Chapter 43- Sleep And Rest

In patients with sleep apnea, elevating the head of the bed can help improve their breathing and reduce the symptoms of the condition. By raising the head of the bed, gravity assists in keeping the airway open, allowing for better airflow and preventing episodes of apnea during sleep. This position helps to alleviate the obstruction or blockage that occurs in the airway, allowing the patient to breathe more easily and have a more restful sleep. Therefore, it is important for the nurse to ensure that the head of the bed is elevated for patients with sleep apnea.

The patient on CPAP (continuous positive airway pressure) is being treated for sleep apnea. Sleep apnea is a sleep disorder characterized by pauses in breathing or shallow breaths during sleep. CPAP is a common treatment for sleep apnea, as it helps to keep the airway open and maintain a continuous flow of air, preventing interruptions in breathing. Restless leg syndrome and parasomnias are unrelated sleep disorders and would not typically be treated with CPAP.

Ambien and Restoril = short term insomnia
Klonipin = seizures, bipolar, nuraglias (numbness, tingling), parkinsonian dysarthria, RLS, schizo, and sleep disorders

In rest, an awareness of the environment is maintained, which means that even though a person is resting, they are still conscious of their surroundings. This implies that they can perceive and respond to stimuli in their environment while at rest. On the other hand, in sleep, an awareness of the environment is not maintained, indicating that during sleep, a person is not conscious of their surroundings and is not able to respond to external stimuli. Therefore, the key difference between sleep and rest lies in the level of awareness and responsiveness to the environment.

The most important information during a sleep assessment is the patient's statement and history. This is because the patient's subjective experiences and reported symptoms provide valuable insights into their sleep patterns, quality, and any potential sleep disorders. The patient's statement and history help healthcare professionals understand the specific sleep-related issues the patient is facing, their duration, and any associated factors. This information is crucial for accurate diagnosis and appropriate treatment planning. Lab results of arterial blood gas may provide additional information about the patient's respiratory function, but they do not capture the comprehensive picture of the patient's sleep-related concerns. The spouse's observations of the patient's sleep can be helpful, but they may not always be reliable or provide a complete understanding of the patient's sleep experiences.

Based on the symptoms described, such as excessive daytime sleepiness, heavy snoring, and restless sleep, the nurse should suspect obstructive sleep apnea. Obstructive sleep apnea is a condition where the muscles in the throat relax and block the airway during sleep, causing pauses in breathing. This can lead to disrupted sleep, snoring, and excessive daytime sleepiness. Insomnia is characterized by difficulty falling asleep or staying asleep, which is not mentioned in the symptoms. Narcolepsy, on the other hand, is a neurological disorder that causes excessive daytime sleepiness and sudden attacks of sleep, but it does not typically involve heavy snoring or restless sleep.

if untreated = increased blood pressure, heart attack, stroke, and increased risk for diabetes

The appropriate action for the nursing student to take is to don gloves because the patient is bladder incontinent at night. This is necessary to maintain proper hygiene and prevent the spread of infection.

Encouraging the patient to go back to sleep is the correct answer because REM (Rapid Eye Movement) sleep is an essential stage of sleep for restorative processes in the body. It is during REM sleep that dreaming occurs, and it is believed to play a crucial role in memory consolidation and emotional regulation. By encouraging the patient to go back to sleep, the nurse is promoting the patient's overall sleep quality and allowing them to complete their sleep cycles, which is important for their physical and mental well-being.

As people age, it is common for them to experience disruptions in their sleep patterns, including waking up multiple times during the night. This is a normal part of the aging process and does not necessarily indicate a problem or require medical intervention. Therefore, the nurse should not take any action and reassure the patient that 1 to 2 awakenings during the night is common and expected as they age.

Exercising after 7 pm can disrupt the patient's sleep cycle as it increases alertness and raises body temperature, making it harder for them to fall asleep. It is recommended to avoid vigorous exercise close to bedtime to allow the body to wind down and prepare for sleep.

Sundowner's syndrome is a condition commonly seen in elderly patients, where they experience increased confusion, restlessness, and agitation during the evening and night. This is believed to be caused by disruptions in the patient's internal body clock, leading to a reversal of their sleep-wake cycle. As a result, the patient may feel awake at night and therefore become agitated.

Satin sheets would help someone with impaired mobility move at night because they have a smooth and slippery surface. This makes it easier for the person to shift and reposition themselves in bed without exerting too much effort or causing discomfort. The satin material reduces friction and allows for smoother movements, providing greater comfort and ease for individuals with impaired mobility during nighttime.

The patient is being awakened from stages 3 or 4. Stages 3 and 4 are both part of the deep sleep stage, also known as slow-wave sleep. Somnambulism and enuresis are both sleep disorders that can occur during this stage. Somnambulism refers to sleepwalking, while enuresis refers to bedwetting. Both of these conditions are more likely to occur during deep sleep, which is why the patient's spouse needs to wake him up when they happen.

The nurse is teaching the client about neurotransmitters responsible for sleep. Serotonin, acetylcholine, and norepinephrine are all neurotransmitters that play a role in sleep regulation. However, adrenaline is not directly involved in sleep regulation. It is a hormone that is released during times of stress or arousal, and it is responsible for the "fight or flight" response. Therefore, adrenaline is the correct answer as it is not a neurotransmitter responsible for sleep.

In stages 3 and 4 of sleep, dreams are typically more realistic. During these stages, known as deep sleep or slow-wave sleep, the brain activity slows down, and dreams tend to be less fantastical or bizarre compared to dreams during REM sleep. Instead, they often reflect real-life situations, experiences, and memories in a more logical and coherent manner. This is why dreams in stages 3 and 4 are considered to be more realistic.

