chapter 18 comfort, rest, and sleep

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 18

Comfort, Rest, and Sleep


Comfort, Rest, and SleepComfort, Rest, and Sleep

• Comfort facilitates rest and sleep

• Safe, clean, and attractive environment contributes to comfort


QuestionQuestion

•Is the following statement true or false?

Client rooms resemble bedrooms that are bare, white, and have sterile environments.


AnswerAnswer

False.

Client rooms are now bright, colorful, and tastefully decorated.


The Client Environment The Client Environment

• Environment: nursing care room, furnishings• Client rooms

– Wall: relaxing color schemes, wallpapers– Floor: carpeted or linoleum surface– Lighting: adequate lighting, adjustable

intensity– Climate control: temperature, humidity,

ventilation


The Client Environment (cont’d)The Client Environment (cont’d)

• Room furnishings

– Bed

o Mattress

o Pillows

o Linen

– Privacy curtain


The Client Environment (cont’d)The Client Environment (cont’d)

• Room furnishings (cont’d)

– Overbed table

– Bedside stand

– Chairs


Sleep and RestSleep and Rest

• Functions of sleep

– Promotes emotional well-being

– Enhances various physiologic processes

– Reduces fatigue


Sleep and Rest (cont’d)Sleep and Rest (cont’d)

• Functions of sleep (cont’d)

– Stabilizes mood

– Improves blood flow to brain

– Improves immune system

– Improves capacity for learning and memory storage



• Sleep phases

– Nonrapid eye movement (NREM)

o Quiet sleep

– Rapid eye movement (REM)

o Active or deepest stage of sleep


Characteristic Electroencephalogram Wave Form

Characteristic Electroencephalogram Wave Form



• Sleep cycles

– Alternate through NREM and REM phases

• Sleep requirements

– Vary among different age groups



• Factors affecting sleep

– Old age

– Light

– Activity

– Environment

– Motivation


REM and NREM Sleep in Younger Adults and Older Adults

REM and NREM Sleep in Younger Adults and Older Adults



• Factors affecting sleep (cont’d)

– Emotions and moods

– Food and beverages

– Illness

– Drugs

o Sedatives and tranquilizers

o Hypnotics and stimulants


QuestionQuestion


Alcohol is a depressive drug that promotes healthy sleep.


AnswerAnswer

False.

Alcohol is a depressive drug that promotes sleep, but it tends to reduce normal REM and deep sleep stages of NREM sleep.


Sleep AssessmentSleep Assessment

• Sleep questionnaires

• Sleep diary

• Nocturnal polysomnography

• Multiple sleep latency test


Sleep DisordersSleep Disorders

• Insomnia

• Hypersomnia

– Narcolepsy

o Sleep paralysis and cataplexy

o Hypnogogic hallucinations

– Sleep apnea/hypopnea syndrome


QuestionQuestion


Apneic episodes can be reduced by sleeping in other than the supine position, losing weight, and avoiding substances that depress respirations such as alcohol or sleeping medications.


AnswerAnswer

True.

Apneic episodes can be reduced by sleeping in other than the supine position, losing weight, and avoiding substances that depress respirations such as alcohol or sleeping medications.


Sleep Disorders (cont’d)Sleep Disorders (cont’d)

• Sleep-wake cycle disturbances

– Shift work

– Jet travel

– Seasonal affective disorder

• Parasomnias


Nursing ImplicationsNursing Implications

• Identify nursing diagnoses

– Develop plan of care

• Sleep-promoting nursing measures

– Maintaining sleep rituals

– Reducing intake of stimulating chemicals

– Promoting daytime exercise


Nursing Implications (cont’d)Nursing Implications (cont’d)

• Sleep-promoting nursing measures (cont’d)

– Adhering to regular schedule for retiring and waking

– Progressive relaxation

– Back massage

o Various techniques and purposes


General Gerontologic ConsiderationsGeneral Gerontologic Considerations

• More comfortable with own bed furnishings

• Prefer warmer room temperatures

• Insomnia and hypersomnia are frequent manifestations of depression

• Sundown and sunrise syndrome

• Relaxation techniques before bedtime


General Gerontologic Considerations (cont’d)


• Hypnotic medications not recommended for use longer than 2 weeks

• Difficulty falling asleep

• Institutional schedules may interfere with established pattern of sleep; modifications may be necessary

• Important to identify potential sources of sleep disorders




• Cognitive impairments may result in sundown or sunrise syndromes

• Chronic conditions may interfere with sleep:

– Pain

– Difficulty breathing

– Frequent urination

• Short naps or rest periods can restore energy without interfering with nighttime sleep

chapter 18 comfort, rest, and sleep

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