Comfort, Rest, and SleepComfort, Rest, and SleepKozier C 45Kozier C 45

ObjectivesObjectives

Identify the characteristics of NREM Identify the characteristics of NREM and REM sleepand REM sleep

Identify the four stages of NREM sleepIdentify the four stages of NREM sleep Describe variations in sleep patterns Describe variations in sleep patterns

throughout the life spanthroughout the life span Identify factors that affect normal sleepIdentify factors that affect normal sleep Describe common sleep disorders Describe common sleep disorders

ObjectivesObjectives

Identify the components of a sleep Identify the components of a sleep pattern assessmentpattern assessment

Develop nursing diagnosis, outcomes, Develop nursing diagnosis, outcomes, and nursing interventions related to and nursing interventions related to sleep problemssleep problems

Describe interventions that promote Describe interventions that promote normal sleepnormal sleep

Question 1Question 1A A client has a history of sleep apnea. The nurse client has a history of sleep apnea. The nurse should ask which of the following most should ask which of the following most appropriate questions?appropriate questions?

1.1. Do you have a history of cardiac irregularities?Do you have a history of cardiac irregularities?2.2. Do you have a history of any kind of nasal Do you have a history of any kind of nasal

obstruction?obstruction?3.3. Have you had chest pain with or without Have you had chest pain with or without

activity?activity?4.4. Do you have difficulty with daytime sleepiness?Do you have difficulty with daytime sleepiness?

Rationales 1Rationales 11.1. Although cardiac arrhythmias may occur, they are Although cardiac arrhythmias may occur, they are

usually only detectable during a sleep study, and thus the usually only detectable during a sleep study, and thus the client would not be aware of them.client would not be aware of them.

2.2. Nasal obstruction is rarely the cause of sleep apnea or a Nasal obstruction is rarely the cause of sleep apnea or a complaint of clients with sleep apnea.complaint of clients with sleep apnea.

3.3. There are many causes of chest pain, and this is unlikely There are many causes of chest pain, and this is unlikely to be something reported by clients with sleep apnea to be something reported by clients with sleep apnea unless they have underlying cardiac disease.unless they have underlying cardiac disease.

4.4. Correct. Most clients with sleep apnea report excessive Correct. Most clients with sleep apnea report excessive daytime sleepiness. If they don’t volunteer this, clients daytime sleepiness. If they don’t volunteer this, clients should be asked if they fall asleep or struggle to stay should be asked if they fall asleep or struggle to stay awake at work. awake at work.

Physiology of SleepPhysiology of Sleep Darkness & preparing for sleep cause Darkness & preparing for sleep cause

decrese in stimulation of the RASdecrese in stimulation of the RAS Pineal gland secretes melatonin Pineal gland secretes melatonin This results in person feeling sleepyThis results in person feeling sleepy Growth hormone is secreted & cortisol Growth hormone is secreted & cortisol

inhibited. inhibited.

BiorhythmsBiorhythmsCircadian Rhythms = “about a day”Circadian Rhythms = “about a day”

Circadian Synchronization = awake Circadian Synchronization = awake when physiologic and psychological when physiologic and psychological rhythms are most active and asleep rhythms are most active and asleep when lest active. when lest active.

Cicadian regularity Cicadian regularity

Begins by 3Begins by 3rdrd week of week of lifelife

May be inherited May be inherited By 5By 5thth or 6 or 6thth month month

more like parents more like parents sleep-wake pattern.sleep-wake pattern.

Question 2Question 2Because of significant concerns about financial Because of significant concerns about financial problems a middle-aged client complains of problems a middle-aged client complains of difficulty sleeping. Which of the following would difficulty sleeping. Which of the following would be an appropriate outcome for the nursing care be an appropriate outcome for the nursing care plan? “By day 5, the client will:plan? “By day 5, the client will:

1.1. Sleep 8 to 10 hours per day.”Sleep 8 to 10 hours per day.”2.2. Report falling asleep within 20 to 30 minutes.”Report falling asleep within 20 to 30 minutes.”3.3. Have a plan to pay all the bills.”Have a plan to pay all the bills.”4.4. Decrease worrying about financial problems and Decrease worrying about financial problems and

will keep busy until bedtime.”will keep busy until bedtime.”

Rationales 2Rationales 21.1. Most adults do not need to sleep 8 to 10 hours Most adults do not need to sleep 8 to 10 hours

per day.per day.2.2. Correct. Falling asleep within 20 to 30 minutes is Correct. Falling asleep within 20 to 30 minutes is

normal for adults and would represent normal for adults and would represent substantial improvement in the client’s substantial improvement in the client’s difficulties. difficulties.

