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71 Cards in this Set
- Front
- Back
Circadian rhythm
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Physical, mental, and behavioral changes that follow a roughly 24-hour cycle. Affects patterns of brain wave activity hormone production, cell regeneration, sensory acuity, mood, and other biological activities.
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What part of the brain controls the circadian rhythm?
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The suprachiasmatic nucleus (SCN): a group of cells located in the hypothalamus
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Biological clock
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drives circadian rhythm. Synchronizes sleep and wake cycles. Highly individual and genetically linked.
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Two phases of sleep
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NREM (nonrapid eye movement) and REM (rapid eye movement)
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Stages of sleep
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1 through 4 and REM
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Describe the typical adult sleep cycle including stages and timeframe
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Presleep sleepiness, Stage 1 (few minutes), Stage 2 (10-20 min), Stage 3 (15-30 min), Stage 4 (15-30 min), Stage 3 (15-30 min), Stage 2 (10-20 min), REM (20 minutes) - typical time to reach REM sleep is 90 minutes.
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Sleep stage 1
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Lightest level of sleep, lasts a few minutes, gradual fall in vitals and metabolism, easily aroused
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Sleep stage 2
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Sound sleep, 10-20 minutes, relaxation progresses, easy arousal
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Sleep stage 3
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Deeper Sleep, 15-20 minutes, difficult arousal, muscles relaxed, vitals decline
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Sleep stage 4
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Deepest sleep, 15-30 minutes, very difficult arousal, significant decrease in vital signs, considerable portion of night spent in this stage.
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REM sleep
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Vivid dreams, Begins about 90 min after onset of sleep. Typified by rapid eye movement, fluctuating heart and respiratory rates, increased BP. Loss of skeletal muscle tone, increased gastric secretions, very difficult arousal, duration increases with each sleep cycle. (20 min average length - may be as long as 60 min during last cycle).
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Describe how many sleep cycles adults typically move through per night and how the sleep cycles change throughout the night.
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4-5 complete cycles. With each successive cycle, stages 3 and 4 shorten and REM lengthens. The REM stages lasts up to 60 minutes in the last sleep cycle.
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What percentage of a typical adult's sleep is spent in NREM stages?
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75%-80%
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Newborns spend more time in ____ whereas older adults sleep cycles tend to be _______.
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Newborns spend more time in deep sleep. Older adults sleep is more fragmented with less time in deep sleep.
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Functions of sleep
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Contributes to physical and psychological restoration, body and brain tissue restoration, preserves cardiac function, preserves energy. Dreams involve learning, memory processing, and stress adaptation.
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Sleep requirements - neonates
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16 hrs average, sleep almost constantly the first week. Sleep cycle: 40-50 mins wakes after 1-2 sleep cycles. 50% is REM which stimulates brain centers and is critical for normal development.
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Sleep requirements - infants
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8-10 hrs of night time sleep by 3 months. Naps during the day. 15 hrs sleep total per day. 30% of sleep is REM. May awaken during the night.
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Sleep requirements - toddlers
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By age 2 - most sleep through the night, Still nap during the day. 12 hrs of sleep per day. May give up naps around age 3. Percentage of REM time falls with age. Bedtime routine may become a struggle.
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Sleep requirements - Preschoolers
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12 hrs per night. 20% REM. By age 5, naps are rare. Problems with sleep may include trouble settling down, bedtime fears, waking during the night, nightmares, partial wakening, crying, sleep-waking, bed-wetting.
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Sleep requirements - school-aged children
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required sleep varies 9-12 hours
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Sleep requirements - adolescents
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Experience changes in circadian rhythms. Secretion of melatonin changes to later in the night. May require 9-10 hours but actually get about 7.5. May result in poor school performance and behavior or mood problems.
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Sleep requirements - young adults
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6-8.5 hours 20% is REM. May begin to experience sleep problems due to stress, social activities, insomnia. Pregnancy may increase need for sleep.
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Sleep requirements - middle adults
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Total time spent sleeping declines. Stage 4 sleep falls and continues to decline with advancing age. Anxiety, depression, and or physical illness may cause sleep disturbances. Menopausal symptoms may lead to insomnia.
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Sleep requirements - older adults
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Increasing complaints of sleeping difficulties. 50% of adults 65 and older have sleep problems. REM sleep shortens. Decrease in stage 3 and stage 4 NREM with a possible total loss of stage 4 or deep sleep. Frequent awakenings and difficulty falling asleep. Chronic illenss may result in loss of sleep - changes caused by changes in CNS that affect sleep regulation. Sensory impairment reduces sensitivity to time cues that maintain circadian rhythms.
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Insomnia
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Chronic difficulty falling asleep, frequent wakings, short sleep. Most common sleep-related complaint.
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Effects/characteristics of Insomnia
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Results in excessive day time sleepiness. More common in women. Often signals underlying physical or psychological disorders or situational stress. Also associated with poor sleep hygiene (practices/habits associated with good health). Increased risk for anxiety, depression. Treatment begins with improved sleep hygiene.
