1. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME ONE | SECOND EDITION Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Comfort 3 Nursing: A Concept-Based Approach to Learning MODULE VOLUME ONE | SECOND EDITION

2. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Exemplar 3.5 Sleep–Rest Disorders

3. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Exemplar Learning Outcomes After reading about this exemplar, you will be able to: 1.Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of sleep–rest disorders. 2.Identify risk factors and prevention methods associated with sleep–rest disorders.

4. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 3.Illustrate the nursing process in providing culturally competent care across the life span for individuals with sleep–rest disorders. 4.Formulate priority nursing diagnoses appropriate for an individual with sleep–rest disorders.

5. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 5.Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with sleep–rest disorders.

6. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 6.Plan evidence-based care for an individual with sleep–rest disorders and his or her family in collaboration with other members of the healthcare team. 7.Evaluate expected outcomes for an individual with sleep–rest disorders.

7. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Overview Sleep is essential to normal physiological functioning Adults need 7–9 hours of sleep each night Sleep-rest disorders prevent some from getting adequate sleep

8. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology Sleep loss  When individual gets < 7–8 hours sleep  Major problem in United States  Daytime drowsiness, fatigue  Chronic sleep loss Insomnia  Most common disorder  Individuals have trouble falling asleep or staying asleep

9. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Sleep apnea  Periods of partial or complete airway obstruction  ≥5 apneic events per hour Severe sleep apnea: >30 per hour  Breathing pauses last 10–20 seconds  Decreased oxygenation  Nonrestorative sleep, daytime drowsiness  Obstructive, central, mixed types

10. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Hypersomnia  Sufficent sleep but still suffers daytime drowsiness  Severe form: narcolepsy Daytime sleep attacks Hallucinations, sleep paralysis, cataplexy Brain cannot regulate sleep–wake cycles May be linked to hypocretin deficiency Onset: between ages 15 and 30

11. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Parasomnias  Abnormal actions during sleep  Occur between stages of sleep  Potentially harmful  Examples Sleep-related eating disorders Sleepwalking (somnambulism) Grinding teeth (bruxism) Sex while sleeping

12. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pathophysiology and Etiology, continued Dyssomnias  Subset of parasomnias  Restless leg syndrome Neurological disorder Overwhelming urge to move legs while at rest Muscle twitches, jerking movements of legs

13. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Etiology Physical factors  injuries, ulcers, aging, excessive weight Medical factors  fibromyalgia, asthma, chronic pain, genetic polymorphisms Psychiatric factors  depression, anxiety Environmental factors  alcohol, medications, extreme temperatures

14. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Risk Factors Insomnia  Female more than male  Over age 60  Mental health disorder Sleep apnea  Obesity  Large neck circumference  Male more than female  Smoking

15. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Risk Factors, continued Parasomnias  Children  Drug or alcohol abuse Restless leg syndrome  Older age  Stress  Kidney disease  Diabetes  Parkinson disease

16. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Clinical Manifestations Vary according to nature of disorder Sleeplessness Sleepiness, fatigue Irritability, distractability Morning headaches

17. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Lifespan and Cultural Considerations Adolescents and sleep  Changes in body's internal clock associated with puberty  Delay in melatonin release each night  Delayed sleep phase syndrome  Treatment: good sleep habits, bright light therapy, medications

18. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Lifespan and Cultural Considerations, continued Pregnant women and sleep  Physical discomfort and changing hormone levels  Emotions and anxiety about labor and delivery  Risk for sleep apnea increased  Frequent urination  Treatment: good sleep hygiene, CPAP for apnea

19. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Lifespan and Cultural Considerations, continued Older adults and sleep  Chronic health problems  Physiological changes of aging  Medications  Changes in sleep patterns  More at risk in long-term care facilities

20. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Collaboration Sleep disorders treated by team of healthcare professionals  Primary care physician  Nurses  Sleep specialists  Nutritionists  Others depending on underlying cause

21. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnostic Tests Polysomnography (PSG) Electroencephalogram (EEG) Video/audio equipment Heart rate, breathing, O 2 saturation

22. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Surgery Remove obstruction in sleep apnea Only if CPAP therapy not tolerated

23. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pharmacologic Therapy Sedative-hypnotic medications Antianxiety medications Half-life of drug important for effectiveness Sleep medications vary in onset, duration

24. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pharmacologic Therapy, continued Initial doses should be low, increased gradually Regular use can lead to tolerance, rebound insomnia Tapered dosages when stopping treatment

25. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Pharmacologic Therapy, continued Side effects  Headache, dizziness, drowsiness, nausea  Tachycardia  Postural hypertension  Older adults at more risk  Drug, food, herbal interactions  Some used only short term because of tolerance issues

26. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nonpharmacologic Therapy Cognitive-behavioral therapy Good sleep hygiene Physical exercise Relaxation techniques Nasal strips

27. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nonpharmacologic Therapy, continued Obstructive sleep apnea  Weight loss  Alcohol abstinence  Avoiding supine position for sleep  CPAP or BiPAP  Surgery

28. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nonpharmacologic Therapy, continued Bright light therapy Stimulus control therapy (behavioral) Sleep restriction Herbal supplements  Valerian  Chamomile  Melatonin

29. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Nursing Process Reports of frustration and annoyance about lack of sleep Risks of accidents increase dramatically in tired people Promote injury prevention  Not driving when tired  Using caution with dangerous equipment  Preventing fires if client smokes

30. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Assessment Sleep history  Sleep partner or parents may provide additional information  Sleep assessment scales

31. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnosis Nursing diagnoses may include:  Insomnia  Sleep Deprivation  Readiness for Enhanced Sleep  Disturbed Sleep Pattern  Fatigue  Wandering

32. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Diagnosis, continued  Ineffective Breathing Pattern  Ineffective Coping  Stress Overload  Risk for Injury  Deficient Knowledge (NANDA-I ©2012)

33. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Planning Goals may include that client will  Sleep through the night  Use relaxation techniques 30–45 minutes prior to bedtime  Maintain consistent bedtime  Use good sleep hygiene  Reduce, remove environmental distractions from the bedroom

34. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Planning, continued  Have sufficient energy for normal daily activities  Report improved quality and quantity of sleep Additional goals may include:  Client's spouse will report decreased snoring  Client's spouse will report no apneic episodes

35. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Implementation Nursing interventions may include:  Educating client about factors associated with impaired sleep–rest patterns  Instructing client in proper use of assistive devices  Reviewing client's medications to determine whether any interfering with sleep  Teachinh client about principles of good sleep hygiene

36. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Evaluation Evaluation should include data collection:  Observations of duration of client's sleep  Questions about how client feels upon awakening  Observations of client's level of alertness during day