3.3. Although it would be ideal to remove the source Although it would be ideal to remove the source of the client’s stress, he is unlikely to have a plan of the client’s stress, he is unlikely to have a plan to pay all his bills within 5 days.to pay all his bills within 5 days.

4.4. Distraction or keeping busy until bedtime will Distraction or keeping busy until bedtime will not prevent the client from worrying about his not prevent the client from worrying about his bills at bedtime.bills at bedtime.

Types of SleepTypes of Sleep Two types of sleepTwo types of sleep

NREM-NREM- REM REM

Stages of Sleep: Stages of Sleep: NREMNREM Stage I- very light sleep (drowsy-Stage I- very light sleep (drowsy-

relaxed) lasts a few mins.relaxed) lasts a few mins. Stage II- light sleep,Stage II- light sleep,

body process continue to slowbody process continue to slow Eyes stillEyes still T, HR & RR decrease slightlyT, HR & RR decrease slightly Lasts about 10 – 15 min Lasts about 10 – 15 min Makes up 44 – 55% of total sleep.Makes up 44 – 55% of total sleep.

Stages of Sleep: Stages of Sleep: NREMNREM

Stage III-heart and Stage III-heart and respiratory rate are respiratory rate are slowerslower

Stages of Sleep: Stages of Sleep: NREMNREM Stage VI-signals deep, restful sleep /w Stage VI-signals deep, restful sleep /w

slower brain waves. slower brain waves. Thought to restore the body physically.Thought to restore the body physically. Some dreaming occurs. Some dreaming occurs. Skeletal muscles relaxedSkeletal muscles relaxed Reflexes diminishedReflexes diminished Snoring most likely to occurSnoring most likely to occur

Physiologic changes during NREM sleepPhysiologic changes during NREM sleep Arterial BP fallsArterial BP falls Pulse increasesPulse increases Peripheral blood vessels dilatePeripheral blood vessels dilate Cardiac output decreasesCardiac output decreases Skeletal muscles relaxSkeletal muscles relax Basal metabolic rate decreases 10 – 30%Basal metabolic rate decreases 10 – 30% Growth hormone levels peakGrowth hormone levels peak Intracranial pressure decreases Intracranial pressure decreases

REM-Rapid eye Movement-REM-Rapid eye Movement- Occurs about every 90 min & lasts 5-Occurs about every 90 min & lasts 5-

30 min30 min Not restfulNot restful Most dreams take place hereMost dreams take place here Brain metabolism increases 20% Brain metabolism increases 20%

Sleep CyclesSleep Cycles Pass the four stages in 90 – 110 minsPass the four stages in 90 – 110 mins Sleeper passes through the 1Sleeper passes through the 1stst 3 3

NREM stages in about 20-30 min. NREM stages in about 20-30 min. After stage IV NREM sleeper passes After stage IV NREM sleeper passes

thru Stages III and II in about 20minsthru Stages III and II in about 20mins Than the 1Than the 1stst REM occurs (lasts 10 REM occurs (lasts 10

mins)mins)

Sleep CyclesSleep Cycles Healthy adult passes thru 4 – 6 cycles of Healthy adult passes thru 4 – 6 cycles of

sleep in 7 – 8 hrssleep in 7 – 8 hrs

Functions of SleepFunctions of Sleep Restores normal levels of activityRestores normal levels of activity Lack of sleep results in poor concentration, Lack of sleep results in poor concentration,

irritability, difficult decision making.irritability, difficult decision making. It use to be thought that a regular sleep pattern It use to be thought that a regular sleep pattern

was more important than actual hours slept but was more important than actual hours slept but sleep deprivation is associated sleep deprivation is associated

with cognitive & health problems. with cognitive & health problems.

Normal Sleep Patterns and RequirementsNormal Sleep Patterns and Requirements Newborns- sleep 16 to 18 hours a day, usually Newborns- sleep 16 to 18 hours a day, usually

seven sleep periods & enter REM sleep seven sleep periods & enter REM sleep immediately. immediately.

Infants at end of yr sleep 14 -15 hours a dayInfants at end of yr sleep 14 -15 hours a day Toddlers- 12-14 hours a day.Toddlers- 12-14 hours a day. Preschoolers- 11-13 hours of sleep per nightPreschoolers- 11-13 hours of sleep per night School Aged children (5 – 12 yrs) need 10- 11 School Aged children (5 – 12 yrs) need 10- 11

hours at night.hours at night.

