Sleep/Rest and Sensory Alterations

Sleep/Rest

100

What is the difference between sleep and rest?

Sleep is an altered state of consciousness with decreased perception. Rest is subjective; stress-free and relaxing.

200

What are the benefits of sleep?

Improves learning, restores energy, improves coping ability, strengthens the immune system; aids in long-term memory storage

300

What is meant by "circadian rhythm"?

Internal clock; affects overall level of functioning; regulated by lunar cycles

400

What can disrupt someone's circadian rhythm?

Changing time zones, working night shift, being hospitalized or institutionalized

500

Give specific examples of how lifestyle factors influence sleep and rest.

Medications can keep you awake at night; alcohol interferes with good sleep, exercising less than 2 hr before bed reduces sleep quality, caffeine can keep some people awake at night even if it's used in the mornings, temp and humidity of the room affects sleep, noise and light keep some people awake, noxious odors keep you awake, uncomfortable bedding prevents good sleep.

Sleep/Rest

100

Why do the elderly have so much difficulty obtaining quality sleep?

advancing circadian clock; wake very early in AM & can't get back to sleep; have very little stage 4 (deep) sleep; spend less time in REM sleep; many are plagued with medical problems and pain that interfere with sleep; being in a nursing home affects sleep quality

200

What is the most common cause of sleep apnea?

obstruction of the airway by the soft palate and pharynx.

300

How is sleep apnea diagnosed and what are common treatments?

sleep study with EEG, EKG, O2 sat monitoring. CPAP to maintain positive airway pressure during apnea, surgery to remove excess tissue or T&A, lose weight, avoid ETOH and smoking

400

Name the most common sleep disorder. What is Restless Leg Syndrome associated with? What is Narcolepsy? What is nocturnal enuresis?

Insomnia Low Iron or use of anti-depressants CNS dysfunction that causes REM sleep suddenly Bedwetting

500

Based on what you know about factors influencing sleep, name some nursing interventions to improve sleep quality.

Cluster care, create the environment, promote comfort, promote bedtime rituals and routines, appropriate snacks and drinks at appropriate timing, relaxation promotion, safety promotion, sleep hygiene, medications as indicated

Application of Sleep Facts

100

List important points of obtaining a sleep history from a client (vol 2 p.765)

What is your usual sleeping pattern? What is your preferred sleeping environment? Do you have bedtime routines/rituals? Do you use special aids for sleep? Have you had changes or problems with your usual sleep habits?

200

You and the RN have collaborated on a care plan for a client with sleeping problems--Sleep Deprivation. List defining characteristics required in order to use this nursing diagnosis.

daytime drowsiness, decreased ability to function, lethargy, fatigue, anxiety, perceptual disorders, increased sensitivity to pain, irritability, decreased concentration, slowed reaction, acute confusion, agitation, combativeness, hallucinations

300

List several specific nursing interventions for the client with Sleep Deprivation nursing diagnosis.

Data collection/assessment of developmental age, physical/psychological stressors, Note medical conditions known to affect sleep quality, note environmental factors affecting sleep, Collect data on client's usual sleep patterns; determine interventions client has used currently or in past to help with sleep; assess caffeine intake and decrease amt prn; avoid eating late at night; avoid exercise 2 hr before bed; limit evening fluids if nocturia is present; suggest abstaining from daytime naps; promote relaxation just before bedtime; provide back massage before bed; promote bedtime rituals/routines; provide quite environment; treat pain;

500

A 74 yr old woman in a nursing home has severe RA that prevents ambulation or independent ADLs. She eats sweets (chocolate, mainly) just before bedtime. She receives a sleeping pill and pain pill at bedtime.Lately she awakens 2 times a night, a bit confused, and needing to void. She is noted to be more sluggish during the day. Why do you think she is now sleeping less? Why is she confused at night? Should you address the sweets before bedtime? Why or why not? What interventions can you think of to address the problem of eating chocolate sweets before bedtime?

Chocolate contains caffeine, so that could be keeping her awake. She is waking up because she needs to urinate. Nocturia is not unusual in older adults, but it can interfere with sleep. Neurologic changes occur with advancing age could be causing confusion, but there is nothing in the scenario to suggest this. If Gwen isn't sleeping enough, she may be confused because of lack of sleep. Confusion may be caused by the side effects of her sleeping pill and/or her pain pill, depending on what they are. you should discuss with Gwen the fact that the chocolate may be affecting her ability to sleep. remove foods with refined sugar and high fat from the room; tell Gwen not to eat sweets or that she can eat them only during the day; tell the family to not bring candy and processed snack food; encourage the family to bring healthy snacks rather than chocolate; or teach Gwen and her family about the effect of chocolate and other foods and beverages containing caffeine on sleep.

