Fundamental Nursing Skills and Concepts

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Fundamental Nursing Skills and Concepts

• Chapter 17
• Page 336

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COMFORT, REST, AND SLEEP

• COMFORT A STATE OF RELIEF FROM DISTRESS
• REST WAKING STATE CHARACTERIZED BY REDUCED
  ACTIVITY AND MENTAL STIMULATION
• SLEEP STATE OF AROUSABLE UNCONSCIOUSNESS
• A safe, clean, attractive environment, aids in
  reducing stress and increases comfort.

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MODIFYING THE ENVIROMENT TO PROMOTE COMFORT,
REST, AND SLEEP

• Relaxing colors (light green or blue) and mauves
  pg. 337, promotes relaxation.
• Pictures of peaceful scenes, carpeted hallways,
  adequate sunlight and artificial light, night
  lights for safety, comfortable room temperature
  and humidity, all promote a restful atmosphere.
  Temperature- optimally for pts. room 68-74, and
  humidity 30-60 .
• Ventilation which removes odors but doesnt
  spread infection. Poor ventilation harbors odors,
  so remove the source as soon as possible. Air
  fresheners and deodorizers help but may be
  offensive to patients.

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MODIFYING THE ENVIROMENT TO PROMOTE COMFORT,
REST, AND SLEEP

• REMEMBER Ill clients may need cooler or warmer
  room temperatures for comfort and may not
  tolerate odors. Nurses must use good hygiene
  practices and not use too much perfume or after
  shave or smell of smoke, onions or garlic when
  giving care. May make patient nauseated.
• REMEMBER gum chewing spreads microorganisms.

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ROOM FURNISHINGS

• BED (ADJUSTABLE HEIGHT AND POSITION OF HEAD AND
  FOOT, SIDERAILS, REMOVABLE HEADBOARD FOR QUICK
  ACCESS, WATERPROOF MATTRESS FOR EASY CLEANING,
  MATTRESS OVERLAYS FOR COMFORT AND INTACT SKIN).
  Bed rails can be considered a form of restraint
  so be familiar with what your institution
  observes.
• PILLOWS AND BED LINEN. Pillows are used to
  support, position elevate and supply comfort. Bed
  linen may or may not be changed daily, depending
  on your institution. Generally linen includes
  mattress pad, bottom sheet, draw sheet (lifter),
  top sheet, spread, pillow case, blanket, may be
  used.

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ROOM FURNISHINGS

• PRIVACY CURTAIN- used out of respect for clients
  privacy and modesty. Remember that you can still
  hear what goes on, so keep in mind
  confidentiality.
• OVERBED TABLE- used for holding, serving tray,
  and other equipment. Adjustable in height. Hidden
  compartments hold personal items. Mirror is
  usually included within the lid of the
  compartment.

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ROOM FURNISHINGS

• BEDSIDE STAND, has drawer for personal items and
  a place to store basin for bath and hygiene
  supplies. Water pitcher and glass is usually
  found on top.
• CHAIRS, usually at least one chair is found in
  the patients room. Maybe straight hard back chair
  or a lounge type that makes into a bed. Hopefully
  they recline for the comfort of those that stay
  with their loved ones.

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FUNCTIONS OF SLEEP

• Promotes emotional well being, enhances various
  physiologic processes.

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FUNCTIONS OF SLEEP cont.

• REDUCING FATIGUE.
• STABILIZING MOOD.
• IMPROVING BLOOD FLOW TO THE BRAIN.
• INCREASING PROTEIN SYNTHESIS.
• MAINTAINING THE IMMUNE SYSTEM.
• PROMOTING CELLULAR GROWTH AND REPAIR.
• IMPROVING LEARNING AND MEMORY STORAGE.

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THE TWO PHASES OF SLEEP

• 1 NONRAPID EYE MOVEMENT SLEEP (NREM SLEEP),
  where eye movement is subdued. quiet sleep
• Progresses through four stages
• Slow waves on an EEG (slow wave or quiet
  sleep)

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THE TWO PHASES OF SLEEP

• 2 RAPID EYE MOVEMENT SLEEP (REM SLEEP) active
  sleep. Where eye movement is similar to awake
  state. Very energetic deepest stage of sleep.
  The deepest stage of sleep.
• EEG waves similar to wakefulness (paradoxical or
  active sleep).
• Sleep cycles- normally pass back and forth
  through four distinct phases of NREM REM, 4-6
  times during the night. Top pg. 341, see the
  length of time involved and the features of each
  cycle.

