Transcript Sleep And Rest

JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 34:
Sleep & Rest
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Sleep Versus Rest
• Sleep
– Cyclical states/altered consciousness
– Decreased motor activity/perception
– Selective response to external stimuli
• Rest
– Mild to no activity
– Relaxation; stress free
– Leads to feeling refreshed
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Benefits of Sleep
• Increases
mental performance
– Improves learning
– Helps the storage of
long-term memory
• Restores energy
• Improves ability to cope
• Strengthens the
immune system
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Terms to Know
• Circadian rhythm
– Internal clock
– 24-hour day-night
sleep/wake pattern
– Affects overall level
of functioning
• Reticular activating system
• Stages of sleep
– NREM
– REM
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Factors Affecting Sleep
• Age
• Lifestyle factors
– Physical activity
• An illness
• Environmental factors
– Food and alcohol
– Temperature
and humidity
– Medications
– Noise and light
– Caffiene
– Noxious odor
– Sleep habits
– Comfort of bedding
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Common Sleep Disorders
• Insomnia
– Inability to fall or remain asleep or go back to sleep
• Circadian disorders
– Abnormality in sleep/wake times (e.g., jet lag, working night
shift, rotating shifts)
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Common Sleep Disorders (cont’d)
• Restless leg syndrome
– Uncontrollable movement of legs during sleep/rest
• Hypersomnia
– Excessive sleeping (especially during daytime)
– Sleep related or disease related
– Can be related to depression
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Common Sleep Disorders (cont’d)
• Sleep apnea
– Periodic breathing cessation for at least
10 sec during sleep
• Narcolepsy
– Chronic disorder caused by the brain’s ineffectiveness in
regulating sleep-wake cycles normally
– Uncontrollable episodes of sleep during the day
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Common Sleep Disorders (cont’d)
• Parasomnias
– Sleepwalking/talking
– Bruxism
– Night terrors
– REM sleep behavior disturbances
– Enuresis
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Promoting Sleep: Nursing Interventions
• Cluster/schedule nursing
care to avoid
interrupting sleep.
• Create a comfortable/
restful environment.
• Promote
comfort/relaxation.
• Support bedtime
rituals/routines.
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Promoting Sleep:
Nursing Interventions (cont’d)
• Offer foods that help promote sleep.
• Maintain safety of the client.
• Teach about sleep hygiene.
• Administer/complete client teaching about
sleep-inducing medications.
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Think Like a Nurse
Compare and contrast insomnia and hypersomnia.
• How are they different?
• How are they alike?
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Subgroups of Late Adulthood
• Young old – 65 to 74 years
• Middle old – 75 to 84 years
• Old old – 85 to 99 years
• Elite old – 100 years +
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Health-Protecting Behaviors
• Vaccinations
– Influenza
– Pneumococcal
– Tetanus (booster every 10 yr)
• Seat belts
• Moderate alcohol
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Health-Protecting Behaviors
(cont’d)
• No smoking
• Smoke detectors/sprinklers in home
• Herbs, supplements (as prescribed)
• Hazard-free environment
– No scatter rugs, waxed floors
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Common Health Issues & Concerns
• Decreased nutrition and hydration
• Decreased mobility
• Stress and loss
• Accidents
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Common Health Issues & Concerns (cont’d)
• Drug use and misuse
• Mental/behavioral health problems
• Neglect and abuse
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Causes of Malnutrition
• Inappropriate/unbalanced foods (e.g., lots of
desserts/sweets)
• Trouble carrying heavy groceries
• Diminished sense of taste, smell
• Tooth loss, poorly fitting dentures
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Causes of Malnutrition (cont’d)
• Reduced income
• Chronic disease, fatigue
• Decreased ability to perform ADLs
• “Fast food” consumption that leads to obesity
• Loneliness
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Geriatric Failure to Thrive (GFTT)
• Complex syndrome:
– Under-nutrition
– Impaired physical functioning
– Depression
– Cognitive impairment
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Benefits of Regular Exercise
• Decreased risk for falls
• Increased mobility
• Increased sleep
• Reduced or maintained weight
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Benefits of Regular Exercise (cont’d)
• Improved well-being and self-esteem
• Fewer depression symptoms
• Improved longevity
• Reduced risk for DM and CAD
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Frequent Sources of Stress
• Rapid environmental changes
• Changes in lifestyle
• Acute or chronic illness
• Loss of significant other
• Financial hardship
• Relocation
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Accidents
• Common in older adults
• Falls most common
• Motor vehicle crashes increase with aging, chronic
disease (Alzheimer’s, arthritis)
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Assessing Risk Factors & Preventing Falls
• Fall history
• Advanced age (greater than 80 yr)
• Multiple illnesses
• Generalized weakness
• Gait and postural stability
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Assessing Risk Factors & Preventing Falls
(cont’d)
• Drug assessment