Sensory Deprivation & Overload

100

List symptoms of sensory deprivation List symptoms of sensory overload

irritable, confused, dec attention span, dec problem solving ability, drowsiness, depression, delusion, hallucinations First four as in deprivation, plus muscle tension, anxiety, can't concentrate, dec ability to perform tasks, restlessness, disoriented

200

List sensory changes with aging affecting vision and hearing

Vision: dec visual acuity, dec night vision, dec accommodation, dec tear production Hearing: dec hearing acuity, presbycusis, tinnitus

300

List sensory changes with aging affecting tase and smell

taste buds atrophy=dec ability to perceive tastes; dry mouth (XEROSTOMIA) = altered sense of taste. atrophy of olfactory neurons=dec ability to perceive smell, which alters sense of taste This all leads to decreased appetite in the elderly

400

List sensory changes with aging that affect touch and kinesthesia (movement)

loss of sensory nerve fibers; changes in brain=dec ability to perceive light touch, pain, & temp variations. Dec in muscle fibers & slower speed of conduction=slowed reaction time, dec speed, dec muscle power, & impaired balance. This put the elder at risk for falling.

500

List hazards of sensory deficits for each: vision, hearing, taste, smell, tactile, kinesthesia

Vision: falls, driving, mobility, interactions Hearing: communication/social interaction; phone, doorbell, smoke alarms (can't hear warnings) Taste: malnutrition, loss of pleasure of eating, spoiled food Smell: gas leak, fire, spoiled food, dec taste, malnutrition, Tactile: burns, sharp, cold, pressure, pain; loss of comfort from touch Kinesthesia: balance, gait, falls (SAFETY)

Care Planning

100

List several data collection points that indicate Disturbed Sensory Perception

reported change in sensory acuity (photosensitivity, alt taste, smell, inability to tell position of body parts) change in usual response to stimuli: rapid mood swings, anxiety, panic; restless or irritable; poor concentration; disorientation, hallucinations, impaired communication; decrease intake of food; new onset of falls or increase in falls; TV/radio turned up LOUD, squinting, over-reaching or under-reaching for items, blank looks, lack of reaction to loud noises, talks LOUDLY, lip reading, ringing in ears, underreaction to painful stimuli, no response when touched, dec sensitivity to odors, excess use of sugar/salt, weight loss, poor balance, shuffling gait

200

Write an excellent goal for a client with a deficit in taste. The client has made statements that "nothing tastes good anymore". The client has lost 10 pounds in 4 weeks.

Client will verbalize importance of eating nutritious foods regularly, even though there is decreased taste, by Oct 15 Client will demonstrate weight gain of 2 lbs by Oct 15

300

List 6 interventions for nursing diagnosis Disturbed Sensory Perception-Auditory

Assess/collect data to determine cause or changes in known cause Collect data on client's ability to hear to get overview of mental, cognitive status & ability to interpret stimuli Ascertain & validate client's perception of problem or changes to assist in planning approp. care & to provide respect for client's feelings Face client and enunciate clearly when speaking Speak in lower tones (due to presbycusis) Do not shout at client Speak slowly and distinctly; use simple sentences Use touch to get client's attention if needed Be aware and careful of facial expressions Be aware of background noise & reduce it to minimum Make sure hearing aids are in good working order, if used If hearing aids are not prescribed, discuss with practitioner the possibility of referral to audiologist

400

List nursing interventions for the client experiencing sensory overload

Minimize unnecessary stimuli: pain, nausea, noxious odors, noise, light, people Establish a schedule for care, esp uninterrupted sleep Promote calm, low stress environment Teach relaxation techniques Limit visitors if necessary

500

List nursing interventions to prevent sensory deprivation.

Help with sensory aids Make regular contact with client; ensure continuity of care Include touch; avoid isolation' Provide orientation cues: message board, calendar, TV Encourage social interaction Monitor sedating medications Stimulate senses: smells (aromatherapy), pet therapy, pictures, music (all as appropriate and as client is capable)