Sleep rest and comfort
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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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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

  • Beta-blocker

  • antidepressant


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.


It is commonly believed that the average person requires

  • 6 hours sleep

  • 7 hours sleep

  • 8 hours sleep

  • More than 8 hours sleep


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


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


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


SLEEP DISORDERS

  • Alteration in sleep patterns/sleep pattern disturbance (page 291, fund. book)

  • Insomnia

  • Hypersomnia

  • Parasomnia

  • Narcolepsy

  • Sleep Apnea

  • Sleep Deprivation


MANAGING SLEEP DISTURBANCE

  • Communication techniques

  • Sleep environment

  • Complementary and alternative modalities

  • Dietary guidelines and dietary aids

  • Relaxation techniques and activities


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


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.


MISC. SEDATIVE-HYPNOTIC

  • Chloral derivatives- choral hydrate (Noctec)

  • Zaleplon ( Sonata)

  • Zolpidem (Ambien)

  • Trozodone (Desyrel)

  • Non prescription sleep aids

  • Case Study


COMFORT AND PAIN

AN INTRODUCTION


WHAT IS PAIN???

  • Definition

  • Pain Myths

  • Acute vs Chronic

  • Neuropathic Pain

  • Factors affecting pain experience

    age

    previous experience

    cultural and attitudes


PAIN ASSESSMENT

  • Location

  • Intensity

  • Quality

  • Associated factors

  • Alleviating factors

  • Physiological responses

  • Pain Intensity scales

  • Pain Assessment tool


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


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.


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


PHARMACOLOGIC/ADJUVANTS

  • Tricyclic Antidepressants

  • Anticonvulsants

  • Corticosteroids


COMPLEMENTARY/ALTERNATIVE THERAPY

  • Heat/cold application

  • Acupuncture and therapeutic touch

  • Relaxation, massage, imagery

  • Herbal remedies

  • Biofeedback

  • TENS

  • Psychotherapy and hypnosis


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