Nursing/ Sleep, caring, patient teaching, therapeutic communication – Flashcards

Is a cyclical physiological process that alternates with longer period of wakefulness. The sleep wake cycle influences and regulates physiological function and behavioral responses.

Neonates-16 hours/day infants- 14-15 hours Toddlers- 12 hours Children- 11-12 hours Adolescents- 7-8 hours a day- need more, but usually get less Adults- about 7-8 hours/day

*CNS maintains *Changes in nervous, endocrine, cardiovascular, respiratory & muscular systems. *Brain activity patterns- multi-stages *Hypothalamus-prostaglandins, I-tryptophans & growth factors *Children grow *Pons & medulla- serotonin

~Stage 1- we experience a light transitional sleep. This is where drowsiness and sleep begin ~Stage 2- more stable sleep occurs. Chemicals produced in the brain block the senses making it difficult to be woken. ~Stage 3- is deep sleep. Growth hormone is released during this stage. Most stage 3 sleep occurs inn the first third of the night. ~REM- is sleep that revitalizes the memory. In this stage brian activity is very high and intense dreaming is likely to occur.

Nonrapid eye movement NREM sleep and rapid eye movement REM sleep. During NREM a sleeper progresses through four stages during a typical 90 minute sleep cycle. Light sleep is stage 1 and 2. Stages 3 and 4 involve a deep, sleep, called slow wave sleep. REM sleep is the phase at th end of each sleep cycle. REM is with rapid eye movement, dreaming and processing our day. Our brain is very active in REM.

#1 Insomnia, abnormal movements or sensation- RLS Excessive daytime sleepiness- hyersomnolence

Linked to motor vehicle crashes, industrial disasters, and medical and occupational errors. Result in chronic diseases: hypertension, diabetes, depression, and obesity, as well as from cancer, increased mortality, and reduced quality of life and productivity. Cortisol is released thus the body produces more sugar to store for fight or flight.

*Drugs/substances *Lifestyle *change in usual sleep patterns *Emotional stress *Pain *Environment *Exercise and fatigue *Food and calorie intake.

~3 types- obstructive, central, & mixed ~Obstructive sleep apnea: Most common ~Most commor in middle-aged obese men, but occurs at any age or sex ~Muscles or structure of oral cavity or throat relax during sleep causing partially or completely blocked airway ~Lack of airflow through nose & mouth from 10-30 seconds or longer during sleep causing loud snoring ~Oxygen levels drop ~Person awakens or moves into Stage 2 ~In severe cases hundreds of apnea episodes occur every hour causing severe interference with deep sleep.

It contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration, biological functions slow and restores. During NREM stage 4 body releases human growth hormone for the repair and renewal of epithelieal and specialized cells such as brain cells. Protein synthesis and cell division for renewal of tissues such as the skin, bone marrow, gastric mucosa, or brain occur during rest and sleep.

feelings of confusion and suspicion. Various body functions (mood, motor performance, memory, and equilibrium) are altered when prolonged sleep loss occurs. Changes in the natural and cellular immune function occur.

~Sleep apnea should be treated *Complications include: *Polycythemia *Hypertension *Right-sided heart failure *Pulmonary hypertension *Glaucoma *Hypersomnoience *Diabetes *Increased risk of stroke, angina, MI or cardiac dysrhythmia.

*Quit smoking *Nasal decongestant *CPAP

*Do a sleep assessment on your patient *Ask about how their sleep is normally? *How many hours usually? *Is it easy to fall asleep *If they're elderly, ask how many times to they get up at night? Why?

~Sleep pattern disturbance (difficulty falling asleep ~Sleep pattern disturbance (frequent awakening) related to.... ~Ineffective breathing pattern related to tracheobronchial obstruction (sleep apnea)

Promote good sleep hygiene ~Environment- ssssh! ~Provide safety- Ouch! ~Provide comfort- Shiver! ~Establish periods of rest and sleep- zzzz! ~Pharmacological interventions

*Foods- Turkey, warm milk *OTC-drugs w/ antihistamines *Herbs- Valerian, chamomile *Supplements- melatonin (serotonin)

*Classification: Sedatives/hypnotics *Used to manage sleep disorders, seizures, muscles spasm, alcohol withdrawal *Action: CNS depression *Precautions: with other CNS depressants- opiates, alcohol, antipsychotics, antidepressants. Caution in elderly *Side effects: Drowsiness, dizziness, Steven-Johnson syndrome, dependency *For short term treatment of insomnia ONLY

*Uses: Insomnia *Action: CNS Depressant *ONSET rapid PEAK 30 min-2hr *Duration 6-8 hr *ROUTE AND DOSAGE- FYI *PO (Adults): Tablets- 10mg at bedtime; Extended release tablets- 12.5 mg at bedtime *PO (Geriatric Patients, Debilitated patients,or patient with Hepatic impairment: Tablets- 5 mg at bedtime initially, may be increased to 10 mg; extended- release tablets- 6.25 mg at bedtime.

