sleep/rest; mood/affect

sleep cycle

1. wakefulness

2. NREM stage I

3. NREM stage II

4. NREM stage III

5. NREM stage IV

6. NREM stage III

7. NREM stage II

8. REM

9. NREM stage II

NREM sleep

- Decreases in blood pressure, pulse, respiratory rate, and body temperature occur

- Physiologic healing and repair occurs during

REM sleep

- Body temperature, blood pressure, and pulse increase

- where one dreams

- essential to mental and emotional equilibrium

- begins around 90 minutes after onset of sleep, first period may only be 10 minutes then progressively gets longer up to 1 hour but must move through the stages again

NREM I

light sleep, awakens easily, "feeling of falling", uncontrolled muscle jerks can startle awake

- what stage of sleep?

NREM II

eye movement ceases, temperature, pulse and respiration begin to slow

- what stage of sleep?

NREM III

deep sleep

- what stage of sleep?

NREM IV

deep sleep

- difficult to awaken, very limited or absent muscle movement

- Awakening from this stage = disorientation before regaining awareness

90-110 minutes

entire sleep cycle is how long?

4-5

During adequate sleep, a person goes through _______ sleep cycles each night.

pregnancy

have to pee all the time, uncomfortable, restless legs, positioning, heartburn

- affects what group?

new parents

infant sleep patterns, worry, hormones

- affects what group?

infancy/toddlerhood

differences in sleep cycles, illness (congestion, ear pain), developmental changes; night terrors

- affects what group?

teenagers

flip in circadian rhythm (why they want to stay up late and sleep in), activities/school/homework, peers, phones

- need about 9 hours of sleep

- affects what group?

college

HOMEWORK, balance

- affects what group?

adulthood

this group seems to have closer to the newborn sleep rhythm, aches and pains, bladder again, responsibilities, stress

- affects what group?

infants

14-16 hours daily

- how much sleep for which group?

toddlers

9 or 10 hours at night in addition to 2-3 hours of daytime naps

- how much sleep for which group?

school age children

9-11 hours

- how much sleep for which group?

adults

7-9 hours

- how much sleep for which group?

sleep hygiene

- comfortable, well ventilated area

- optimal temp

- quiet & as dark as possible at night

- no screens 1-2 hours before sleeping

- consistent bedtime & awakening time

68-72 F

infant optimal sleep temp

65-68 F

adult optimal sleep temp

3

avoid alcohol/food at least ___ hours before bedtime

6

avoid stimulants at least ___ hours before bedtime

true

true or false:

MOST childhood sleep problems are behavioral and consistent sleep hygiene is the most important intervention - this takes time and effort

infant sleep hygiene

- keep daytime bright & loud, nighttime dark and quiet

- sleep in parents room until 6 months of age

- sleep on back alone

10

stop caffeine ____ hours before bed

2, 1

stop work ___ hours before bed and screens __ hour before bed; don't press snooze in the morning

family in transition infants

- consistent schedules

- sensory elements (ceiling projector, dim lights, smell)

- feed outside of the bedroom & before the start of the sleep routine

- sleep when baby sleep

- avoid sneaking out; wake a little when you set them down and then leave

- expect changes in sleep w/ illness or developmental leaps

teenager sleep hygiene

- consistent schedule

- no screens in the bedroom

- no energy drinks

sleep meds

1. melatonin

2. magnesium

3. iron supplements

4. other pharms interventions

melatonin

Should be given 30-60 minutes before bedtime

- age 2+

- Use for short periods of time (no more than 3-6 mo) and should be used with behavior modification (sleep hygiene)

magnesium

balancing neurotransmitters and helping with production of melatonin

- citrate if prone to constipation

iron

supplementing this can help with restless leg syndrome

- addresses deficiency in the brain which may contribute to the symptoms

mood

the way a person feels

affect

the observable response a person has to his or her own feelings

depression

Children with _________ often appear cranky, hyperactive, or have learning disorders

adolescents

______________ have more variability in mood states and affect than adults

- may abuse substances, engage in risky behaviors, or have poor school performance

women

________ have two to three times the risk of mood disorders

- women or men?

