Sleep & Rest and Loss, Grief, & Spirituality

Fundamentals Final Review

true or false
research shows that sleep is essential for physical, mental, and spiritual well being.
- conserves energy and restores the tissues, which speeds recovery from illness
- helps in regulation of emotions; it helps maintain memory and learning

true

w/ out proper amt of sleep, our ability to concentrate, make judgements, and participate in daily activity INCREASE OR DECREASE

decrease

______ _______ represent one of the most sleep-deprived segments of our population

college students

during________ insignificant things are kinda erased from the brain (ex:cram for test doesn't lead to long term memory)

REM

this is needed for the consolidation of implicit memories. these are long term memories such as task that we can do without consciously thinking about it

REM

this kind of sleep is needed for consolidation of explicit memories. these memories require conscious thought such as recalling who came to dinner last night of info from this lecture

NREM

QUANTITY OR QUALITY of sleep is related to good academic performance

quantity

getting enough of this at the right times is essential to survival as food and water

quality sleep

affected by light, temp, social activities and work routines

24 hr individualized biological clock helps coordinate mental and physical health

circadian rhythms

true or false

when the sleep wake cycle becomes disrupted, anxiety, restlessness, irritability, and impaired judgement are common symptoms

true

one of the most clear critical examples of circadian rhythms
- day: exposed to light and master clock sends signals to brain--> alertness and helps keep you awake

- night: dark--> body produces melatonin

sleep wake cycle

functions of what?

- conservation of energy

- restoration of tissues and growth

- thermoregulation

- regulation of emotions

- neural maturation

- memory and learning

- 10 hr/night is ideal for best performance

sleep

sleep is a window to that early ________ development
- memories stored
- synapses are being formed
- brain tissue developing
- connections being established
- babies grow and learn
- this is why babies sleep so much

neural

true or false
lack of sleep has serious effects on our brain's ability to function. after one night w/ out sleep, concentration becomes more difficult and attention span shortens a great deal

true

______ hours w/ out sleep leads to a decrease in performance that is equivalent to a blood alcohol level of 2 glasses of wine

17

does lack of sleep make you lose brain tissues?

yes

stroke risk _______ when you don't sleep

quadruples

a normal adult has how many cycles each night

4-6 (cycles)

each cycle is how many minutes

90-110 (minutes)

each cycle is split into what 2 categories

NREM
REM

stage 1-2 OR stage 3-4

light sleep: person is easy to wake up

stage 1-2

stage 1-2 OR stage 3-4

progressively deeper, decrease w/ age

stage 3-4

in this stage the person is in a transitional stage

- decreased physical activity begins w/ gradual fall in vital signs and metabolism

- person is in a relaxed state

- involuntary muscle jerking

- stage lasts usually 10-30 min

- sensory stimuli such as noise easily arouse person

- when awakened, person feel as though daydreaming has occurred

NREM stage 1

Stage __ NREM: Sleep usually lasts ______ minutes and is easy to wake up from. It can be hard to tell if someone is asleep or just _____ or even distracted.

During this stage, if you are engaged in a simple activity, you may keep going through the motions as you drift ___ ___ ___ of sleep.

This explains why driving can be so dangerous while you are tried. If you drift through stage 1 and into stage 2 the driving stops but the car does not!

1
5-10 minutes
relaxed
in and out

sleep walking and enuresis (bed wetting) sometimes occur in what stage

NREM Stage 4

this stage usually begins about 90 minutes after sleep has begun
- duration increases w/ each cycle and averages 20 minutes
- vivid full color dreaming occurs; less vivid dreaming occurs in other stages

- eyes ___ back and forth quickly
- small muscle ______ such as on the face
- large muscle immobility, resembling paralysis
- respirations _____; sometimes interspersed w/ apnea
- rapid or irregular pulse
- BP increases or fluctuates
- increase in gastric secretions
- metabolism increases; body temp increases

REM
dart
twitching
irregular

true or false

brain decreases activity in sleep

false

(brain is as active when you're sleep as you are when you're awake)

• All sleep is important but REM and stage ___ deep sleep are critical for learning and memory!

4

involves the inability to fall asleep or stay asleep

insomnia

sleep disorders that involve difficulty breathing during sleep are classified as…

sleep related breathing disorders/apnea

a group of sleep disorders that causes a person to be excessively sleepy or hav prolonged nighttime sleep. condition may not be r/t underlying disease process

hypersomnias

conditions in which the sleep times are out of alignment. a patient w/ one of these disorders does not follow the normal sleep times at night

circadian rhythm sleep wake disorders

a group of sleep disorders that involve unwanted events or experiences that occur while you are falling asleep, sleeping or waking up

parasomnias

most common sleep related disorder
- trouble falling asleep or staying asleep through the night that lasts for at least one month
- more common in older adults w/ stress, w/ some medical or mental health problems
- leads to fatigue: problems w/ attention, concentration or memory (cognitive impairment); poor performance; moodiness or irritability; daytime sleepiness; impulsiveness or aggression; errors or accidents

needs to occur for at least one month to be considered a disorder

Causes: adjustment sleep disorder (acute insomnia); inadequate sleep hygiene; or medical condition

insomnia

to treat insomnia, you need to treat the _________

underlying cause (and improve sleep hygiene measures)

a person experiences the absence of breathing or diminished breathing during sleep b/w snoring intervals

