In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills pf rest and sleep in order to: Show
Some of the terms and terminology that you should be familiar with in terms of rest and sleep are described below. InsomniaInsomnia, simply defined, is the absence of sleep. The two basic types of insomnia are inducement insomnia and maintenance insomnia. Clients affected with inducement insomnia have difficulty falling asleep and clients with maintenance insomnia have difficulty maintaining sleep and staying asleep once they have fallen asleep. Some clients are affected with both inducement insomnia and maintenance insomnia. Additionally, some clients may have an acute, short lived episode of insomnia, and other clients may have chronic insomnia. Both types of insomnia are caused by a number of different physical and psychological factors such as pain and anxiety. Insomnia, which is the most commonly occurring sleep disorder, can also be classified as chronic-intermittent which is a combination of periods of insomnia interspersed with period of restful sleep. The two populations that are at greatest risk for insomnia are females and members of the aging population. Insomnia causes the affected person to wake up without feeling that they are rested as well as day time sleepiness, irritability and problems in terms of cognitive functioning such as decreased levels of mental concentration and poor problem solving. Non REM SleepThe sleep cycle consists of both non REM sleep and REM sleep. Non REM sleep is sleep that is not accompanied with rapid eye movements (REM). Non REM sleep has four phases which include the stage of very light sleep, the stage of very light sleep with the non movement of the eyes, the stage of deep sleep with delta waves and finally, the last stage with is deep sleep and increased delta brain waves. The vast majority of sleep is non REM sleep and this part of the sleep cycle can occur during about 80% of the time that the person is sleeping in a cyclical manner. Some of the physiological changes that occur during non REM sleep include decreases in terms of the person's basal metabolic rate, intracranial pressure, blood pressure, cardiac rate and cardiac output in addition to the relaxation of the person's muscles and their peripheral circulatory vasculature. REM SleepRapid eye movement sleep is a state of deep sleep that is accompanied with rapid eye movements and dreams. Some of the physiological changes that occur during REM sleep include increased brain activity dreams, and a decrease in terms of muscular and reflex activity. NarcolepsyNarcolepsy is defined as excessive day time sleepiness that a person can be affected with secondary to the paucity of hypocretin within the area of the central nervous system that controls sleep. HypersomniaHypersomnia, which can also be caused by a number of different factors and forces, is defined as the client's failure to stay awake during day time hours even when they have had enough sleep the night before. Some of the risk factors associated with hypersomnia, all of which are physical in nature, include disorders such as hypothyroidism, central nervous system dysfunction, and alterations of the client's metabolism including diabetic ketoacidosis. ParasomniaParasomnia is defined as a sleep disorder that interferes with sleep. There are a number of parasomnias including sleep walking, sleep talking, grinding of the teeth that is referred to as bruxism, nocturnal enuresis and restless leg syndrome. Sleep ApneaSimply stated, sleep apnea is apnea that occurs during sleep. There are a couple of types of sleep apnea including obstructive sleep apnea that is typically caused by large anatomical structures such as the tongue and the collapse of the oropharynx when the client is sleeping, central sleep apnea which results from some deficit of the central nervous system such as an insult to the brain stem, and mixed sleep apnea, which occurs as the result of the combination of both central and obstructive sleep apnea, and results from multiple related disorders and diseases. Circadian RhythmCircadian rhythm is the human's natural and innate 24 hour a day clock. Circadian rhythms are sometimes referred to as our body clock. In essence, humans take on cyclical 24 hour periods of time that are associated not only with sleep, but also in terms of their hormone secretion, their bodily temperature and other physiological and other psychological variations. Good sleep habits and rest promote better health and well-being in people. A lack of sleep and rest do not. Poor sleep habits can lead to inability to mentally focus, adversely affect moods, and increase the risk of depression, heart attack, high blood pressure, obesity, and other health problems. Assessing the Client's Need for Sleep and Rest and Intervening As NeededHow much sleep is needed depends upon the individual, their age and their level of wellness. For example, some individuals just simply require and need more or less sleep than others do even when the person is not affected with a health related problem or disorder and it varies according to age and well-being. Clients who are ill and who are experiencing signs and symptoms related to the illness will need more sleep than they did prior to the illness. The amount of sleep that is needed also varies among the age groups. Below are some guidelines that you can use to determine whether or not a client is getting enough sleep and rest for physiological and psychological health.
