1. Chapter42 1NRS_105/320_Collings

2.  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] 2NRS_105/320_Collings

3.  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 3NRS_105/320_Collings

4.  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 schedule [weeks]  Emotional Stress  Exercise & fatigue – effect R/T type  Fatigue R/T exercise promotes sleep  Fatigue r/T stress inhibits sleep  Food intake: indigestion, caffeine/stimulants  Alcohol causes early sleep then waking  Hunger makes it hard to sleep 4NRS_105/320_Collings

5.  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 5NRS_105/320_Collings

6.  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] 6NRS_105/320_Collings

7.  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 7NRS_105/320_Collings

8.  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 8NRS_105/320_Collings

9.  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 9NRS_105/320_Collings

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

11.  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 11NRS_105/320_Collings

12.  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 12NRS_105/320_Collings

13. Questions ? NRS_105/320_Collings13