SLEEP Chapter 42 NRS105320Collings 1 Sleep Basics Sleep

SLEEP Chapter 42 NRS_105/320_Collings 1

Sleep Basics � Sleep contributes to healing & tissue repair � Human Growth Hormone released � Protein synthesis, cell division � Brain tissue repair � May help us process information and experiences [learning] � REM � sleep During sleep, HR, RR, B/P decrease � Muscles relax [paralysis during deep sleep] NRS_105/320_Collings 2

Factors Influencing sleep � Anything that causes pain, anxiety, discomfort [e. g. full bladder] interferes with sleep � Hospitalization, � � � illness, anxiety, pain= poor sleep Respiratory disease – may need head up Nocturia – disrupts sleep Environment � Noise, smells, light levels, interruptions common in healthcare facilities � Sleeping alone NRS_105/320_Collings 3

Factors Influencing sleep � Medications – � may interfere with REM, sleep cycle, or cause side effects [e. g. flushing, vivid dreaming] that disrupt sleep � Lifestyle – changes in sleep/work/play pattern � Shift work, social activities � To adjust body clock, stay on � � Emotional Stress Exercise & fatigue – effect R/T type � Fatigue � schedule [weeks] R/T exercise promotes sleep r/T stress inhibits sleep Food intake: indigestion, caffeine/stimulants � Alcohol � Hunger causes early sleep then waking makes it hard to sleep NRS_105/320_Collings 4

Baseline sleep Patterns � � � Infants – sleep 12 -16 hours a day Toddlers – School Age children: sleep time decreases with age; 12 – 10 hrs needed Adolescents – may need much more sleep than they get [7 hrs] leading to poor concentration Young adult: need 6 -9 hours to function at peak Middle Age: Deep sleep declines, emotional and physical issues may cause insomnia Older adults: > 50% have sleep problems R/T physical illness/pain/nocturia. May increase confusion during daytime and at night NRS_105/320_Collings 5

Sleep Disorders � Sleep apnea � Obstructive type most common Client may not be aware of waking Usually SO c/o snoring Causes impairment during waking hours, cardiac prob, increases risk of HTN, stroke, sexual dysfunction… � Anesthesia causes temporary obstructive sleep apnea – monitor and position [not supine] � Insomnia � Difficulty falling asleep � Frequent waking or trouble � falling back to sleep Sleep deprivation � Chronic lack of sleep [nurses, students, patients] NRS_105/320_Collings 6

Assessment � � � � Usual sleep patterns Recent changes Describe a typical night…. [open ended] S/SX – snoring, problems falling asleep /staying asleep/waking Effect & Severity – impact on function, interaction, concentration Contributing factors [meds, intake, exercise, illness, etc. ] Usual routine at bedtime/environment NRS_105/320_Collings 7

Nursing diagnoses � � Ineffective breathing pattern R/T obstruction of airway 2* to sleep apnea AEB snoring, daytime drowsiness Ineffective Role Performance R/T poor concentration 2* to lack of sleep AEB decline in grades, falling asleep in class Risk for injury R/T daytime drowsiness Confusion r/t chronic lack of sleep AEB LOC, forgetfullness NRS_105/320_Collings 8

Goals � � Work with client to develop goal Overall: improve sleep pattern/ improve daytime functioning � Client will verbalize satisfaction with quality of rest/sleep while hospitalized � Pt will demonstrate improved sleep pattern by napping less than 1 hour/day by end of week � Client will demonstrate proper use of CPAP for sleep apnea by end of visit today NRS_105/320_Collings 9

Interventions � � Promote client control, information to decrease stress Promote usual sleep patterns � Bedtime, � Control environment and interruptions � Within � ability Control Pain � position � of comfort, massage, shower, pillows/position Promote safety � Night � routine light or bathroom light in unfamiliar room Medications � Best for acute/short term use only NRS_105/320_Collings 10

Evaluation � Client is best source for evaluating � Did client verbalize good/improved rest? � Does client nap less next day? � Is client behavior different? � � Goal met? Revise or continue with plan NRS_105/320_Collings 11

Try it � � Do you have good sleep habits? Write a care plan for yourself or another/ hypothetical student You may use a patient, friend, or case study if you prefer This may be your self-care plan NRS_105/320_Collings 12

Questions? NRS_105/320_Collings 13