Normal Sleep Patterns and RequirementsNormal Sleep Patterns and Requirements

Adolescents- 9-10 hours of sleepAdolescents- 9-10 hours of sleep Young adults- 7-9 hours may require lessYoung adults- 7-9 hours may require less Older Adults- 7-9 hours Older Adults- 7-9 hours

Sundowner’s syndromeSundowner’s syndrome

Question 3Question 3A client reports to the nurse that she has been A client reports to the nurse that she has been taking barbiturate sleeping pills every night for taking barbiturate sleeping pills every night for several months and now wishes to stop taking several months and now wishes to stop taking them. The nurse advises the client to:them. The nurse advises the client to:

1.1. Take the last pill on a Friday night so disrupted Take the last pill on a Friday night so disrupted sleep can be compensated on the weekend.sleep can be compensated on the weekend.

2.2. Continue to take the pills since sleeping without Continue to take the pills since sleeping without them after such a long time will be difficult and them after such a long time will be difficult and perhaps impossible.perhaps impossible.

3.3. Discontinue taking the pills.Discontinue taking the pills.4.4. Continue taking the pills and discuss tapering Continue taking the pills and discuss tapering

the dose with the primary care provider.the dose with the primary care provider.

Rationales 3Rationales 31.1. Suddenly stopping barbiturate sleeping pills can Suddenly stopping barbiturate sleeping pills can

precipitate a dangerous withdrawal.precipitate a dangerous withdrawal.

2.2. Stopping requires a plan but can be done.Stopping requires a plan but can be done.

3.3. Suddenly stopping barbiturate sleeping pills can Suddenly stopping barbiturate sleeping pills can precipitate a dangerous withdrawal.precipitate a dangerous withdrawal.

4.4. Correct. Doses should be tapered gradually and Correct. Doses should be tapered gradually and the tapering process supervised by the client’s the tapering process supervised by the client’s primary care providerprimary care provider..

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Factors Affecting SleepFactors Affecting Sleep Age- One of the most important factors Age- One of the most important factors

affecting persons sleep and rest periods.affecting persons sleep and rest periods. Illness- causing pain or physical distress Illness- causing pain or physical distress

can result in sleep problems.can result in sleep problems. Environment-Noise levelEnvironment-Noise level Fatigue- more tired the shorter the first Fatigue- more tired the shorter the first

(REM) sleep(REM) sleep Lifestyle-Shift workLifestyle-Shift work

Factors Affecting SleepFactors Affecting Sleep Emotional StressEmotional Stress Alcohol and StimulantsAlcohol and Stimulants DietDiet SmokingSmoking MotivationMotivation MedicationsMedications

Drugs That Affect Sleep Drugs That Affect Sleep

Alcohol Alcohol AntidepressantsAntidepressants Beta-blockersBeta-blockers CaffeineCaffeine Bronchial dilatorsBronchial dilators Steroids Steroids DecongestantsDecongestants Narcotics Narcotics AmphetaminesAmphetamines

Common Sleep DisordersCommon Sleep Disorders Insomnia- most common sleep disorder, Insomnia- most common sleep disorder,

inability to obtain an adequate amount or inability to obtain an adequate amount or quality of sleep.quality of sleep.

Hypersomnia- Opposite of insomnia, excessive Hypersomnia- Opposite of insomnia, excessive sleep, especially daytime.sleep, especially daytime.

Narcolepsy- Sudden wave of overwhelming Narcolepsy- Sudden wave of overwhelming sleepiness that occurs during the day. Referred sleepiness that occurs during the day. Referred to as “sleep attack”.to as “sleep attack”.

Primary Sleep DisordersPrimary Sleep Disorders Sleep Apnea- periodic cessation of Sleep Apnea- periodic cessation of

breathing during sleep.breathing during sleep. Obstructive apneaObstructive apnea Central apneaCentral apnea Mixed Mixed

>5 apneic episodes or 5 breathing pauses >5 apneic episodes or 5 breathing pauses longer than 10 seconds/hour.longer than 10 seconds/hour.

Primary Sleep DisordersPrimary Sleep Disorders Sleep Apnea-Sleep Apnea-

Load snoringLoad snoring Nocturnal awakeningsNocturnal awakenings Excessive daytime sleepinessExcessive daytime sleepiness Difficulties falling asleepDifficulties falling asleep Morning headachesMorning headaches Memory/cognitive problemsMemory/cognitive problems Irritability.Irritability.