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SLEEP REQUIREMENTS

• Need for sleep decreases from birth to adulthood.
• With age, less NREM sleep and more REM sleep.
• Younger adults sleep more on weekends while older
  adults sleep more on weeknights.
• Older adults take more naps during the day,
  nights maybe shorter due to hours slept during
  the day. They may be awake and alert at 4 a.m.
• Urination is a problem that awakens the elderly
  at night disturbing their rest.
• Sleep requirements vary.

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FACTORS AFFECTING SLEEP

• CIRCADIAN RHYTHM OF DAYLIGHT AND NIGHT. Daylight
  and darkness influence the sleep wake cycle.
• MELATONIN SECRETION INDUCES SLEEP LIGHT
  SUPPRESSES MELATONIN SECRETION. In the absence of
  bright light, the pineal gland secrets
  melatonin, (hormone that induces drowsiness and
  sleep). Light triggers the suppression of
  melatonin secretion.
• EXERCISE PROMOTES SLEEP, increases fatigue and
  the need for sleep, but be careful, too close to
  bedtime exercise may stimulate and not allow for
  rest.

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FACTORS AFFECTING SLEEP

• PEOPLE SLEEP BEST IN A FAMILIAR ENVIRONMENT, same
  noises, same habits. Usual environment induce
  sleep. Traffic noise or household noises in a new
  place may disturb rest.
• SLEEP RITUALS HELP INDUCE SLEEP.
• Motivation- the desire to stay awake may win out
  over the need to sleep if the motivation is
  strong enough.
• Emotions and moods- anticipation that difficulty
  will be experienced, trying to sleep increases
  anxiety, this anxiety floods the brain with
  stimulating chemicals that interfere with
  relaxation, so natural sleep is compromised.

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FACTORS AFFECTING SLEEP

• Hunger or thirst interferes with sleep. Protein
  foods such as L-TRYPTOPHAN (FOUND IN DAIRY
  PRODUCTS AND POULTRY) PROMOTES SLEEP. Be careful
  of stimulants such as coffee, tea, chocolate or
  colas they contain caffeine which is a stimulant.
  Hypnotics are sleep inducing.
• ALCOHOL INTERFERES WITH NORMAL SLEEP STAGES.
• Illness, stress, anxiety, discomfort may alter
  your sleep pattern.

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MORE FACTORS AFFECTING SLEEP

• LYING FLAT WORSENS CARDIAC AND RESPIRATORY
  ILLNESSES
• PAIN DISTURBS SLEEP.
• EMOTIONS INTEREFERE WITH SLEEP (FOR EXAMPLE,
  ANGER OR ANXIETY).
• DEPRESSION MAY CAUSE INABILITY TO SLEEP OR
  INCREASED SLEEP.
• STRESS INTERFERES WITH NORMAL SLEEP PATTERNS.

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DRUGS THAT AFFECT SLEEP

• ALCOHOL AND CAFFEINE INTERFERE WITH SLEEP.
• STIMULANTS CAUSE WAKEFULNESS, excite the brain.
• DIURETICS INCREASE URINATION, WAKING THE SLEEPER
  TO EMPTY THE BLADDER.
• SEDATIVES AND TRANQUILIZERS PROMOTE REST, produce
  a relaxing and calming effect.
• HYPNOTICS INDUCE SLEEP.
• SEDATIVES AND HYPNOTICS MAY HAVE A PARADOXICAL
  EFFECT ON THE ELDERLY, PRODUCING RESTLESSNESS
  INSTEAD OF SLEEP.

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DRUGS

• DRUG TOLERANCE, DEMINISHED EFFECT FROM THE DRUG
  AT ITS USUAL DOSAGE RANGE.
• DIURETICS, GIVEN IN MORNING.

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ASSESSING SLEEP PATTERNS

• QUESTIONNAIRE COMPLETED INDEPENDENTLY BY THE
  CLIENT OR BY THE NURSE DURING AN INTERVIEW,
  IDENTIFIES SLEEP PATTERNS AND PROBLEMS (344A LIST
  QUESTIONS TO ASK PATIENT).
• SLEEP DIARY DAILY ACCOUNT OF SLEEPING AND
  WAKING ACTIVITIES, INCLUDING FOODS CONSUMED. DONE
  EVERY 15 MINUTES FOR A 24 HOUR LOG FOR 2 WEEK
  PERIOD. MEDS ARE NOTED AS WELL FOR ANALYSIS.

