Exam 1

what are sleep distubrances?

poor quality of sleep

what causes sleep disturbances?

health related or enviro causes

what are AE of sleep disturbances?

increased cancer risk

cardiovascular d/o

decreased immune response

what are sleep disorders?

abnormalities unique to sleep

what are examples of sleep disorders?

insomnia

obstructive sleep apnea

narcolepsy

parasomnias

what are examples of diagnostic testing you can do for sleep?

polysomnography (PSG) sleep study:

EMG —> muscle tone

EOG —> eye movement

EEG —> brain activity heart rate monitoring
oximetry —> oxygen levels

what is insomnia?

difficulty falling or staying asleep leading to non-restorative sleep

what are symptoms of insomnia?

waking up too early

waking up feeling unrefreshed

avoiding scheduled bedtime

inability to sleep w/o intervention

what is short term insomnia?

difficulty falling asleep 3x week < 3 months

what is chronic insomnia?

difficulty falling asleep 3x week < 3 months

what are tx for insomnia?

melatonin receptor agonists

non-pharm —> cognitive behavior therapy (CBT-1)

drug therapy —> OTC

what are nursing considerations for insomnia?

assess sleep patterns and duration

identify underlying causes (pain, stress, meds, caffeine)

promote non-pharm interventions first (relaxation, routine, envir)

med if needed, short term sedatives

pt education on sleep hygiene

what are melatonin receptor agonists?

rapid onset meds for insomnia with difficult falling asleep

NOT for waking during the night

what are examples of melatonin receptor agonists?

antidepressants —> some have sedation side effects (SRI, SNRI)

antihistimines —> anticholinergic side effects (daytime sleepiness)

what are non-pharmacologic tx for insomnia?

education on sleep and behavioral strategies

good sleep hygiene

what is drug therapy for insomnia?

individualized, short term tx

OTC meds —> benedryl, tylenol PM

what is a potential AE of drug therapy for insomnia?

rebound insomnia —> worsening of sleep from abruptly stopping certain sleep meds

what is obstructive sleep apnea (OSA)?

upper airway obstruction (tongue/soft palate collapse) —> narrowing of airway passages or tongue/soft palate

intermittent hypoxia and fragmented sleep (REM sleep)

what is apnea?

>90% cessation of resp airflow lasting > 10 sec causing brief arousals

what are risk factors for OSA?

obesity —> neck circumference > 16 in in men

male sex

postmenopausal women

older age (>65)

craniofacial abnormalities

smoking

alc use, sedatives

hypothyroidism

what are key S/S of OSA?

loud, frequent snoring

witnessed apneic episodes

excessive daytime sleepiness

morning headaches

irritability, poor concentration

gasping or choking at night

hypertension

cardiovascular strain —> increased risk for HTN, dysrhythmias, MI, stroke

what does a positive pressure (CPAP) machine do?

prevents airway from collapsing

what are factors that affect OSA?

compliance

ETOH/sedatives

side lie

weight loss

lifestyle changes

post op comps —> airway obstruction and hemorrhage

what is considered being compliant when using a CPAP machine?

5x or more per week for 4 hrs

what are nursing considerations for OSA?

assess for snoring, daytime sleepiness, morning headaches

encourage weight loss and lifestyle mods

CPAP/BiPAP adherence

avoid sedatives and opioids (risk of resp depression)

monitor cardio status (HTN, arrhythmias)

what are periodic limb movements in sleep?

involuntary, repetitive, unaware/unconscious repetitive limb jerks —> mostly legs, rarely arms

fragmented NREM

what is restless leg syndrome (RLS)?

unpleasant urge to move legs before sleep

relieved by movement

what are examples of meds used to reduce or eliminate limb movements/arousals?

benzo (clonazepam) —> improve sleep quality

valproic acid —> reduces muscle activity

what is narcolepsy?

chronic neurologic d/o causing excessive sleepiness despite adequate sleep opportunity and sudden sleep attacks

may include cataplexy

unable to regulate sleep wake cycles —> uncontrollable urge to sleep (REM sleep)

what are the types of narcolepsy?

type I (w cataplexy)

type II (w/o cataplexy)

what is cataplexy?

brief and sudden loss of skeletal muscle tone

what are tx for narcolepsy?

antidepressants —> tricyclics, SSRI

sleep hygiene

scheduled naps —> 20-30min to conserve energy

what are nursing considerations for narcolepsy?

maintain safe enviro —> risk for falls/accidents during sleep attacks

sche frequent naps and structure sleep routine

meds —> stimulants (modafinil) as ordered

educate pts on lifestyle mods ad safety measures

monitor for depression and emotional health

what are arousal parasomnias (NREM)?

abnormal behaviors or experiences during sleep

EX: sleepwalking, night terrors, REM behavior d/o

what are the types of arousal parasomnias (NREM)?

sleep walking —> sit up in bed, move objects, walk around, drive car

sleep terrors —> sudden awakening, loud cry and signs of panic, no recall

what happens during sleep walking?

may not speak

limited or no awareness of event or recall

misinterpreted as ICU psychosis —> overstimulation from noise in the ICU leading to psychosis

what happens during sleep terrors?

increased HR and resps, diaphoresis, autonomic arousal

ICU-related sleep disruption and deprivation, fever, stress, exposure to noise and light can contribute

what are nursing considerations for parasomnias?

ensure safety —> prevent injury during episodes

maintain consistent sleep sched

assess for triggers (stress, meds)

educate family/caregivers on safety measures

meds for severe cases if ordered

what does sleep look like for the gerontologic population?

