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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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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
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
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
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
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
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
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
SLEEP DISORDERS
  • Alteration in sleep patterns/sleep pattern disturbance (page 291, fund. book)
  • Insomnia
  • Hypersomnia
  • Parasomnia
  • Narcolepsy
  • Sleep Apnea
  • Sleep Deprivation
managing sleep disturbance
MANAGING SLEEP DISTURBANCE
  • Communication techniques
  • Sleep environment
  • Complementary and alternative modalities
  • Dietary guidelines and dietary aids
  • Relaxation techniques and activities
drug interventions
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-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
MISC. SEDATIVE-HYPNOTIC
  • Chloral derivatives- choral hydrate (Noctec)
  • Zaleplon ( Sonata)
  • Zolpidem (Ambien)
  • Trozodone (Desyrel)
  • Non prescription sleep aids
  • Case Study
comfort and pain
COMFORT AND PAIN

AN INTRODUCTION

what is pain
WHAT IS PAIN???
  • Definition
  • Pain Myths
  • Acute vs Chronic
  • Neuropathic Pain
  • Factors affecting pain experience

age

previous experience

cultural and attitudes

pain assessment
PAIN ASSESSMENT
  • Location
  • Intensity
  • Quality
  • Associated factors
  • Alleviating factors
  • Physiological responses
  • Pain Intensity scales
  • Pain Assessment tool
pain management
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
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
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
PHARMACOLOGIC/ADJUVANTS
  • Tricyclic Antidepressants
  • Anticonvulsants
  • Corticosteroids
complementary alternative therapy
COMPLEMENTARY/ALTERNATIVE THERAPY
  • Heat/cold application
  • Acupuncture and therapeutic touch
  • Relaxation, massage, imagery
  • Herbal remedies
  • Biofeedback
  • TENS
  • Psychotherapy and hypnosis