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SLEEP, REST AND COMFORT

SLEEP, REST AND COMFORT. Bedtime fears, wakefulness during the night, and nightmares are associated with which of the following age groups. Infants Toddlers Preschoolers school-age children. Which of the following medications may create sleep disturbance?. Antihistamine Narcotic

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SLEEP, REST AND COMFORT

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  1. SLEEP, REST AND COMFORT

  2. Bedtime fears, wakefulness during the night, and nightmares are associated with which of the following age groups • Infants • Toddlers • Preschoolers • school-age children

  3. Which of the following medications may create sleep disturbance? • Antihistamine • Narcotic • Beta-blocker • antidepressant

  4. The client, while sitting up at 3:00AM, tells you she cannot sleep. What should the nurse do first? • Assist the client back to bed • Obtain an order for a hypnotic • Provide a glass of warm milk and back rub • Ask about activities that have helped the client in the pastto sleep.

  5. It is commonly believed that the average person requires • 6 hours sleep • 7 hours sleep • 8 hours sleep • More than 8 hours sleep

  6. PHYSIOLOGY OF SLEEP • State of altered consciousness • Slowing of the body’s physiological processes. • Stages of sleep/ 2 categories • NREM-non-rapid eye movement/90 min. • REM- rapid eye movement-80% dreams • Sleep cycle- 70-90 minutes

  7. SLEEP REGULATION • Biological clock/Circadian rhythms • Reticular Activating System • Stimuli: visual, auditory, pain, tactile • Emotions and Thoughts • Norepinephrine and Serotonin • Diet, drugs, and other substances • Life Span considerations

  8. SLEEP ASSESSMENT • Nature, quality, routines , environment • Associated factors and own opinion • Alleviating factors/ WHAT WORKS! • Effect of problem on Client • Disturbed Sleep Pattern (NANDA) • Cultural considerations

  9. SLEEP DISORDERS • Alteration in sleep patterns/sleep pattern disturbance (page 291, fund. book) • Insomnia • Hypersomnia • Parasomnia • Narcolepsy • Sleep Apnea • Sleep Deprivation

  10. MANAGING SLEEP DISTURBANCE • Communication techniques • Sleep environment • Complementary and alternative modalities • Dietary guidelines and dietary aids • Relaxation techniques and activities

  11. DRUG INTERVENTIONS • Tricyclic Antidepressants- amitriptyline (Elavil) and doxepin (Sinequan) • Antihistamines- hydroxyzine (Vistaril, Atarax), and diphenhydramine (Benadryl) • Herbal and Vitamin preparations Melatonin, Chamomile, Passion flower, Kava kava

  12. SEDATIVE-HYPNOTIC MEDS • Sedative agent-relaxes patient for rest • Hypnotic agent- produces sleep • Age considerations • Benzodiazepines : diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan) • Barbituates: secobarbital (Seconal) short acting, amobarbital (Amytal) intermediate phenobarbital (Luminal) long acting.

  13. MISC. SEDATIVE-HYPNOTIC • Chloral derivatives- choral hydrate (Noctec) • Zaleplon ( Sonata) • Zolpidem (Ambien) • Trozodone (Desyrel) • Non prescription sleep aids • Case Study

  14. COMFORT AND PAIN AN INTRODUCTION

  15. WHAT IS PAIN??? • Definition • Pain Myths • Acute vs Chronic • Neuropathic Pain • Factors affecting pain experience age previous experience cultural and attitudes

  16. PAIN ASSESSMENT • Location • Intensity • Quality • Associated factors • Alleviating factors • Physiological responses • Pain Intensity scales • Pain Assessment tool

  17. PAIN MANAGEMENT • Alleviation of Pain or reduction to acceptable level of comfort • Views on Mgmt: HPNA and NIC • Client education is Crucial • Nurse-Client Relationship • Pharmacologic vs Nonpharmacologic

  18. PHARMACOLOGIC/OPIOIDS • Pure Opioid Agonists: produce maximal response from cells when they bind to the cells’ opioid receptor sites. Morphine, fentanyl, methadone, hydromorphine (Dilaudid), codeine, meperidine (Demerol), oxycodone • Mixed Agonists-antagonists: ceiling effect for pain relief. Activate one opioid receptor while blocking another.

  19. PHARMOCOLOGIC/NSAIDS • Prevents production of Prostaglandin • COX-1 normally present in GI tract • Classified by chemical structure propionic: Ibuprofen (Advil), naproxen (Aleve) acetic: indomethacin (Indocin) salicylate: aspirin, sodium salicylate cox-2 inhibitors: celecoxib (Celebrex), rofecoxib

  20. PHARMACOLOGIC/ADJUVANTS • Tricyclic Antidepressants • Anticonvulsants • Corticosteroids

  21. COMPLEMENTARY/ALTERNATIVE THERAPY • Heat/cold application • Acupuncture and therapeutic touch • Relaxation, massage, imagery • Herbal remedies • Biofeedback • TENS • Psychotherapy and hypnosis

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