increased risk —> falls, injuries, cognitive disturbances

overall shorter sleep times

decreased sleep efficacy

what probs are there for the gerontologic pops?

under-reporting and under-diagnosing

chronic conditions —> COPD, CVD, pain, depression, diabetes, dementia, cancer

why do you need to be cautious with sleep meds with the gerontologic pops?

metabolism of hypnotic drugs decreases with aging (drugs are more effective)

avoid long-acting benzos

diphenhydramine is sedating (careful of OTC “PM”)

what is involved in a pain assessment?

direct interview —> OPQRSTU, wong-baker

observation —> grimacing, guarding

diagnostic studies —> x-ray, MRI

physical assessment

vital signs

what are the different types of pain?

acute

chronic

nociceptive

neuropathic

ischemic

referred

what is acute pain?

sudden onset

resolves within 3 months

what is chronic pain?

gradual onset

lasts > 6 months

what is nociceptive pain?

somatic

visceral

EX: appendix pain

what is neuropathic pain?

damage or dysfunction of somatosensory nervous sys

what is ischemic pain?

insufficient oxygen supply

what is referred pain?

pain felt in different location

what are some long term AE of chronic pain for the gerontologic and other pops?

depression

sleep probs

decreased mobility

inc health care use

physical and social role dys —> slower metabolism (can cause issues w pain management), risk of GI bleeds (NSAIs), multiple analgesics

what are barriers to managing chronic pain?

belief that pain is an inevitable part of aging (burden, complainer)

high prevalence of cognitive, sensory (perceptual), and motor probs

assess for behavioral changes

what are the normal lab value ranges for WBC?

4000-11000

what does a high count of WBCs indicate?

infection

inflammation

tissue injury

what does a low count of WBCs indicate?

leukopenia (infection risk)

how long do neutrophils live for?

24-48 hrs

what are the normal lab value ranges for neutrophils?

50-70%

what does a high number of neutrophils indicate?

bacterial infection

what does ANC mean?

absolute neutrophil count

what is a normal ANC range?

>2000

what is a low ANC range?

< 500 w

what does a low ANC indicate?

neutropenic

left shift = acute bacterial infection/sepsis

what is left shift?

more neutrophils in circulation cause an increase in WBC numbers

what are the normal lab value ranges for lymphocytes?

20-40%

what does a high count of lymphocytes indicate?

viral infection

what does a low count of lymphocytes indicate?

HIV

steroid use

what are the normal lab value ranges for eosinophils?

1-4%

what does a high count of eosinophils indicate?

allergies

parasite

what does ESR mean?

erythrocyte sedimentation rate

what are the normal lab value ranges for ESR?

< 20

what does ESR indicate in lab values?

nonspecific, inflamm somewhere in body

what does a high count of ESR indicate?

inflamm/infection (nonspecific)

what does a low count of ESR indicate?

very slow (shows chronic)

what does CRP mean?

c-reactive protein

what do CRP lab values indicate?

acute inflamm

what is the normal lab value range for CRP?

<1

what does a high range for CRP indicate?

acute inflamm

bacterial infection

what does a low range for CRP indicate?

quicker (use to monitor)

what is the normal lab value range for lactate?

0.5-2

what does a high range of lactate indicate?

tissue hypoxia

sepsis

what does a low range of lactate indicate?

>4 = shock

can be drawn for a suspected seizure

what are the 5 classic signs of local inflamm?

redness (rubor)

heat (calor)

swelling (tumor)

pain (dolor)

loss of fxn

what are signs of systemic inflamm?

fever

malaise or fatigue

elevated WBC count (leukocytosis)

increased HR, CRP, ESR

anorexia, weight loss

what are therapies for inflamm?

antipyretic & anti-inflamm —> salicylates, NSAIDS

antipyretic —> acetaminophen

anti-inflamm —> corticosteroids

what is the RICE method?

R —> REST the injured area for 48 hrs

I —> ICE for 20min at a time, 2-3x per day

C —> COMPRESS to help reduce swelling

E —> ELEVATE the injured limb 6-10inch above the heart

what is a type I HS?

IgE mediated

inflamm from histamine —> subsequent rxns worse

immediate

what cells are involved in a type I HS?

mast cells

what is an ex of a type I HS?

anaphylaxis

what does a localized type I HS rxn look like? ?

wheal & flare

min-hrs

what does a systemic type I HS rxn look like?

anaphylaxis, min

bronchial constriction —> shock

what is type II HS?

cytotoxic —> IgM and IgG learn the wrong enemy, “friendly fire”

tissue specific

days

what cells are involved in a type II HS?

phagocytes

what’s an example of a type II HS?

MS

GB

rheumatoid arthritis

lupus

hashimotos

what tests can be used for type II HS?

direct coombs test —> antibodies on RBC

indirect coombs —> circulating antibodies

what is type III HS?

antigen-antibody immunocomplex gets stuck in cellular tissue/wall (chronic inflamm)

months

specific markers for dz

what cells are involved in a type III HS?

phagocytes

what are ex of type III HS?

serum sickness

raynauds

glomerulonephritis

what is type IV HS?

24-48 hrs

no antibody, tissue mediated

what cells are involved in type IV HS?

cyotoxic

t-lymphocytes (CD8+), peak later

what are ex of type IV HS?

contact dermatitis

transplant rejections

drug rxns

infections