NI - Exam 4 material

when is melatonin released

when the eyes sense darkness in the external environment

% of sleep that is non-REM and % that is REM

75% non-REM

25% REM

what is REM rebound

when the body makes up for lost REM sleep the following night of lost REM

what is polysomnogram

stages of sleep are understood via brain activity, eye movement and muscular activity

EEG

EOG

EMG

s1 n-REM

transitional state between wakefulness and sleep

hypnic jerk occurs - involuntary sensation of falling

lasts only a few minutes

s2 n-REM

asleep but in a light state of sleep

easy to woken up

½ of sleep time

s3 n-REM

deeper sleep

more difficult to awaken

increased relaxation leads to snoring

s4 n-REM

deepest sleep

slower brain activity

realistic dreams

name for s1 and s2 n-REM sleep

light sleep

name for s3 and s4 n-REM sleep

deep sleep/delta sleep/slow wave sleep

what occurs during REM sleep

fluctuating vitals

skeletal muscles relax

difficulty to awaken

ABC’s of safe sleep for infants

Alone

Back

Crib

In adults, which sleep cycle stage experiences a decrease and is absent by older adulthood

n-REM s4

how many hours does each age group sleep

infants - 16 hrs

toddlers/prek - 11 to 14 hrs

school aged - 9 to 12 hrs

adolescents - 8 to 10 hrs

adults - 7 to 9 hrs

which sleep cycle stage constitutes most of the sleep cycle for infants

REM sleep

what is the most common sleep disorder

insomnia

does insomnia occur more in females or males

females

tx for insomnia

CBT (cognitive behavioral therapy)

relaxation techniques

sleep restriction

sleep hygeine

what does the process of sleep restriction look like

wake up at the same time every day, without taking any naps during the daytime

how long does insomnia last before it is considered chronic

persists for more than 1 month (3 episodes per week for 3 months)

obstructive sleep apnea (OSA)

frequent mini-arousals during sleep

what changes about someones vitals when they experience sleep apnea

HR increases, BP increases

sx of OSA

excessive sleepiness

fatigue

depressed mood

difficulty concentrating

poor memory

tx for OSA

CPAP

surgery

position changes

weight loss

what is the greatest risk that OSA poses

CV disease (HTN, CVA)

hypersomnia

excessive daytime sleep without relief from naps

narcolepsy / sleep attacks

excessive daytime sleepiness and frequent overwhelming urges to sleep

cataplexy that narcolepsy pts experience

involuntary loss of skeletal muscle tone

somnambulism

sleep walking

REM behavior disorder (RBD)

acting out dreams

sleep terrors

in deepest sleep stage often occurring in children where they sit up screaming from sleep without being able to reason

nightmares

vivid and disturbing dreams

bruxism

teeth grinding

enuresis

bed wetting

sleep related eating disorder

eats while asleep w/o recollection

Restless leg syndrome (Willis-Ekbom disease)

cannot lie still d/t unpleasant, creeping, crawling or tingling sensations

% of population with RLS/WED

15%

what temp should a room be to promote a restful environment

60-67 degrees

what combo of food should be offered as bedtime snacks/beverages

tryptophan and complex carbs (milk and cookies)

ventilation

air in and out of the lungs (aka breathing)

respiration

gas exchanged between alveoli and capillaries

perfusion

oxygenated capillary blood passing throughout the body

inspiration

diaphragm and intercostal muscles contract

expiration

diaphragm and intercostal muscles relax

during inspiration, does the intrathoracic pressure increase or decrease and vice versa for expiration

inspiration - decreased pressure

expiration - increased pressure

which system regulates ventilation

central nervous system (medulla and brainstem)

when we experience a drive to breath, what is our body recognizing is happening

recognizing that CO2 and hydrogen ions are both increasing in the blood

what process allows for respiration to occur

diffusion (diffusion from higher to lower concentrations

what happens with O2 and CO2 during perfusion

O2 delivered to cells of the body, CO2 delivered to the lungs

what factors influence perfusion (4)

body position

activity level

adequacy of blood supply

CV function

hyperventilation

ventilation in excess that causes CO2 to drop low and remove too much from the body

causes of hyperventilation (5)

anxiety

infection/fever

hypoxia

DKA

aspirin overdose

hypoventilation

ventilation is inadequate to meet the body’s demand for oxygen OR remove sufficient CO2

causes of hypoventilation (3)