*Which are most significant? *CNS: amnesia, daytime drowsiness, dizziness, "drugged" feeling *GI: diarrhea, nausea, vomiting *MISC: hypersensitivity reactions, physical dependence, psychological dependence, tolerance.

*Drug-Drug: *Increase CNS depression may with other sedative/hypnotics, alcohol, tricyclic depressants, opioid analgesics, or antihistamines *Drug-Natural: *Concomitnant use of kava, valerian or chamomile can Increase CNS depression *Drug-Food: *Food decrease and delays absorption

~Assess mental status, sleep patterns, and potential for abuse prior to administration. ~Prolonged use of >7-10 days may lead to physical and psychological dependence. Limit amount of drug available to the patient. ~Assess patient for pain. Medicate as needed. Untreated pain decreases sedative effects ~Before administering, reduce external stimuli and provide comfort measures to increase effectiveness of medication. ~Protect patient from injury. Raise bed side rails. Assist with ambulatins take patient's cigarettes ~Tablets should be swallowed whole with full glass of water. For faster onset of sleep, do not administer with or immediately after a meal. ~Swallow extended-release tablets whole: do not crush, break or chew.

*Instruct patient to take Zolpidem (Ambien) as directed. Do not take more than the amoun t prescribed because of the habit-forming potential. Not recommended for use longer than 7-10 days. *If used for 2 wk or longer, abrupt withdrawal may result in fatigue, nausea, flushing, light-headedness, uncontrolled crying, vomiting, GI upset, panic attack, or nervousness. *Because of rapid onset, advise patient to go to bed immediately after taking zoipidem *May cause daytime drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to this medicationis known. *Caution patient to avoidconcurrent use of alcohol or other CNS depressants.

*doxepin (dox-e-pin) Sinequan, Triadapin, Zonalon *CLASSIFICATIONS: *Therapeutic: Antianxiety agents, antidepressants antihistamines (topical) *Pharmacologic: Tricyclic antidepressants *INDICATIONS - PO *Management of endogenous depression *Treatment of anxiety *Unlabelled uses: Management of chronic pain, pruritus *Topical: Short-term control of pruritus

*Action: Prevents the reuptake of norepinephrine and serotonin by presynaptic neurons; resultant accumulation of neurotransmitters potentiates their activity *Also possesses significant anticholinergic properties *Topical: Antipruritic action due to antihistanminic properties *Therapeutic Effects: *PO: Relief of depresson ~Decreased anxiety *Topical: Decreased pruritus

Absorption: Well absorbed from the GI Tract, although much is metabolized on first pass through the liver. Some systemic absorption follows topical application Distribution: Widely distributed. Enters breast milk; probably crosses the placenta (Pregnancy category C) Metabolism and Excretion: Metabolized by the liver. Some conversion to active antidepressant compound. May re-enter gastric juice via secretion from enterohepatic circulation, where more absorption may occur Half-life: 8-25 hr Onset: 2-3 weeks Peak: Up to 6 weeks Duration: Days- weeks

Contraindicated in ~Hypersensitivity ~Some products contain bisuiifites and should be avoided in patients with known intolerance ~Untreated narrow-angle glaucoma ~Period immediately after myocardial infarction *Use Cautiously in: *Geri: Associated with increased fall risk secondary to anticholinergic and sedative effects. Geriatric patients should have initial dosage reduction *Pre-existing cardiovascular disease (increased risk of adverse reactions) *Prostatic enlargement (more susceptible to urinary retention) *Seizures *OB: Use during pregnancy only if potential material benefit outweighs risks to fetus: use during lactation may result in neonatal sedation *Pedi: May increase risk of suicide attempt/ideationn especially during dose early treatment or dose adjustment risk may be grater in children or adolescents *Pedi: Children <12 yrs (safety not established)

CNS: fatigue,sedation, agitation, confusion, hallucinations EENT: Blurred vision, increased intraocular pressure CV: hypotension, arrhythmias, ECG, abnormalities GI: Constipation, dry mouth, paralytic ileus GU: Urinary retention Derm: Photosensitivity, rashes Misc: hypersensitivity reactions