Sleep DisordersSleep Disorders Parasomnias- Behavior that may interfere Parasomnias- Behavior that may interfere

with sleep. (somnambulism, sleep talking, with sleep. (somnambulism, sleep talking, Nocturnal enuresis, nocturnal erections, Nocturnal enuresis, nocturnal erections, bruxism).bruxism).

Insufficient Sleep - prolonged disturbance Insufficient Sleep - prolonged disturbance resulting in decreases amount, quality, resulting in decreases amount, quality, consistency of sleepconsistency of sleep. .

Box 43-3 Parasomnias

Assessment of SleepAssessment of Sleep Assessment of a client’s sleep Assessment of a client’s sleep

includes:includes: a sleep history, a sleep history, sleep diary, sleep diary, physical examination,physical examination, a review of diagnostic studies.a review of diagnostic studies.

Sleep HistorySleep History

When does client usually go to sleep?When does client usually go to sleep? Bedtime rituals?Bedtime rituals? Does client snore?Does client snore? Can client stay away during day?Can client stay away during day? Taking any prescribed or OTC Taking any prescribed or OTC

medications?medications?

Sleep HistorySleep History What is the usual sleeping pattern, What is the usual sleeping pattern,

specifically:specifically: sleeping and waking timessleeping and waking times hours of undisturbed sleep, etc.hours of undisturbed sleep, etc.

Bedtime ritualsBedtime rituals Use of sleep medicationsUse of sleep medications Sleep environmentSleep environment Changes in sleep patternChanges in sleep pattern

Sleep DiarySleep Diary Written record to be much more preciseWritten record to be much more precise

Total number of sleep hours a dayTotal number of sleep hours a day Activities performed 2-3 hours before sleepActivities performed 2-3 hours before sleep Bedtime ritualsBedtime rituals Any worries that may affect client’s sleepAny worries that may affect client’s sleep Factors that client believes to be positive or Factors that client believes to be positive or

negative towards sleepnegative towards sleep

Physical ExaminationPhysical Examination Observation of clients facial appearance, Observation of clients facial appearance,

behavior, and energy level.behavior, and energy level. Darkened areas around the eyes, puffy Darkened areas around the eyes, puffy

eyelids, reddened conjunctiva, glazed or eyelids, reddened conjunctiva, glazed or dull appearing eyes.dull appearing eyes.

Irritability, yawning, slumped posture, Irritability, yawning, slumped posture, hand tremor, rubbing of eyes, confusion, hand tremor, rubbing of eyes, confusion, fatigued, lethargic, etc. fatigued, lethargic, etc.

Physical ExaminationPhysical Examination

Rarely yields information unless client has Rarely yields information unless client has obstructive sleep apneaobstructive sleep apnea Enlarged and reddened uvula and soft palateEnlarged and reddened uvula and soft palate Enlarged adenoids and tonsils (children)Enlarged adenoids and tonsils (children) Obesity (adults)Obesity (adults) Neck circumference > 17.5 inches (men)Neck circumference > 17.5 inches (men) Deviated septum (occasionally)Deviated septum (occasionally)

Diagnostic studiesDiagnostic studies

Polysomnography – (EEG, Polysomnography – (EEG, electromyogram & electro-electromyogram & electro-oculogram are recorded oculogram are recorded simultaneously).simultaneously).

May also include respiratory effort May also include respiratory effort & airflow, ECG, leg movement & & airflow, ECG, leg movement & OO22 sat. sat.

NANDA Nursing DiagnosesNANDA Nursing Diagnoses

Disturbed Sleep PatternDisturbed Sleep Pattern With specific descriptions such as “difficulty With specific descriptions such as “difficulty

falling asleep” or “difficulty staying asleep”falling asleep” or “difficulty staying asleep” Various etiologies may be involved and Various etiologies may be involved and

specifiedspecified

NANDA Nursing DiagnosesNANDA Nursing Diagnoses

Sleep pattern disturbances as etiology of Sleep pattern disturbances as etiology of other diagnoses: other diagnoses: Risk for injuryRisk for injury Ineffective copingIneffective coping FatigueFatigue Risk for impaired gas exchangeRisk for impaired gas exchange Deficient knowledgeDeficient knowledge Anxiety Anxiety Activity intoleranceActivity intolerance

Outcomes for ClientsOutcomes for ClientsWith Sleep DisturbancesWith Sleep Disturbances

