Foundations exam 4 - Comfort, rest and sleep

Maslow’s hierarchy of needs

A system that prioritizes human needs from basic survival to personal growth.
Meet the lowest unmet need first

What are the 5 levels of Maslow's Hierarchy?

1. Physiological – Airway, breathing, circulation, food, water, sleep

2. Safety – Security, protection, freedom from injury

3. Love & Belonging – Family, friends, relationships

4. Esteem – Confidence, respect, achievement

5. Self-Actualization – Reaching one's full potential

How is Maslow used in nursing?

• Treat physiological needs first (ABCs).

• Then address safety.

• Social, emotional, and personal growth needs come after survival needs

Purpose of sleep

Conservation of energy → Growth & development → Brain waste clearance → Neural growth/maturation → Immune response modulation

What are the stages of the sleep cycle?

Sleep includes 4 stages of Non-Rapid Eye Movement (NREM) sleep followed by Rapid Eye Movement (REM) sleep

How many sleep cycles occur each night?

After Stage 1, a person goes through 4–6 cycles of the remaining NREM stages and REM sleep each night

What happens to REM sleep during the night?

• With each sleep cycle, the amount of time spent in REM sleep increases.

• REM is the stage when most dreaming occurs and is important for memory and learning.

What is stage 1 NREM sleep

very light sleep, only a few minutes long, vital signs & metabolism beginning to drease, awakens easily, feels relaxed and drowsy

What is stage 2 NREM sleep

deeper sleep, 10 to 20 minutes long, vital signs & metabolism continuing to slow, increased relaxation

What is stage 3 NREM sleep

initial stages of deeper sleep, 15-30 minutes long, vital signs decrease, difficult to awaken, relaxation with little movement

What is stage 4 NREM sleep

delta sleep; deepest sleep; physiologic rest and restoration, repair and renewal of tissue

What is REM sleep?

• Vivid dreaming
• 90 minutes after falling asleep
• Longer with each sleep cycle
• Average length is 20 minutes
• Cognitive restoration

Generally Inadequate sleep increases risk for:

• CV disease
• Obesity
• DM
• Depression
• Some cancers
• Mental illness

Generally Inadequate sleep impairs:

• concentration

• decision making

Generally Inadequate sleep increases:

• irritability

• stress response

Generally Inadequate sleep decreases:

• coping

• immune response

Factors that Interfere with Sleep

• Circadian rhythm
• Age
• Meds
• Caffeine
• ETOH
• Nicotine
• Level of fatigue
• Stress
• Illness
• Pain
• Exercise (timing, type
• Food (timing, type)
• Bedtime routines
• Environment

Patient Education for sleep

• Exercise regularly 2 hours before bedtime
• Establish a bedtime routine
• Arrange the sleep environment for comfort
• Limit fluids 2-4 hours before bedtime

How can nurses promote sleep in the hospital?

• Follow the patient's normal sleep routine when possible.

• Provide comfort measures (e.g., bathing, back rubs)

What environmental changes promote sleep?

• Maintain quiet hours (mid-afternoon and nighttime).

• Respond promptly to alarms and call bells to reduce noise

Why is coordinating care important for sleep?

Group nursing care activities together to minimize interruptions and allow longer periods of uninterrupted sleep

What is insomnia?

• is the inability to sleep despite having the opportunity.

• It may involve difficulty falling asleep, staying asleep, waking too early, or not feeling rested.

How does insomnia affect health?

• Causes fatigue and low energy.

• Can lead to poor concentration and mood disturbances.

• Affects physical, emotional, and mental health

What health conditions are associated with insomnia?

• Heart disease (HD)

• Hypertension (HTN)

• Endocrine dysfunction

What is obstructive sleep apnea (OSA)?

A sleep disorder in which the upper airway becomes blocked when the muscles of the mouth and throat relax during sleep

What are the signs and causes of obstructive sleep apnea?

• Signs: Snoring, interrupted sleep, excessive daytime sleepiness, low energy.

• Causes/Risk factors: Obesity, inactive tongue, enlarged tonsils.

• Oxygen saturation may or may not decrease during episodes

How is obstructive sleep apnea treated?

• CPAP (Continuous Positive Airway Pressure) keeps the airway open during sleep to improve breathing and sleep quality.

How does a CPAP machine work?

• Air pressure acts like a splint, preventing the airway from collapsing when throat muscles relax.

• Helps prevent apnea (breathing pauses) and snoring

What should nurses know about CPAP therapy?

• CPAP should be used every night.

• Monitor the patient's oxygen levels and ensure the device is being used correctly

How can nurses promote sleep for hospitalized patients?

• Help establish a bedtime routine.

• Limit waking patients during the night.

• Encourage personal hygiene to improve comfort before bed

When are sleep medications used?

• Sleep medications are a last resort after non-drug measures have been tried.

• Benzodiazepines may be prescribed for insomnia.