- most common type is obstructive ______ _____ (OSA)

- characterized by the lack of airflow through the mouth and nose for at least 10 seconds, and up to 2 minutes during sleep

sleep apnea

Excessive loud snoring and snorting sounds. Excessive daytime sleepiness. Patients with this often wake with a headache

One of the most common ways to evaluate the risk for or improvement of a patients ______ is to ask their spouse about their snoring. At greater risk for hypertension, Heart disease, and heart failure

obstructive (sleep apnea)

sudden and irresistible onset of sleep during waking hours

- characterized by recurrent "sleep attacks" that the patient can't fight

- person goes directly to REM SLEEP

- sleep attacks are about ______ min long

- patient feels refreshed by the sleep, but typically feels sleepy again several hrs later.

- about 40% of patients w/ this have had another mental disorder

-men and women equally affected

narcolepsy (hypersomnia)

(autoimmune neuro disorder characterized by brains ability or inability to control sleep wake cycles)

10-20

true or false

1/4 symptoms of narcolepsy is excessive daytime sleepiness (EDS)

true

a circadian rhythm sleep disorder

not a regular day shift
- imbalanced circadian rhythm
- after several weeks, the biological clock usually does adjuts

shift work

if you do have shift work obtain a minimum of _____ hrs of sleep

6

to help your bio clock adjust when doing shift work, include a 4 hour _______ sleep time during which sleep is scheduled whether on or off work

anchor

to help the bio clock adjust when doing shift work,

before the 1st night shift, power nap ____ to ____ min before leaving for work

30-90 (min)

result of decrease in amt, quality, and consistency of sleep

S/S:
- daytime drowsiness, impaired congitive function, restlessness, perceptual disorders, slowed reaction time, irritability, somatic (body) complaints (such as hand tremors) and a general feeling of malaise
- if it is severe and prolonged....delusion, paranoia and other psychotic behavior may occur

- illnesses and hospital are common causes of this

sleep deprivation

which is worse?

sleep deprivation or intoxication

sleep deprivation (work and auto accidents, poor work and school performance)

this can lead to
- chronic tiredness
- mood changes
- frustration
- difficulty controlling emotions
- inability to think abstractly
- absenteeism

sleep deprivation

infants should sleep on their _____ to reduce SIDS (the second most common cause of death among infants 1 to 12 months old)

back

(also don't put pillow, stuffed toys or loose fitting blankets bc they can suffocate)

In a sleep assessment, what is the first question you ask?

What is your usual sleep pattern? (can ask spouse too)

this is who's responsibility?

- knowing that cure isn't always possible
- help patient achieve peaceful and comfortable death (palliative care)
- be honest with patients when they ask "am i dying"

nurse

true or false

when a patient asks if they are dying you should give them false hope or lie

false (be honest, they will be more at peace)

what type of loss?

loss of a loved one

necessary (loss)

what type of loss?

- kids leave home
- parent's feelings on 1st day of kindergarten
- menopause

maturational (loss)

what type of loss?

- accidents
- injuries

situational (loss)

actual or perceived loss?

- no longer see, feel hear or know
- ex: amputation, mastectomy

actual (loss)

actual or perceived loss?
- less obvious, more emotional
- ex: loss of friend

perceived (loss)

emotional response to loss or to a poor prognosis
- INWARD feelings
- based on personal experiences, cultural expectations, and spiritual beliefs

grieving

OUTWARD expression
- behaviors associated w/ loss such as crying

mourning

- combination of grief and mourning; emotional responses and outward behaviors

bereavement

when someone passes away after a drawn out suffering period it's normal for people to think I'm so glad they don't have to suffer anymore

this is a normal (uncomplicated) feeling of grief known as

relief

this kind of grief is "letting go"
- few days before someone passes to say goodbye
- preparing for the inevitable

- recommended resources for adjustment (ex: counseling, support groups)

anticipatory (grief)

this kind of grief is marginal or unsupported grief
- not socially acceptable to share the grief

disenfranchised (grief)

this kind of grief is prolonged or significantly difficult time moving forward after a loss
- ex: more common w/ homicide, suicide, sudden accidents or death of a child

- could be exaggerated w/ self destructive behavior or obsessions
- could be delayed (too overwhelming)
- could be masked (physical, usual or disruptive behavior)

complicated grief

this is one of 5 stages of dying from Dr. Kubler Ross

people can't accept it. can't cope so they just deny it

denial (and isolation)

this is one of 5 stages of dying from Dr. Kubler Ross

usually people are angry w/ the people they love the most (ex: spouse or God) and may lash out

anger (rage, envy, and resentment)

this is one of the 5 stages of dying from Dr. Kubler Ross

when people say "if you'll allow this to happen I'll do this"

bargaining

this is one of the 5 stages of dying from Dr. Kubler Ross

losing sense of hope and staying there for weeks feeling very low like a pit you can't crawl out of

depression

this is one of the 5 stages of dying from Dr. Kubler Ross

"I don't like it but i have accepted and come to my own terms"

acceptance

this is a multidimenional concept
- it energizes and provides comfort for those w/ challenges
- goes from feeling vulnerable to living life as fully as possible
- depends on strong relationships and emotional connectedness w/ others

hope

this arises from inability to feel hopeful; impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself

spiritual distress

what are these rights?