first

The _______ episode of depression often occurs in adolescence or early adulthood, with the highest frequency occurring in peoples' late 20s to early 30s and late 60s

individual risk factors

- Trauma

- Abuse/neglect

- Comorbid anxiety

- Comorbid substance use disorder

- Genetics

postpartum depression risk factors

- undesired/unplanned pregnancy

- history of depression or other mental health disorder

- hx of PPD

- recent major life changes

- infant with a disability or chronic condition

- Premature or complicated birth

- lack of family or social support

- financial stress

- marital discord

- adolescent age

- low self-esteem

- history of substance use

- homelessness

PPD reasons

- Hormone shifts

- Sleep deprivation/lack of sleep

- Poor nutrition

- Inadequate hydration

- Lack of support

- Stress

brand new job without an instruction manual

baby blues

characterized by mood swings, sadness, crying, irritability, feeling overwhelmed, anxiety that last up to 2 weeks postpartum

- usually resolve day 10-14

postpartum depression

characterized by depressed mood, severe mood swing, excessive crying, severe anxiety, difficulty bonding with baby, insomnia or sleeping too much, feelings of guilt or inadequacy, thoughts of harming self or baby

postpartum depression timeline

- symptoms can begin immediately and up to a year postpartum

- feelings become worse over time rather than improving

- symptoms do not go away on their own and may persist for a minimum of 6 months if left untreated

postpartum psychosis

characterized by depressed mood, obsessive thoughts about baby, hallucinations, delusions, sleep disturbances, paranoia, attempts to harm self or baby

- risk of suicide & infanticide

postpartum psychosis timeline

symptoms begin in the first 3 months postpartum but can occur at any point during the first year after birth

- women experiencing this should not be left alone with their infant; often results in hospitalization

PPD signs & symptoms

- anorexia or weight loss

- fatigue

- inability to concentrate

- anhedonia

- withdrawal

- excessive fear about infant's health/safety

- flat affect

- depressed almost every day for at least 2 weeks

etc.

postpartum psychosis signs

- hallucinations & delusions

- agitation

- confusion, disorientation

- sleep disturbances

- suicidal & homicidal thoughts

- loss of touch with reality

- resembles a sudden manic attack

diagnostic tests

1. Edinburgh postnatal depression scale

2. postpartum depression screening scale

3. patient health questionnaire

4. beck depression inventory II

edinburgh postnatal depression scale

this test is most used to assess for depression postpartum

- shouldn't override clinical judgement

- scores 13+ indicating depressive illness, or a high risk of developing a depressive disorder

- done postpartum appointment, 2 week, 6 week and pediatric appointment

intervention

if answers yes to "thought of harming myself has occurred" this requires ____________

- question 10 on EPDS = always look at client's response

baby blues treatment

treatment:

watch & wait; provide support

postpartum depression treatment

treatment:

combination of antidepressant meds, anxiolytic med, adequate sleep & rest, & psychotherapy

postpartum psychosis treatment

treatment:

psychotropic drugs (lithium, quetiapine), psychotherapy, & hospitalization

primary prevention

addressing inequities such as poverty, racism, violence and stress to minimize the severity of symptoms

- what kind of prevention?

independent nursing interventions

motivational interviewing, education, & screening

SSRI examples

ex: sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro)

- fluoxetine shouldn't be used in nursing mothers

SSRI side effects

SE in infant: uneasy sleep, colic (inconsolable cry), irritability, poor feeding, drowsiness

- all are detected in breastmilk

what class of meds?

SNRI

monitor for infant sedation & weight gain

ex: venlafexine, duloxetine

tricyclic antidepressant

ex: amitriptyline, nortriptyline

- limited data

Saint John's Wort

herbal supplement indicated for depression,

- this med CANNOT be used with SSRIs

Saint John's Wort side effects

SE: Monitor for drowsiness, lethargy

Poorly excreted in human milk

supplements

a. calcium

b. omega 3 fatty acids

collaborative management

- CBT, interpersonal psychotherapy

- hypnosis

- exercise

- biofeedback

- meditation, acupuncture, aromatherapy

- bright light therapy, massage

- electroconclusive therapy

key nursing interventions

- therapeutic communication

- listen

- provide support

- recognize signs/symptoms

- encourage rest

- prompt referrals

- assess safety

PPD

for ______, assess with postnatal depression scale & ask about support at home

- monitor for thoughts of harm and insomnia