The factors that impact on sleep, its duration and its quality are described below.
Clients are assessed by the nurse for their sleep and rest patterns and any sleep disturbances. After a complete physical assessment of the client is assessed using other subjective and objective data, as discussed immediately below. The physical assessment may reveal some data that can suggest a sleep disorder. Some of this data can include a deviated nasal septum, enlarged tonsils and obesity, all of which can lead to a sleep disorder or disturbance. Other assessments can include: The review of the client's reports about their sleep: The nurse may ask a client to record their sleep patterns and record it in a sleep log or diary for a week or more, after which, the nurse will assess and analyze this data to determine any sleep disturbances. Some of the data that is recorded in this sleep log can include:
Diagnostic studies, such as a polysomnography which is done in a sleep center by a respiratory therapist, is used to diagnose sleep disturbances. A polysomnography is done in the sleep laboratory by placing electrodes on the client's head is a combination of three diagnostic studies which are an electrocephalogram, an electro-oculogram and an electromyogram. An electrocephalogram measures and displays the brain waves while the client is sleeping; an electro-oculogram measures and displays eye movements during sleep; and an electromyogram to measure muscular movements during sleep. These diagnostic tests, in combination with pulse oximetry and an electrocardiogram, are used to assess clients for sleep disorders such as sleep apnea, restless leg syndrome and bruxism. Some of the nursing diagnoses that the nurse can arrive at after a complete and thorough assessment of the client are:
Interventions for sleep disturbances are described below. These interventions are often referred to as sleep hygiene measures.
Applying a Knowledge of the Client's Pathophysiology to Rest and Sleep InterventionsAs mentioned immediately above and in other sections of "Rest and Sleep", many interventions for sleep disorders and disturbances are based on the needs of the specific client as specific to their physiological and psychological pathologies. For example, stress and relaxation, in addition to other complementary and non pharmacological interventions are used when the client is adversely affected with anxiety that disrupts sleep, continuous positive airway pressure (CPAP) is used when the client's anatomical structures are abnormally large or they abnormally relax and collapse during sleep, and analgesics are administered to relieve pain as the result of an acute or chronic physical disorder or disease. Scheduling Client Care Activities to Promote Adequate RestThe promotion of sleep and adequate rest depends on correcting any underlying problems, including pain and alcohol use, and then planning activities and routines that will enhance the duration and the quality of sleep. Some of these sleep promotion interventions and schedules include:
Many hospitals and nursing homes have established policies and procedures to promote sleep by decreasing the noisiness of client care areas. For example, the hospital may stop over head paging after a certain hour; they may turn down the telephone ringer volume after a certain hour and turn down the lights in the hallways. RELATED CONTENT:
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Alene Burke, RN, MSN Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members. Latest posts by Alene Burke, RN, MSN (see all) Which nursing intervention would be beneficial for a patient with insomnia?Therefore, it is important to provide effective nursing interventions to promote sleep. A literature review found evidence for effective nursing interventions including massage, acupuncture, and music or natural sounds.
What nursing care interventions would you provide for a client who is suffering from sleep disturbances?Some of these sleep promotion interventions and schedules include: Establishing and adhering to a regular sleep time and wake time for the client based on their patterns and needs. Limiting the duration and frequency of day time naps. The promotion of daily exercise.
What are some nursing interventions to promote sleep?Nurse Snooze: 7 Sleep-Promoting Tips Nurses Must Share to their Clients. Sleep Hygiene. ... . Relief for the Sleep-Challenged. ... . Beating the Hours Before Bedtime. ... . Setting Up a Sleep-Inviting Environment. ... . Diet for Good Sleep. ... . Promoting Comfort and Relaxation. ... . Addressing Emotional Stress. ... . Medication for Enhanced Sleep.. What are some of the recommended techniques for dealing with insomnia?Basic tips:. Stick to a sleep schedule. Keep your bedtime and wake time consistent from day to day, including on weekends.. Stay active. ... . Check your medications. ... . Avoid or limit naps. ... . Avoid or limit caffeine and alcohol and don't use nicotine. ... . Don't put up with pain. ... . Avoid large meals and beverages before bed.. |