chapter42 1nrs_105/320_collings. sleep contributes to healing & tissue repair human growth...

NRS_105/320_Collings 1

SLEEPChapter42


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]


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


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 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


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


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]


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


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


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


Interventions

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


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


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


Questions?

chapter42 1nrs_105/320_collings. sleep contributes to healing & tissue repair human growth...

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