• Urinary incontinence
• Communication/visual impairment
• Alcohol/substance abuse
• Change of shift/mealtime in hospital/ nursing home
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Restraints
• Reduced use in nursing homes, hospitals
• Chemical
– Antipsychotics
– Antianxiety drugs
– Antidepressants
– Sedative-hypnotics
• Physical (used when chemical restraints and warnings
fail)
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Improving Driving Safety
• Assess any physical/mental deficits
• Consult with provider to treat health problems
• Suggest community-based transportation
• Discuss driving concerns with patient
• Wear glasses/hearing aids
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Improving Driving Safety (cont’d)
• Encourage driving refresher classes; consult certified
specialist
• Avoid high-risk locations/conditions
– Wet or icy weather
– Busy urban interstates
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Drug Use and Misuse
• Polymedicine
• Intolerance to standard drug dosages
• Physiologic changes affect absorption, distribution,
metabolism, excretion
• “Start low and go slow” policy
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Effects of Drugs
• Often intolerant of standard doses
• Age-related changes:
– Affect absorption
– Affect metabolism
– Reduce liver blood flow and serum enzyme activity
• Changes in kidneys result in high plasma drug
concentrations
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Creatinine Clearance Test
Measures glomerular filtration rate of kidneys
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Self-Administration of Drugs
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Medication Assessment & Health Teaching
• Obtain complete drug list (OTC, prescribed, herbs,
supplements)
• Highlight all drugs that are part of Beers criteria
• Assess for duplicate drugs
• Give verbal and written information
• Remind not to share/borrow drugs
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Mental/Behavioral Health Problems
• Legal competence –
– 18 yr or older
– Pregnant or married minor
– Legally emancipated
– Not declared incompetent by a court of law
• Clinical competence – person is legally competent;
can make clinical decisions
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Increased Risk for Cognitive Health
Problems
• 3 D’s
– Depression
– Delirium
– Dementia
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Depression
• Mood disorder having cognitive, affective, physical
manifestations
• Primary (lack of neurotransmitters)
• Secondary or situational (illness or loss)
• Geriatric Depression Scale used for assessment
(GDS-SF)
• Treatment includes drug therapy, psychotherapy
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Dementia
• Syndrome involving slow, progressive cognitive decline
(also known as chronic confusion)
• Global impairment of intellectual function; generally
chronic and progressive
• Alzheimer’s disease
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Delirium
• Acute state of confusion
• Usually short-term; reversible within 3 weeks or less
• Often experienced by people in unfamiliar settings
• Can include physical manifestations of change
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Causes of Delirium
• Drug therapy
• Electrolyte imbalance
• Metabolic problems
• Nutritional deficiencies
• Infection (UTIs, pneumonia)
• Fecal impaction, diarrhea
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Causes of Delirium (cont’d)
• Surgery
• Neurologic disorders
• Circulatory, renal, pulmonary disorders
• Hypoxia
• Relocation
• Major loss
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Confusion Assessment Method
• Determine delirium:
– Nine open-ended questions
– Diagnostic algorithm
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Alcohol Use & Abuse
• Increase risk for falls, other accidents
• Affect mood, cognitive ability
• Lead to complications of chronic diseases (e.g.,
diabetes mellitus, hypertension, GERD)
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Alcohol Use & Abuse (cont’d)
• Isolation, depression, delirium can result
• NIAAA recommends no more than one drink/day or
seven drinks/wk for people over 65
• http://pubs.niaaa.nih.gov/
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CAGE Test
• Four questions:
– Have you ever tried to cut down on your drinking?
– Have people annoyed you by criticizing your drinking?
– Have you ever felt bad or guilty about your drinking?
– Have you ever had a drink first thing in the morning to
settle your nerves?
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Elder Neglect and Abuse
• Neglect – failure to provide basic needs
• Abuse –
– Physical – use of physical force that results in bodily injury
– Financial – mismanagement or misuse of property or
resources
– Emotional – intentional use of threats, humiliation,
intimidation, isolation
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Skin Breakdown Prevention
• Nutritional support
• Avoid injury from friction, shearing forces
• Repositioning, support surfaces
• Increase mobility and activity level, when appropriate
• Cleanse skin, use moisture barriers
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Resources
• http://nij.gov/topics/crime/elder-abuse/Pages/extent.aspx
• http://www.justice.gov/ovw/domestic-violence
• http://consultgerirn.org/topics/delirium/want_to_know_m
ore
• http://consultgerirn.org/topics/dementia/want_to_know_
more
• http://consultgerirn.org/topics/depression/want_to_know
_more
• http://consultgerirn.org/topics/elder_mistreatment_and_a
buse/want_to_know_more
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