NUR 326: fatigue, sleep disorders 💯

what is fatigue

distressing, persistent, subjective sense of physical, emotion, and/or cognitive tiredness or exhaustion that is not proportional to recent activity and interferes with usual functioning

what is physiological fatigue

- extended imbalance between an activity (physical, cognitive, emotional) and the typical restorative actions (sleep and diet)

what is pathological fatigue

- associated with mental or physical diseases

what are the classifications of fatigue in regards to length

- acute: lasting less than 6 months
- chronic: lasting greater than 6 months

what are population risk factors of fatigue

populations at risk:
- older adults
- 40-50 years of age: most common group affected
- young adults: secondary to increased responsibilities
- women: after puberty are 2-3x more likely to be diagonosed

what are individual risk factors of fatigue

- genetics: inflammation-related genes
- underlying conditions: illness, mental health, childhood stress
- treatment related factors: pharmacotherapy, side effects of meds, psychoactive substances, cancer therapy
- nutritional status: protein deficiecy
- lifestyle choices: physiological fatigue due to exercise, poor diet, consumption of substances, poor sleep, work

what is subjective assessment of fatigue

- goal: understanding client’s personal experience of their fatigue
- onset and duration
- factors that alleviate or exacerbate
- effects on daily life
- other physical, emotional, and cognitive symptoms that accompany the fatigue (fatigue + depression + perceived stress)

what is objective assessment of fatigue

- inspection: general appearance (alertness: any agitation, impairment, how is grooming/posture/gain/skin color)
- palpation: assess for lymphadenopathy, thyroid nodules, and goiter, muscle appearance and strength, reflexes, sensory and cranial nerves
- auscultation: heart and lungs underlying conditions

what is primary prevention for fatigue

- refers to intentional activities to prevent disease
- healthy lifestyle: good nutrition, exercise, getting adequate sleep, managing stress
- patient teaching: individualized based on client’s risk factors related to fatigue

what is secondary prevention for fatigue

- refers to screening efforts for early detection of disease
- fatigue is a symptom associated with multiple health conditions, there is no population-wide screening efforts for fatigue
- high-risk clients should be screened for fatigue using a relevant fatigue screening tool

what is myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS)

- aka systemic exertion intolerance disease (SEID)
- poorly understood condition because it lacks definite pathology and no known cure
- diagnosed based on self-reported symptoms and exclusion of other health conditions
- primary symptoms: excessive/persistent fatigue, post exertional malaise, unrefreshing sleep, cognitive impairment, orthostatic intolerance, muscle and joint pain, headaches

what are the sleep stages of NREM (non-rapid eye movement)

- stage 1: brief transition between wakefulness and sleep (2-5% of total sleep), body temp declines, muscles relax, easily aroused. time to fall asleep is called sleep latency
- stage 2: 45-55% of total sleep, eye movement stops, heart rate and respiratory rate decline, requires more stimuli for arousal
- stage 3/4: slow wave sleep or “delta sleep” (13-23% of total sleep). further reduction in HR, RR, BP, and response to stimuli. this is restorative sleep with reduced sympathetic activity

what is REM sleep (rapid eye movement)

- EEG activation, muscle atonia, and episodic bursts of rapid eye movement

what is the sleep cycle pattern

- sleep beings in NREM and progresses through deeper stages before the first REM episode occurs about 80-100 mins later
- the entire sleep cycle (all NREM stages + REM) typically take 90 mins and repeats 4-6 times throughout the night

regarding chronic fatigue syndrome/immune dysfunction/myalgic encephalomyelitis, how does it affect hematologic systems

- Damage to immune and hematologic systems
→ Low RBC and HCT → anemia
→ Low hct and high fatigue = Chronic Fatigue Syndrome
→ High Hgb and high HCT = good sleep

what are nursing and collaborative interventions to minimize the impact of fatigue

- Manage poor lifestyle choices and disease
- Manage secondary fatigue to treat underlying condition and reduce fatigue
- exercise/rest therapy: 150 of moderate intensity aerobic activity in a week
- naps in the afternoon should be less than a hour
- Pharmacotherapy: treat underlying conditions causing fatigue
- Psychoeducational intervention: distraction, counseling, spiritual care
- Complementary therapy: yoga, meditation, progressive muscle relaxation 
- Primary prevention: good nutrition, exercise, adequate sleep, manage stress