Right to
- be treated as a living human until I die
- maintain a sense of hopefullness
- to be cared for by those who maintain sense of hopefullness
- express feelings and emotions about death my own way
- participate in decisions of my care
- right to expect continuing mediacl nd nursing attention even tho cure goals may change to comfort goals
- to not die alone
- to be free of pain
- to have my questions answered honestly
- to remain individuality and not be judged for my decisions that may be contrary to beliefs of others
- to expect sanctity of human body will be respected after death
- to be cared for by caring and knowledgeable people

dying person's bill of rights

true or false

sometimes just being present can be enough. this is very important

true

this place is available 24 hours a day

focuses on COMFORT MEASURES AND PAIN MANAGEMENT

involves
- physicians
- nurse
- social workers
- psychiatrists
- clergy
- volunteers
- family
- patient

hospice

signs of approaching what?

- coolness of hands and feet
- mottling of hands and feet
- sleeping a lot
- confusion of mind (disorientation)
- incontinence
- congestion in lungs or throat---> death rattle
- restlessness
- fluid and food decrease
- urine decrease
- slow pulse rate, resp rate, and BP
- breath pattern change

death

breath pattern common before death

- breathing heavily followed by periods of apnea

cheyne stokes

are these NORMAL OR ABNORMAL emotional, spiritual and mental signs of approaching death

- withdrawal
- vision like experiences
- decreased socialization
- unusual communication
- giving permission
- saying goodbye (hearing is last sense to go)

normal

what is the last sense to go

hearing

this is a nursing intervention for a patient who is dying

frequent ___________. for comfort measures and also because aspiration is likely. use yankauer for suction of mouth when coughing/choking occrs

oral hygiene

this is a nursing intervention for a patient who is dying

allow family members to _______ w/ care such as bathing or suctioning the oral mucosa if they wish to help

assist

this is a nursing intervention for a patient who is dying

if a patient and family or clergy are ________, nurse should join them in prayer or stand quietly in room until prayer is over. be respectful

praying

this is a nursing intervention for a patient who is dying

encourage family members to do a ___________ (reminiscing about the past)

life review

this is a nursing intervention for a patient who is dying

when explaining death to a _______ be direct and simple "grandma died and we all feel very sad" using words like "loss" confuses them

child

a physiological change after death

stiffening of body developing 2-4 hrs after death

normal anatomical position, close eyelids and mouth, insert dentures if necessary

rigor mortis

a physiological change after death

reduction in body temp w/ loss of skin elasticity

- gently remove all tape and dressings to prevent tissue damage

algor mortis

a physiological change after death

purplish discoloration of the skin in dependent areas

- elevate head of bed

livor mortis

who becomes the nurse's secondary patient after the death of his/her primary patient

family

true or false

these are normal symptoms of those who suffer loss of a loved one
- tightness in throat/heaviness in chest
- empty feeling in stomach/ loss of appetite
- feeling guilty and or angry
- forgetfulness/wandering aimlessly
- preoccupied w/ life of deceased
- difficulty sleeping/dream of loved one
- crying at unexpected times/irritable

true

the purpose of this is to prepare the patient for viewing by family
- ensuring proper identification of patient prior to transportation to the morgue or funeral home
- securing patient's belongings
- maintaining vital organs if donation is planned

post mortem care

when you are providing post mortem care you should cover the patient w/ a clean sheet up to the _______ w/ arms on outside of sheet

chin

true or false

after your patient dies you should give family support. offer viewing of body, encourage touching and saying goodbye

true

how many ID tags are there

3 (person's name, room and bed number; date and time of death; physician name)

1st, 2nd or 3rd tag

tied to big toe, hand or foot

1st

1st, 2nd or 3rd tag

attached to the shrouded body

2nd

1st, 2nd or 3rd tag

attached to the personal belongings

3rd

true or false

the nurse must ensure that patient's identification bracelet is not removed

true

broad term including living wills, health care proxies, and durable powers of attorney for health care. based on values of informed consent, patient autonomy over end of life decisions, truth telling, and control over dying process

decision of patient. must respect their decisions

advance directive

written doct that directs treatment in accordance w/ a patient's wishes in event of a terminal illness or condition

living will

legal doc that designates a person or persons of one's choosing to make healthcare decisions on his or her behalf

healthcare proxy (or durable power of attorney for health care)

do not resuscitate. no code. documentation is required to be on patient chart. if heart stops beating, patient stops breathing, no measures are taken to restart heart or breathing like cpr

DNR

what is it called when a patient's heart stops and they're not breathing, cpr w/ defibrillation is initiated

full code

surgical dissection of boy after death to determine exact cause and circumstances of death or discover pathway of disease. law requires autopsy when death is result of foul play, homicide, suicide or accidental causes

autopsy