, continued • Lifestyle assessment § § § Personal lifestyle, habits of client Physical activity Nutritional practices Smoking, alcohol and drug consumption Lifestyle assessment tools Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment, continued • Spiritual health assessment § Ability to develop inner being to fullest § Beliefs can affect individual's interpretation of life events Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment, continued • Social support systems review § Social context in which person lives § Creates environment for healthy behavior • Life stress review § Stress affects mental, physical well-being Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Individual Assessment • Goal is individuals being responsible for their own health • • • How would you rate your own health? Are you currently doing any regular exercises? Describe a typical day of meals. Do you have any problems with elimination? How many hours of sleep do you get at night? What is your perception of yourself? List your various roles. How do you resolve conflicts? How do you express tenderness and affection? What do you believe makes a person healthy? Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Family Health Assessment • Family members share responsibility for the functional health of all members • What are the family roles and functions? • Describe the family structure. • What is the current health status of the family members? • What are the preventive health practices in your family? • How does the family express emotions? • What does your family value? • What causes stress in your family? • What types of things does your family do to cope? Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Community Assessment • Community environment affects well being of the individual and family • • • Nursing: A Concept-Based Approach to Learning Volume One, Second Edition What are the major health problems in your community? Are there parks, and bike and hike paths? Do residents seem well nourished in your community? How is hazardous waste disposed of in your community? Do noises in the community interfere with sleep patterns? Are schools providing a good education? Are residents proud of their community? Can individuals access agencies easily in terms of health issues? Review the marriage and birth statistics for the community. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnosis • Readiness for Enhanced Self-Health Management • Readiness for Enhanced Knowledge Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Planning • Health promotion plan developed in response to needs, desires, priorities • Nurse acts as resource person Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation • Client self-responsibility • Ongoing support by nurse § Focuses on desired behavior change • Facilitate social support § Assist client to assess, modify, and develop social support • Provide health education • Enhance behavior change § Strategies at each stage of change § Advance client to next stage of changing Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Risk Factor Modification and Changing Health Behaviors • Precontemplation § Not intending to make changes within the next 6 months • Contemplation § Considering a change within the next 6 months • Preparation § Making small changes in preparation for a change in the next month Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Risk Factor Modification and Changing Health Behaviors (cont’d) • Improvement in health may involve a change in health behaviors. • Action § Actively engaged in strategies to change behavior; lasts up to 6 months • Maintenance stage § Sustained change over time; begins 6 months after action has started and continues indefinitely Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Evaluation • Ongoing • Monitoring short-term, long-term goals • Target date determined for attaining goals written during planning • Client may continue plan, reorder priorities, change strategies, or revise plan • Collaborative effort between nurse and client Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar 7. 1 Physical Fitness and Exercise Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Overview • Physical fitness § § § Improving mood and overall mental health Reducing risk for cardiovascular disease Strengthening bone and muscle Reducing risk of some illnesses Improving stability Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise • Musculoskeletal system § § Muscles hypertrophy Increased efficiency of muscular contraction Joints receive nourishment through activity Bone density, strength maintained through weight bearing Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Cardiovascular system § Helps to prevent stroke, CV disease § Increases heart rate, strength of heart muscle § Mediates harmful effects of stress Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Respiratory system § Ventilation, oxygen intake increase § Toxins eliminated with deeper breathing § Problem solving, emotional stability enhanced § Prevents pooling of secretions Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Gastrointestinal system § Improves appetite § Increases GI tract tone § Abdominal compressive exercise improves symptoms of IBS Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Metabolic/endocrine system § Elevates metabolism § Weight loss, exercise stabilize blood sugar • Urinary system § Promotes efficient blood blow § Body excretes wastes more efficiently Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Immune system § Lymph fluid pumped more efficiently § Circulation improves § Benefits of moderate exercise in older adults § Strenuous exercise may reduce immune function Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Psychoneurological system § Mental, affective disorders may affect desire to move § Fatigue of chronic stress discourages exercise § Role of exercise in elevating mood, relieving stress, anxiety § Regular exercise Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Psychoneurological system § § § Increases levels of endorphins Improves oxygenation Releases stored stress Improves quality of sleep Aerobic exercise • Dramatic positive effect on insomnia in older adults Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Cognitive function § Physical exertion induces cells in the brain to strengthen and build neuronal connections. § Exercise has positive effects in individuals with Parkinson disease, Alzheimer disease Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Spiritual health § Enhances experience of mind–body–spirit connection § Lower anxiety § Fewer psychotic symptoms § Less substance abuse Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Benefits of Exercise, continued • Spiritual health § Better coping mechanisms § Success in aging, end-of-life issues § Longer survival, healthier behavior, less distress Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar 7. 