A rape victim might experience difficulty sleeping due to increased vigilance. After experiencing such a traumatic event, the victim may constantly feel on edge and hyperaware of their surroundings, making it difficult for them to relax and fall asleep. This heightened state of vigilance is a common response to trauma and can greatly impact their ability to get a good night's sleep.

The statement "i was just daydreaming" suggests that the patient was not fully asleep but rather in a state of wakefulness or light sleep. This implies that they are not in the deeper stages of sleep, such as Stage two.

intense or rapid tiring and need to conserve energy are characteristics of fatigue.

maintenance insomnia = multiple awakenings

Disrupted sleep affects the human body by causing the body's inability to make stress hormones. During sleep, the body produces and regulates various hormones, including stress hormones like cortisol. When sleep is disrupted, the normal production and regulation of these hormones are disrupted as well. This can lead to imbalances in hormone levels, which can have negative effects on the body's ability to respond to stress and regulate other bodily functions.

Serotonin is the correct answer because it is a neurotransmitter that is known to decrease the activity of the RAS (Reticular Activating System). The RAS is responsible for regulating wakefulness and arousal in the brain. Serotonin has an inhibitory effect on the RAS, leading to a decrease in its activity and promoting relaxation and sleep. Norepinephrine and acetylcholine, on the other hand, are neurotransmitters that have excitatory effects on the RAS, increasing its activity and promoting alertness and wakefulness.

REM (Rapid Eye Movement) sleep is a stage of sleep that is associated with dreaming and plays a crucial role in emotional regulation and processing. During REM sleep, the brain consolidates and processes emotions, helping individuals cope with stress and anxiety. Therefore, someone who is worried or stressed would be at the greatest need for REM sleep as it helps in reducing their emotional distress and promoting overall well-being.

Patients who are on antidepressants or morphine may experience a decrease in REM sleep. This is because these medications can suppress the REM sleep cycle, leading to a reduction in the amount of time spent in this stage of sleep. REM sleep is important for various physiological and cognitive functions, including memory consolidation and emotional regulation. Therefore, a decrease in REM sleep can have implications for the patient's overall sleep quality and well-being.

Use of meds =for situational cases, REM is most vulnerable, effectiveness decreases after 4 weeks, DO NOT use when pulmonary function is compromised

The correct answer is "this is of concern, sleep latency is 10 to 30 minutes for an average person." Sleep latency refers to the amount of time it takes for a person to fall asleep after getting into bed. The average sleep latency for a healthy person is typically between 10 to 30 minutes. Therefore, if a patient reports a sleep latency of 30 minutes to 1 hour, it is longer than the normal range and may indicate a sleep problem or underlying issue that needs to be addressed.

"consistency, consistency, consistency." - Joyce

A polysonogram is a recording of multiple physiological signals during sleep. It typically includes an EEG to measure brain activity, an EOG to measure eye movements, and an EMG to measure muscle activity. However, it does not include an ECG, which is used to measure heart activity.

When on the floor, a nurse should schedule runs to ensure patients get at least 90 to 120 minutes of undisturbed sleep. This answer suggests that the nurse should prioritize providing a specific duration of uninterrupted sleep for the patients. It implies that the patients may not be able to get a full night's sleep, but the nurse should aim to give them a significant period of rest without disturbances.

Adolescents are most likely to suffer from narcolepsy. Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness and sudden attacks of sleep. It commonly begins during adolescence or early adulthood. While older adults may experience sleep-related issues, narcolepsy is more prevalent in adolescents. Newborns, on the other hand, have different sleep patterns and are not typically associated with narcolepsy.

L-tryptophan is an amino acid found in turkey and other protein-rich foods. It is known to increase the production of serotonin, a neurotransmitter that promotes sleep. Stage 4 is the deepest stage of sleep, also known as slow-wave sleep. Therefore, with increased L-tryptophan levels, it is likely that patients will have a longer duration of stage 4 sleep.

Patients suffering from severe hepatic disease and glaucomas should not be administered Klonipin because it can worsen their condition. Klonipin is a benzodiazepine medication that is primarily metabolized by the liver. In patients with severe hepatic disease, the liver's ability to metabolize drugs is impaired, leading to a buildup of the medication in the body. This can increase the risk of adverse effects and toxicity. Additionally, Klonipin can also increase intraocular pressure, which is harmful to patients with glaucomas as it can further damage the optic nerve. Therefore, it is contraindicated in these patients.

psychological*

Passive awake is not part of the three waking stages of newborns and infants. The three waking stages include crying, active awake, and quiet awake. Passive awake is not a recognized stage and therefore is not included in the list of waking stages for newborns and infants.

The patient is describing the characteristics of REM (Rapid Eye Movement) sleep, which is also known as Stage 5 sleep. During REM sleep, vivid and unrealistic dreams occur, and the body experiences temporary paralysis or inability to move. This stage is characterized by rapid eye movements and increased brain activity, similar to wakefulness.

During stage 5-REM (Rapid Eye Movement) sleep, the brain activity is similar to wakefulness. This is the stage where most dreaming occurs and the body experiences muscle paralysis. The brain waves during REM sleep resemble those of an awake state, with high-frequency, low-amplitude waves. This stage is important for memory consolidation and emotional processing.

During REM (Rapid Eye Movement) sleep, blood pressure and pulse fluctuate rapidly, respirations are irregular, O2 consumption is increased, and thermoregulation is lost. However, the presence of bursts of sleep spindles is not a characteristic of REM sleep. Sleep spindles are actually a characteristic of stage 2 non-REM sleep, which occurs before REM sleep.