*Drug-Drug: *Doxepin metabolized by the cytochrome p. 450 2D6 enzyme; other drugs compete fro metabolism by this enzyme including other antidepressants, phenothiazines, carbamazephine, class 1C antiarrhythmics (propafenone flecainide); When used concurrently, dosage decrease of one or the other or both may be necessary. *Concurrent use of other drugs that inhibit the activity of the enzyme, including cimetidine, quinidine, amiodarone, and ritonavir, may result in increasing effects of doxepin. *May cause hypotension, tachycardia, and potentially fatal reactions when used with MAO inhibitors (avoid concurrent use - discontinue 2 wk prior to doxepin) *Concurrent use with SSRI antidepressants may result in increase toxicity and should be avoided (fluoxetine should be stopped 5 wk before) *Concurrent use with clonidine my result in hypertensive crisis and should be avoided.

*Drug-drug: *concurrent use with levodopa may result in delayed/ decreased absorption of levodopa or hypertension. Blood levels and effects may be decrease by rifamycins *Increase CNS depression with other CNS depressants including alcohol, antihistamines, clonidine *Opioid analgesics, and sedative/hypnotics *Barbiturates may alter blood levels and effects *Adrenergic and anticholinergic side effects may be increase with other agents having these properties *Phenothiazines or hormonal contraceptives increase levels and may cause toxicity *Smoking may increase metablolisme and alter effects *Drug-natural: *Concmitant use of kava, valerian, or chamomile can increase CNS depression *increased anticholinergic effects with jimson weed and scopolia.

Caring and nursing- synonymous terms. We are nurses because- We Care.

Transpersonal Caring Relationship: Transpersonal caring relationshipe are the foundation of the work;transpersonal conveys a concern for the inner life world and subjective meaning of another who is fully embodied but transpersonal also goes beyond the ego self and beyond the given moment reaching to the deeper connections to spirit and with the broader universe. Thus transpersonal caring relationship moves beyond ego-self and radiates to spiritual, even cosmic concerns and connections that tap into healing possibilities and potentials. Transpersonal caring seeks to connect with and embrace the spirit or soul of the other through the processes of caring and healing and being in authenitc relation in the moment. A caring moment........

*Provide basic human needs *Facilitate healing enviornment *Human respect *Enouraging manner *Touch *Listening *Provide presence *Mutual problem solving *Attentive reassurance *Interrelated

*It is through critical thinking- the nursing process *Assess: Verbal, visual, non-verbal *Diagnose: health care needs, preceptions *Plan: Teaching, written sheets, referrals *Implement: activites, document *Evaluate: modify & update

Don't worry you'll feel better soon.

*Knowledge: you impart new learning subject *Comprehension: patient needs to understand *Applicatation: using the new information in a concrete situation *Analysis: breaking down the new facts/information into organized parts *Synthesis: applying knowledge & skill to a new situation *Evaluation: Judgement of worth of information. "What did I learn? Is it useful? Will I use it again?"

Message -> Encode -> Send ->Decode -> Interpret ->Feedback -> and then the process loops back around

*Assess *Culture (zones) *Launguage (use interpreter) *Age (different needs) *Disabilities (hearing) *Educational background (your words) *Pain (medicate) *Congnitive function ( include family) *Current illness (are they ready:)

10 Strategies for effective cross- cultural communication *Ask quetions *Distinguish perspective *Build self awareness *Recognize the complexity *Avoid stereotyping *Respect differences *Listen actively *Be honest *Be flexible *Think twice

Visual (reading) Auditory (hearing) Kinesthetic (doing) Multimodal (combination) Your vark results show?

Use appropriate teaching methods Cognitive- understanding Affective -attitudes, expression, feeling Psychomotor-psychomotor skills

*Motivation to learn *Is the client able to focus on learing? *What is the benefit of learning? *Self-efficacy- if a person believes they can master a task they are more likely to do it *Readiness to learn *Must accept illness before they can learn about it *Grieving stages.

*Facilitate communication of distressing feelings *Assist patients with problem-solving to facilitate activities of daily living *Help patients examine self-defeating behaviors and test alternatives *Promote self-care and independence.

Communication skills ~Oral: Presentation, audience awareness, critical thinking, body lanuage ~Written: Academic writing, revitation and editing, critical reading, presentation of data ~Non-verbal: Audience awareness, personal presentaiton, body launguage

1. Caring attitude 2. Openness 3. Respect