COPD

obesity

atelectasis

hypoxia

inadequate oxygen available for the cells

cause of hypoxia

dec. HGB

hypoventilation

aspiration

poor perfusion

s/s of acute hypoxia (8)

anxiety

restlessness

confusion

inc. pulse

dyspnea

tachypnea

inc. BP

arrhythmias

s/s of chronic hypoxia

pallor

fatigue

HA

angina

clubbing

anorexia

constipation

dec. UOP

CV function r/t oxygenation of the body

blood pumps and delivers oxygen/nutrients throughout the body and remove waste via circulation

what causes arrhythmias

electrical conduction causing irregular/ineffective heart beats

cause of ischemia

impaired oxygen delivery to the body

things that ischemia can lead to (3)

MI

angina

CVA

cause of cardiac valve stenosis

inefficient pumping d/t stiffening/narrowing of cardiac valves

does cardiac valve stenosis increase or decrease stroke volume, and what does this cause to occur

decreases stroke volume

dec oxygen delivery

cause of HF

inefficient pumping of the blood supply

cause of hypovolemia

inadequate blood supply

if you need to ask a pt about their health history, but they are dyspneic, what should you do?

ask yes/no questions or ask others who might have the info needed

if teaching a pt about pursed lip breathing, what is one way you can describe this

smell the roses, blow out the candles

what condition is diaphragmatic breathing most helpful for

COPD

how does belly breathing help

create a functional respiratory pattern by decreasing RR and increasing gas exchange in alveoli

how to pursed lip breath

sit upright

inhale via nose for 3 sec

exhale via pursed lips for 7 sec

how to belly breath

hand on abd and other on chest

inhale via nose and let abd protrude

exhale via pursed lips and contract abd muscles

press upward and inward with hand

most efficient ways to manage airways of pts (4)

C&DB

IS

Chest physiotherapy

suctioning

how does a pt use IS

semi fowlers, splint PRN

exhale normally

inhale through mouth

hold breath for 3secs

exhale normally

use x10 every hour while awake

how to know if a pt is deep breathing correctly

their bottom ribs should move

what does chest physiotherapy help to do

mobilize secretions for large amounts of secretions or ineffective coughs via percussion/vibration/postural drainage

tracheal suctioning requires clean or sterile technique

sterile

4 risks of suctioning pt secretions

hypoxia

tissue trauma/bleeding

anxiety

death (via hypoxia/cardiac stress)

what ppe should be used when suctioning pt secretions

gloves

gown

goggles

mask

what percentage of room air is oxygen

21%

If a pt is experiencing respiratory distress due to inadequate oxygenation but doesn’t have an order for oxygen delivery, what should the nurse do

treat the patient first, and then get the order

indications for administering oxygen (4)

hypoxia / dec O2

tachypnea

tachycardia / angina

anesthesia recovery / opioid use

flow meter oxygen admin

attaches to O2 outlet on wall

verify anytime you enter a pts room

humidifier oxygen admin

sterile water attaches which provides moisture to O2

prevents infection

prevents drying, cracking and bleeding of nasal mucosa

portable compress O2 admin

store upright

verify amount of O2 in the tank

used short term/for transportation

compressor O2 admin

used in home / LT facilities

RA changed into medical grade O2

high flow oxygen system

provide total amount of inspired air

oxygen delivery doesn’t vary with breathing

low flow oxygen system

provide only partial of total inspired air

comfortable

oxygen delivery varies with breathing

what does SpO2 monitor

% of O2 carried by the available hbg to peripheral tissues

nasal cannula (NC) admin

most common type

1-6 L

simple face mask admin (SFM)

claustrophobia

Not suitable for COPD pts

5-10L

venturi mask admin

high flow system

2-15L

O2 mixes with air

high flow NC (HFNC) admin

aka AIRVO

pts spontaneously breathing who need more oxygen/pressure

2-60L

non-rebreather mask (NRM)

bag attached to delivery system

valve prevents inhalation of room/exhaled air

10-15L

Bipap admin

mechanical ventilator to assist w inspiration

different pressure created in airway during inspiration/expiration

positive pressure

helps prevent atelectasis

CPAP admin

air under constant pressure

decrease periodic hypoxemia

ventilator admin

artificial ventilation of the lungs

artificial airway required for use

rate, depth, FiO2 and pressure all manually set

how many mL of urine can the bladder hold

800mL

at what # of mL does the urge to void occur

200mL

why are females more likely to get UTIs

the length of the urethra is shorter in females