Maintain (or develop) a sleeping pattern Maintain (or develop) a sleeping pattern that provides sufficient energy for daily that provides sufficient energy for daily activitiesactivities

Enhance feeling of well being Enhance feeling of well being Improve the quality and quantity of the Improve the quality and quantity of the

client’s sleepclient’s sleep

ImplementationImplementation

Nursing interventions are used to enhance Nursing interventions are used to enhance the quantity and quality of sleep & involve the quantity and quality of sleep & involve largely non-pharmacologic measures.largely non-pharmacologic measures. Interventions include- Interventions include- guided imageryguided imagery therapeutic messagetherapeutic message progressive muscle relaxationprogressive muscle relaxation uninterrupted sleep periods.uninterrupted sleep periods.

ImplementationImplementation Client teachingClient teaching

Individuals need to learn the importance of Individuals need to learn the importance of rest and sleep in maintaining active and rest and sleep in maintaining active and productive lifestyles.productive lifestyles.

Supporting bedtime ritualsSupporting bedtime rituals Many are accustomed to rituals or pre-sleep Many are accustomed to rituals or pre-sleep

routines and if altered can affect sleep.routines and if altered can affect sleep. Creating Restful EnvironmentCreating Restful Environment

Bedtime RitualsBedtime Rituals

Altering or eliminating routines can affect sleepAltering or eliminating routines can affect sleep AdultsAdults

Listening to musicListening to music ReadingReading Soothing bathSoothing bath PrayingPraying

ChildrenChildren Need to be socialized into presleep routineNeed to be socialized into presleep routine Usually preceded by hygienic ritualUsually preceded by hygienic ritual

ImplementationImplementation Promoting Comfort and RelaxationPromoting Comfort and Relaxation

Assist client with hygienic routinesAssist client with hygienic routines Offer back messageOffer back message Administer analgesics 30 min before sleepAdminister analgesics 30 min before sleep

Enhancing Sleep with MedicationsEnhancing Sleep with Medications Nurse responsible for making decisions with Nurse responsible for making decisions with

the client about when to administer sedative the client about when to administer sedative or hypnotics.or hypnotics.

Figure 43.2 One suggested pattern for a back massage.

Effeurage massage consists of long, slow, gliding strokes.

Question 4Question 4During a yearly physical, a 52-year-old male client During a yearly physical, a 52-year-old male client mentions that his wife frequently complains about his mentions that his wife frequently complains about his snoring. During the physical exam, the nurse notes that snoring. During the physical exam, the nurse notes that his neck size is 18 inches, his soft palate and uvula are his neck size is 18 inches, his soft palate and uvula are reddened and swollen, and he is overweight. The most reddened and swollen, and he is overweight. The most appropriate nursing intervention for this client is to:appropriate nursing intervention for this client is to:

1.1. Recommend that he and his wife sleep in separate Recommend that he and his wife sleep in separate bedrooms so that his snoring does not disturb his wife.bedrooms so that his snoring does not disturb his wife.

2.2. Refer him to a dietician for a weight loss program.Refer him to a dietician for a weight loss program.3.3. Caution him not to drink or take sleeping pills since they Caution him not to drink or take sleeping pills since they

may make his snoring worse.may make his snoring worse.4.4. Refer him to a sleep disorders center for evaluation and Refer him to a sleep disorders center for evaluation and

treatment of his symptoms.treatment of his symptoms.

Rationales 4Rationales 41.1. This does not address the client’s problem.This does not address the client’s problem.2.2. It would not be wrong to refer him to a dietician It would not be wrong to refer him to a dietician

for weight loss counseling, but being evaluated for weight loss counseling, but being evaluated by a sleep disorders specialist is more critical.by a sleep disorders specialist is more critical.

3.3. Drinking alcohol or taking sleeping pills is not Drinking alcohol or taking sleeping pills is not advised in clients with sleep apnea because they advised in clients with sleep apnea because they reduce the client’s ability to get around.reduce the client’s ability to get around.

4.4. Correct. The client’s symptoms, combined with Correct. The client’s symptoms, combined with his weight, suggest that he has obstructive sleep his weight, suggest that he has obstructive sleep apnea and should be referred to a sleep apnea and should be referred to a sleep disorders specialist for further evaluation.disorders specialist for further evaluation.

