REST, COMFORT, SLEEP

1
REST, COMFORT, SLEEP

• NUR 102
• Module H
• Dianne Watts

2
REST

• When people are at rest, they usually feel
  mentally relaxed, free from anxiety, and
  physically calm
• Rest does not imply inactivity

3
SLEEP

• Sleep is a recurrent, altered state of
  consciousness that occurs for sustained periods
• Sleep is a cyclical physiological process
• Circadian rhythm
• Biological clocks

4
Sleep Regulation

• Sleep involves a sequence of physiological states
  maintained by the CNS
• RAS ( reticular activating system) wakefulness
  BSR (bulbar synchronizing region) sleep

5
STAGES OF SLEEP

• NREM sleep nonrapid eye movement - involves 4
  stages
• REM sleep rapid eye movement

6
Stage 1 NREM

• Lightest level of sleep
• Lasts a few minutes
• Easily aroused by sensory stimuli
• Waken, person feels as though daydreaming has
  occurred

7
Stage 2 NREM

• Period of sound sleep
• Relaxation progresses
• Arousal is still relatively easy
• Stage lasts 10-20 minutes
• Body functions, vital signs metabolism, slow

8
Stage 3 NREM

• Involves initial stages of deep sleep
• Sleeper is difficult to arouse and rarely moves
• Muscles are completely relaxed
• Lasts 15-30 minutes

9
Stage 4 NREM

• Very difficult to arouse sleeper
• Deepest stage of sleep
• If sleep loss has occurred, sleeper will spend
  considerable portion of night in this stage
• Vital signs are significantly lower than during
  waking hours
• Lasts approximately 15-30 minutes
• Sleepwalking and enuresis may occur

10
REM SLEEP

• Vivid, full-color dreaming may occur in REM.
• Usually begins about 90 minutes after sleep has
  begun
• Typified by autonomic response of rapidly moving
  eyes, fluctuating heart and resp rates, increased
  BP

• Loss of skeletal muscle tone occurs
• Gastric secretions increase
• Very difficult to arouse
• Duration of REM sleep increased with each cycle
  and averages 20 minutes

11
Functions/Purpose of Sleep

• Restoration
• Psychological
• Physiological
• Biological
• Cognitive
• Conservation of energy

12
FACTORS THAT AFFECT SLEEP

• Physical illness
• Drugs and substances
• Lifestyle
• Emotional stress
• Environment
• Exercise and fatigue
• Food and caloric intake

13
SLEEP DISORDERS

• INSOMNIA
• SLEEP APNEA
• NARCOLEPSY
• SLEEP DEPRIVATION
• PARASOMNIAS

14
INSOMNIA

• Chronic difficulty falling asleep
• Frequent awakenings from sleep
• Short sleep or nonrestorative sleep

15
SLEEP APNEA

• Disorder in which the individual cannot breath
  and sleep at the same time
• Lack of airflow through the nose and mouth for
  periods from 10 seconds to 1-2 minutes, there can
  be 10 or 15 to more than 100 respiratory events
  per hour of sleep
• Three types central, obstructive, and mixed

16
CENTRAL SLEEP APNEA

• Caused by cessation of diaphragmatic and
  intercostal respiratory effort as a result of
  dysfunction of the brains respiratory control
  center
• Impulse to breath fails, temporarily
• Least common form

17
OBSTRUCTIVE APNEA

• Most common form
• Characterized by cessation of airflow despite the
  effort to breath
• Occurs when muscles or structures of the oral
  cavity or throat relax during sleep
• Usually have loud snoring

18
NARCOLEPSY

• A CNS dysfunction of mechanisms that regulate the
  sleep and wake states
• Falls asleep uncontrollably at inappropriate
  times
• Treated with stimulants

19
SLEEP DEPRIVATION

• S/S blurred vision, fine motor clumsiness,
  decreased reflexes, slowed response time,
  decreased reasoning and judgment, cardiac
  arrhythmias
• Psychological S/S confusion, disorientation,
  increased sensitivity to pain, irritable,
  withdrawn, agitation, decreased motivation

20
PARASOMNIAS

• Sleep problems that are more common in children,
  one common exception is bruxism (tooth grinding)
• SIDS
• Somnambulism(sleepwalking)
• Nightmares
• Nocturnal enuresis (bedwetting)

21
ASSESSMENT

• Normal sleep pattern, restful? sufficient?
• Self- reported
• Sleep log
• Bedtime routines
• Bedtime environment
• Client expectations

22
Pain

• Physical sensation
• Involves physical, emotional and cognitive
  components
• Stimulus

23
Physiology of Pain

• Transduction
• Transmission
• Perception
• Modulation

24
Types of Pain

• Acute
• Chronic
• Idiopatic
• Inferred
• nociceptive
• neuropatic

25
Pain Assessment

• Scales
• Nonverbal pain indicators
• Behavioral indicators

26
Pain Management

• Pharmacological interventions
• Non-pharmacological interventions
• Barriers
• Cultural considerations
• Reassessment

27
Environmental factors affecting common and sleep

• Comfortable room temperature
• Proper ventilation
• Minimal noise
• Comfortable bed
• Proper lighting

28
Promoting Bedtime Routines

• Help client to relax in preparation for sleep
• Avoid mental stimulation before bedtime
• Relaxation exercises
• Guided imagery
• Good sleep hygiene

29
Sleep Hygiene

• Avoid sleeping long hours during weekend or
  holiday
• Bedroom should not be used for intensive
  studying, snacking, TV watching, or other
  nonsleep activity
• Avoid worrisome thinking when going to bed
• Avoid heavy meals for 3 hours before bedtime

30
Promoting comfort

• Encourage client to wear loose-fitting nightwear
• Instruct family on ways to position client and
  support dependent body parts to aid in muscle
  relaxation
• Have client void before going to bed
• Back massage
• Keep bed linens dry

31
Activity

• If client is at home, encourage physical activity
  during daytime
• Avoid rigorous exercise at least several hours
  before bedtime

32
Control of noise in hospital

• Close doors to clients room
• Keep doors to work areas closed
• Reduce volume of nearby telephones and paging
  equipment
• Avoid abrupt loud noises
• Keep necessary conversations at low levels