2 Oral Health Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment • Health history § Oral hygiene practices § Dental visits § Self-care abilities • Physical assessment: inspect oral cavity § § Plaque Tartar Gingivitis Pyorrhea Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation: Promote Oral Health Throughout the Life Span • Infants and toddlers § Begin dental hygiene when first tooth erupts § Beginning at 18 months: soft toothbrush § Fluoride supplement as recommended § Inspection visit at 18 months § Initial dental visit at 2– 3 years § Seek professional dental attention for problems Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation: Promote Oral Health Throughout the Life Span, continued • Preschoolers, school-age children § Dental care § Establish good dental habits early § Fluoride remains important • Adolescents and adults § Diet § Tooth and mouth care Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation: Promote Oral Health Throughout the Life Span, continued • Older adults § § § § At risk for cavities, periodontal disease Increased risk because of self-care deficits Brushing, flossing Caring for artificial teeth: plate(s), bridge Assisting with oral care Wear gloves Foam swabs often used Privacy in cleaning artificial teeth Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation: Promote Oral Health Throughout the Life Span, continued • Clients with special oral hygiene needs § Debilitated, unconscious client • Oral mucosa, tongue in addition to teeth § Mouth tends to become dry • Tooth decay, infections § Predisposing client to tooth decay • Remove plaque, microorganisms § Soft-bristled toothbrush § Oral swab and water-soluble moisturizer Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar 7. 3 Normal Sleep–Rest Patterns Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Overview • Sleep is a basic human need. • Universal biological process § Reasons we sleep • • Cope with stress Conserve energy Restore mind and body Vital for psychological, physiological functioning Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Types of Sleep • NREM sleep § Stage I: very light sleep, lasts a few minutes § Stage II: light sleep § Stages III and IV: deepest sleep § Physiological changes Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Types of Sleep, continued • REM sleep § Every 90 minutes, lasts 5– 30 minutes § Brain highly active § Dreaming Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Sleep Cycles • 90– 110 minutes/cycle in adults • Four to six cycles during 7– 8 hours • Sleeper awakened during any stage must start anew at stage I NREM • Duration of NREM/REM sleep varies throughout sleep period • Deep sleep longer in early part of night Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Sleep Cycles, continued • Later, less time in stages III, IV of NREM • REM sleep increases, longer dreams • Stages I, 11 NREM sleep, REM sleep predominate toward end of sleep period Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements • Newborns § 16– 18 hours/day • Irregular schedule • Enter REM sleep immediately • Put to bed on back when sleepy but not asleep Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements, continued • Infants § 14– 15 hours/day • Awaken every 3– 4 hours • Eat, back to sleep • Sleep through the night, daytime naps by 6 months • Half of time in light sleep • Active during light sleep • Put to bed when sleepy but not asleep helps them become self-soothers Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements, continued • Toddlers § 12– 14 hours/night with nap(s) • Nighttime fears, nightmares common • Security object can help • Consistent bedtime routine, sleep schedule help Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements, continued • Preschoolers § 11– 13 hours/night • • Need fluctuates in relation to activity, growth Restless, irritable if not enough sleep Maintain consistent sleep schedule Wake frequently at night, may fear dark or have night terrors, nightmares Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements, continued • School age § 10– 11 hours/night • Most get less • Demands of homework, sports, social activities • Spend more time at computer, TV • Caffeinated beverages • Consistent sleep schedule, routine help Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements, continued • Adolescents § 9– 10 hours/night • Most get less • Later sleep–wake patterns conflict with daily schedule • Nocturnal emissions Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements, continued • Adults § 7– 9 hours/night • Individual variation • Signs of not enough sleep • Falling asleep or getting drowsy during nonfatiguing task • Inability to concentrate or remember information • Unreasonable irritability Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Normal Sleep Patterns and Requirements, continued • Older adults § Awaken earlier, go to bed earlier § Increase in disturbed sleep affects quality of life § Better health more likely to sleep well § Adults with more medical conditions sleep problems Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Factors Affecting Sleep • Irregular morning or nighttime schedule • Exercise § Moderate in morning or early evening good sleep § Late in day can delay sleep • Emotional stress • Stimulants, alcohol Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Factors Affecting Sleep, continued • Diet § Weight gain reduces total sleep time § Weight loss increases total sleep time • Smoking § Difficulty falling asleep § Easily aroused Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Factors Affecting Sleep, continued • Motivation § Can increase alertness in some situations § Won't overcome sleepiness • Medications § Hypnotics: interfere with deep sleep, suppress deep REM sleep § Beta-blockers: insomnia, nightmares § Narcotics: suppress REM sleep, cause frequent awakenings, drowsiness Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Factors Affecting Sleep, continued • Medications § Antidepressants: suppress REM sleep, therapeutic § REM rebound, intense dreams when hypnotics and antidepressants are discontinued Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
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