P. Arredondo 9/2/13 VRNS Chapter 18 Study Guide: Comfort, Rest, and Sleep 1) Define comfort.

A state in which a person is free of distress. 2) Define rest. Wakeful state with reduces physical and mental activity. 3) Define sleep. State of arousable unconsciousness. 4) What is the healthcare environment? The room and facility where the client receives care. 5) How do nurses try to enhance comfort, rest, and sleep? By controlling the clients environment within the room. 6) What are the different variations for light brightness? When should each be used? Dark is used for sleep, subtle for rest, and bright for doing procedures. 7) Are humidity, ventilation, and temperature adjustable? Yes. 8) To provide patient safety, the bed should always be in what position? When is it ok to change it? It should always be in the low position except when providing nursing care or changing linens ( it can be raised). 9) Sheets should be drawn tight and be wrinkle free to prevent what? Skin breakdown. 10) How long is a full bed rail? How many are on each side of the bed? They are the full length of the bed, and there is 1 on each side. 11) How long is a half bed rail? How many are on each side of the bed? They are half the length of the bed, and there are 1 to 2 on each side. 12) What are some arguments for and against bed rails? Some feel they always promote safety, and others feel a side rail is a risk because patients get hurt climbing over them to exit the bed. In acute care generally nurses put the rails up for all patients. Oriented patients who dont want the rails up can sign a release form to have them down. 1

P. Arredondo 9/2/13 13) Are side rails a form of restraint? Are they used in long term care? Yes. They are only used when justified. Usually used in long term care for majority of patients. 14) What is Mrs. Grausos opinion on curtains that only cover the doorway? They are inadequate for privacy. 15) What are some ways clients can be injured in the bed? If it is left in high position and they fall out, if the side rails are left down and the fall out, and if the sheets have wrinkles causing the patient to develop pressure sores. 16) What are some benefits of sleep and rest? Maintain health, facilitate recovery, reduce fatigue and increase energy, improve mood, maintain bodily functions including immune system, promote cell growth and repair. 17) What are the 2 phases of sleep? Which occurs first? Nonrapid eye movement (NREM), and Rapid eye movement (REM). NREM occurs first. 18) How many stages does NREM have? 4 stages that progress from light sleep to deep sleep (4th stage) 19) What occurs in REM? This is the stage of deepest sleep where most dreams occur. 20) What is a sleep cycle? How many cycles can a person have in 1 night of sleep? One cycle is a period of NREM followed by REM, then NREM again etc.. 4-6 cycles is typical and varies with the individual. 21) How much sleep do newborns need? Elderly? Students? Is there a pattern? Newborns need 20 hr/day, elderly need 7-9 hr/night, students only get 4-5 hr/night. As always an individuals needs may vary. 22) Describe the circadian rhythm (physiological factor that affects sleep). Sleep and wakefulness correspond to light of day and darkness of night. In the absence of bright light the pineal gland secretes melatonin which causes drowsiness and sleep. 23) What are some medical factors that affect sleep? Pain, and the need to urinate (aka Void). For example, the urge to urinate due to BPH (benign prostatic hypertrophy) or drugs that increase urination (diuretics). 24) How can physical activity affect sleep? 2

P. Arredondo 9/2/13 Physical activity during the day causes fatigue and promotes sleep at night, but physical activity before bedtime causes stimulation and interferes with sleep. 25) How can the environment affect sleep? Being in an unfamiliar environment, and not being able to perform your bed time rituals if any at all. 26) What are some mental and emotional conditions that can affect sleep? Worry, fear, anxiety, and excitement interfere with sleep. Depression may cause too much sleep. Expectations of sleep are powerful forces (I will or I wont sleep). 27) How can hunger and thirst interfere with sleep? What is L-tryptophan? Hunger and thirst interfere with sleep. L-tryptophan promotes sleep, and can be found in foods with protein like milk, poultry, fish, and eggs. 28) How does alcohol effect sleep? It has a 2 part effect. Initial CNS depression = sleep: After alcohol wears off, rebound neuron stimulation = wakefulness. 29) What are some examples of sedatives and tranquilizers that cause a sense of relaxation and promote sleep? Sedative: Haldol Tranquilizer: Xanax 30) How do hypnotics affect sleep? Give an example of one. They induce sleep. Ex. Nembutal & Restoril 31) How do stimulants affect sleep? Give an example of one. They induce wakefulness. Ex. Ritalin, Dexedrine 32) What is tolerance in relation to drugs? Diminished effect from the same dose of a drug=need for larger dose or to take more frequently to achieve same effect. 33) What are paradoxical drugs? Opposite drugs. Ex: quieting drugs causing excitement. May occur especially in the elderly, and it may occur in any age if drug stopped being taken abruptly (rebound effect). 34) What is insomnia? How can you resolve it? Characterized by: difficulty falling asleep, staying asleep, or awakening early. Best to try non-drug treatments first such as: go to bed and get up at same time daily, get out of bed if you dont fall asleep within 20 minutes, and only use bed and bedroom for sleep and sex. 35) What is hypersomnia? What are the 2 forms? 3

P. Arredondo 9/2/13 Characterized by feeling sleepy, the amount of sleep may have been normal or insufficient. 2 types are narcolepsy, and sleep apnea/hypopnea syndrome. 36) What is narcolepsy? How can it be treated? Sudden onset of sleep during the day time. May include cataplexy=sudden loss of muscle tone triggered by emotion resulting in patient collapse. Can be treated with stimulants (Ritalin/Dexedrine). 37) What is sleep apnea/hypopnea syndrome? How can it be treated? Absent or slow breathing for 10 seconds or longer, 5 or more times per hour. Apnea causes blood O2 to decrease (hypoxemia) and CO2 to increase (hypercapnia) causing multiple awakenings and general sleep deprivation. Apnea may cause heart attack or stroke. Often seen in elderly people, obese people, men who snore. Common treatments are use of non-supine sleeping positions, weight loss, and CPAP(continuous positive airway pressure) strapped to patients face. 38) Night shift workers may experience micro sleep What is this? 20-30 seconds of unintentional sleep 39) What is Seasonal Affective Disorder (SAD)? Occurs during winter due to fewer hours of daylight and sunshine in places near arctic circle like Alaska and Norway. Symptoms include hypersomnolence (excessive sleeping), depression, and weight gain due to increased appetite. Easily treated with 2-6 hours a day of photo therapy (exposure to ultraviolet lights). 40) What are parasomias? Activities that occur during sleep. 41) What is somnambulism? Sleep-walking. 42) What is enuresis? Bedwetting. 43) What is bruxism? Grinding of teeth. 44) What is somniloquy? Sleep-talking. 45) What is restless leg syndrome (RLS)? Involuntary, compulsive leg movements. May also occur when in recumbent position when awake. 46) What are some things nurses can to facilitate sleep? 4

P. Arredondo 9/2/13 Provide environment that is ok with patient, teach progressive relaxation (patient actively contracts then relaxes different muscle groups to release tension), and give a back rub prior to bed time. 47) Describe effleurage. Place the entire surface of the hands on either side of the lower spine and move them upward over the shoulders and back again using long continuous strokes. 48) Describe petrissage. Pull the skin in opposite directions in a kneading fashion to lift and stretch is from the base of the spine to the shoulder areas. 49) Describe frolement. End the backrub by lightly stroking the length of the back, gradually lightening the pressure as you move the fingers downward.