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ASSESSING SLEEP PATTERNS

• NOCTURNAL POLYSOMNOGRAPHY DIAGNOSTIC MONITORING
  DURING AN ENTIRE NIGHTS SLEEP TO OBTAIN
  PHYSIOLOGIC DATA. (FOR EXAMPLE, BRAIN WAVES, EYE
  MOVEMENTS, AND MUSCLE TONE, LIMB MOVEMENT, BODY
  POSITION, NASAL AND ORAL AIR FLOW, RESPIRATORY
  EFFORT, SNORINGSOUNDS, OXYGEN IN BLOOD). CLIENTS
  HOME IS USED.
• MULTIPLE SLEEP LATENCY TEST DIAGNOSTIC
  MONITORING DURING SEVERAL DAYTIME NAPS TO ASSESS
  DAYTIME SLEEPINESS. EVERY 2 HOURS, TAKE A NAP OF
  20 MINUTES, EXPERINCING EARLY REM, IS A
  PATHOLOGIC FINDING SICE REM SHOULD NOT OCCUR
  DURING A 20 MIN. TEST NAP.

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SLEEP DISORDERS

• INSOMNIA difficulty falling asleep, awakening
  frequently during the night, or awakening early.
  The client does not feel rested the next day.
• HYPERSOMNIA feeling sleepy despite getting
  normal sleep. Includes narcolepsy (sudden onset
  daytime sleep) and sleep apnea/hypopnea syndrome
  (slowed or absent breathing during sleep which
  disturbs sleep and can cause heart attack or
  stroke).FIVE OR MORE TIMES AN HOUR -10 SECONDS OR
  MORE.

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SLEEP DISORDERS

• SLEEP-WAKE CYCLE DISTURBANCE interference with
  normal biological rhythms of sleep caused by
  shift work, jet travel, or seasonal affective
  disorder.
• PARASOMNIA conditions associated with
  activities that cause arousal such as
  sleep-talking, grinding teeth(bruxism), restless
  legs syndrome. Includes somnambulism
  sleepwalking and nocturnal enuresis bedwetting.

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PROMOTING SLEEP

• MAINTAINING SLEEP RITUALS
• PROMOTING DAYTIME EXERCISE
• ADHERING TO A REGULAR SCHEDULE FOR RETIRING AND
  AWAKENING
• REDUCING LIGHTING
• EATING A SNACK OF FOOD CONTAINING L-TRYPTOPHAN
• AVOIDING ALCOHOL
• AVOIDING CAFFEINE (COFFEE, TEA, CHOCOLATE, COLAS)

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TWO NURSING MEASURES THAT PROMOTE RELAXATION

• PROGRESSIVE RELAXATION A THERAPEUTIC EXERCISE
  IN WHICH A PERSON ACTIVELY CONTRACTS AND THEN
  RELAXES MUSCLE GROUPS TO BREAK THE WORRY-TENSION
  CYCLE THAT INTERFERES WITH RELAXATION. Deep
  breathing, close eyes clear your mind, breathe in
  to count of 4. breathe out to the count of 6.
  Four times in succession, makes you feel very
  relaxed.
• BACK MASSAGE RELAXES TENSE MUSCLES AND IMPROVES
  CIRCULATION. Table 17-5 pg. 350 massage
  techniques. Pg. 361 skill 17-3 back massage.

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In pain

• Assist pt. first with distraction, relaxation
  techniques, back rub, change positions, empty
  bladder. Then on to meds as needed if the
  distraction did not work.
• After surgery, the first 24 hours, you must
  medicate.
• Pursed lip demonstration.
• Nursing guidelines 17-1 for progressive
  relaxation pg. 349.

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SLEEP AND OLDER ADULTS

• OLDER ADULTS HAVE MORE DIFFICULTY FALLING ASLEEP,
  AWAKEN MORE READILY, AND SPEND LESS TIME IN THE
  DEEPER STAGES OF SLEEP.
• COGNITIVE IMPAIRMENT MAY PRODUCE SUNDOWN SYNDROME
  (ONSET OF DISORIENTATION AS THE SUN SETS) OR
  SUNRISE SYNDROME (EARLY MORNING CONFUSION).
• HYPNOTIC AGENTS TEND TO HAVE PARADOXICAL EFFECTS
  AND INTERFERE WITH REM SLEEP.
• HYPNOTICS WITH A SHORT HALF-LIFE ARE BETTER
  TOLERATED.