Sedative-Hynoptic MedsSedative-Hynoptic Meds

Medication Medication Half-LifeHalf-Life Chloral hydrate Chloral hydrate 7-10 hrs7-10 hrs PlacidylPlacidyl 10-20 hrs10-20 hrs Dalmane Dalmane 47-100 hrs47-100 hrs Doriden Doriden 1-12 hrs1-12 hrs Ativan Ativan 10-20 hrs10-20 hrs Lunesta Lunesta 6 hrs6 hrs

Sedative-Hynoptic MedsSedative-Hynoptic Meds

Medication Medication Half-LifeHalf-Life MelatoninMelatonin 1 hr1 hr Restoril Restoril 9-15 hrs9-15 hrs Halcion Halcion 1.5-5.5 hrs1.5-5.5 hrs Sonata Sonata 1 hr1 hr Ambien Ambien 2.6 hrs 2.6 hrs

Reducing Environmental Reducing Environmental Distractions in HospitalsDistractions in Hospitals

Close window curtains if street lights Close window curtains if street lights shine throughshine through

Close curtains between clients in Close curtains between clients in semiprivate and larger roomssemiprivate and larger rooms

Reduce or eliminate overhead lighting: Reduce or eliminate overhead lighting: provide night light at the bedside or in provide night light at the bedside or in the bathroomthe bathroom

Close the door of the client’s roomClose the door of the client’s room

Reducing Environmental Reducing Environmental Distractions in HospitalsDistractions in Hospitals

Perform only essential noisy activities Perform only essential noisy activities during sleeping hoursduring sleeping hours

Ensure that all carts wheels are well Ensure that all carts wheels are well oiledoiled

Wear rubber soled shoesWear rubber soled shoes Keep required staff conversations at Keep required staff conversations at

low levels: conduct nursing reports or low levels: conduct nursing reports or other discussions in a separate area other discussions in a separate area away from clients roomsaway from clients rooms

Teaching to promote rest & sleepTeaching to promote rest & sleep

Establish regular betime & wake upEstablish regular betime & wake up Eliminate lengthy napsEliminate lengthy naps Exercise just not 2 hrs before bedtimeExercise just not 2 hrs before bedtime Est regular bedtime routine – listen to Est regular bedtime routine – listen to

music, warm bath, music, warm bath, Avoid heavy meals 3 hrs before bedtimeAvoid heavy meals 3 hrs before bedtime

Teaching to promote rest & sleepTeaching to promote rest & sleep

Avoid alcohol & caffeine at least 4 hrs Avoid alcohol & caffeine at least 4 hrs before bedtimebefore bedtime

Decrease fluid intake 2-4 hrs before bedDecrease fluid intake 2-4 hrs before bed Use sleeping meds as last resortUse sleeping meds as last resort Take analgesics before bedtime if neededTake analgesics before bedtime if needed

Question 5Question 5A new nursing graduate’s first job requires 12-hour A new nursing graduate’s first job requires 12-hour night shifts. Which of the following strategies will make night shifts. Which of the following strategies will make it easier for the graduate to sleep during the day and it easier for the graduate to sleep during the day and remain awake at night?remain awake at night?

1.1. Wear dark wrap-around sunglasses when driving home Wear dark wrap-around sunglasses when driving home in the morning, and sleep in a darkened bedroom.in the morning, and sleep in a darkened bedroom.

2.2. Exercise on the way home to avoid having to stand Exercise on the way home to avoid having to stand around as long waiting for equipment at the gym.around as long waiting for equipment at the gym.

3.3. Drink several cups of strong coffee or 16 oz of Drink several cups of strong coffee or 16 oz of caffeinated soda when beginning the shift.caffeinated soda when beginning the shift.

4.4. Try to stay in a brightly lit area when working at night.Try to stay in a brightly lit area when working at night.

Rationales 5Rationales 5

1.1. Correct.Correct. Reducing exposure to bright light in the Reducing exposure to bright light in the morning, driving home, and when going to sleep will morning, driving home, and when going to sleep will make it easier to fall asleep after work. make it easier to fall asleep after work.

2.2. Exercising before going to bed will increase arousal. Exercising before going to bed will increase arousal. 3.3. Caffeine consumed at the beginning of a 12-hour shift Caffeine consumed at the beginning of a 12-hour shift

will not assist the nurse in remaining awake during the will not assist the nurse in remaining awake during the later part of the shift. later part of the shift.

4.4. Although working in a brightly lit area will reduce Although working in a brightly lit area will reduce drowsiness, this strategy is rarely available to nurses drowsiness, this strategy is rarely available to nurses working the night shift; lights are often dimmed in working the night shift; lights are often dimmed in hospital corridors and client rooms.hospital corridors and client rooms.