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Sleep Apnea
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Lack of airflow (apnea) or diminished airflow (hypopnea) through the nose and mouth for periods of 10 seconds or longer. May be central, obstructive, or mixed. Most common is Obstructive (OSA).
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Effects/characteristics of sleep apnea
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Causes loud snoring. Affects 10-15% of middle-aged adults. Risk factors include smoking, obesity, alcohol, family history. Results in excessive daytime sleepiness. Causes a decline in arterial oxygen saturation. Increased risk of cardiac dysrhythmias, right sided heart failure, pulmonary hypertension, angina attacks, stroke, hypertension.
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Polysomnography
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Testing for sleep apnea. A number of physiologic variables are measured and recorded during sleep. These include - Brain electrical activity, eye and jaw muscle movement, leg muscle movement, airflow, respiratory efford (chest and abdomincal excursion), EKG, oxygen saturation
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Treatment for sleep apnea
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CPAP, VPAP, or BIPAP - Continuous, Variable, or Bi-pressure Positive Airway Pressure
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Narcolepsy
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Dysfunction of the mechanism that regulates sleep and wake states
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Effects/characteristics of narcolepsy
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Excessive daytime sleepiness, REM sleep occurs within 15 min of falling asleep. Treated with medications, exercise, diet modifications, deep breathing, scheduled naps.
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Parasomnias
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a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Includes - Sleepwalking, night terrors, nightmares, bed wetting (nocturnal enuresis), tooth griding, body rocking.
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Effects/characteristics of parasomnias
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More common in children. Sleep hygiene becomes very important. Safety is key.
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Examples of chronic diseases that poor sleep is believed to contribute to -
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Heart disease, diabetes, immunity, obesity
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Assesment for sleep issues includes
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Asking about usual sleep patterns, physical and psychological illness, current life events, emotional and mental status, bedtime routines, bedtime environments, behaviors of sleep deprivation
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Nursing diagnoses related to sleep issues
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Anxiety, ineffective breathing pattern, acute confusion, compromised family coping, ineffective coping, insomnia, disturbed sensory perception, sleep deprivation.
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Nursing planning related to sleep issues
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Client will -
Control environmental sources disrupting sleep within 1 month Identify factors in the immedicate home environment that disrupt sleep in 2 weeks Report having a discussion with family members about environmental barriers to sleep within 2 weeks. Report changes made in the bedroom to promote sleep within 2 weeks. Report fewer than 2 awakenings per night within 4 weeks. |
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Rest
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A state of mental relaxation, free from anxiety and physically calm
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Urination during the night which affects sleep cycle
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Nocturia
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Involves the use of electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG), to monitor stages of sleep
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Polysomnogram
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Results in impaired waking function, poor work performance, accidents, and emotional problems
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Excessive daytime sleepiness (EDS)
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Most common sleep complaint, signaling an underlying physical or psychological disorder
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Insomnia
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More common in children, an example is SIDS
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Parasomnias
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Cyclical process that alternates with longer periods of wakefulness
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Sleep
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Rapid eye movement phase at the end of each sleep cycle
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REM
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Synchronizes sleep cycles
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Biological clock
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Influences the pattern of major biological and behavioral functions
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Circadian rhythm
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Sleep that progresses through four stages (light to deep)
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NREM
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More vivid and elaborate during REM sleep and are functionally important to learning
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Dreams
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Characterized by the lack of airflow through the nose and mouth for 10 seconds or longer during sleep
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Sleep apnea
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Practices that the client associates with sleep
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Sleep hygiene
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Inadequacies in either the quantity or quality of nighttime sleep
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Hypersomnolence
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Problem clients experience as a result of dyssomnia
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sleep deprivation
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Sudden muscle weakness during intense emotions at any time during the day.
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cataplexy
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Dysfunction of mechanisms that regulate the sleep and wake states (excessive daytime sleepiness)
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narcolepsy
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Neonates sleep for _____hours per day _____% is REM
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16 hrs, 50% REM
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Neonates sleep cycles are ____ minutes long and they usually wake after _____ cycles
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40-50 minutes, 1-2 cycles
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Infants sleep _____ hours at night. ____ hours total per day including naps with ___ % REM
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8-10 hrs at night, 15 hours total, 30% REM
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Toddlers sleep ____ hours total per day with 1-2 naps.
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12hrs
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Preschoolers sleep ____ hours at night, ____ % is REM
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12 hours, 20% REM
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School-aged kids: A typical 6-yr-old sleeps ____ hours per night. Typical 11-yr-old sleeps ____ hours per night
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11-12 hours at age 6, by age 11 that has dropped to about 9-10 hours per night
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Adolescents sleep an average of ___ hrs per night
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7.5 hours
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Young adults sleep an average of _____ hours per night
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6-8.5 hours
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Sleep patterns of middle adults -
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Sleep begins to decline. Time spent in stage 4 declines. Insomnia is common, especially in women going through menopause
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Sleep patterns of older adults
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More than 50% of adults over 65 experience sleep problems. Decrease in length of stages 3 and 4, with ultimately almost no time spent in stage 4.
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Components of a sleep history
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Description of sleeping problems, usual sleep pattern, physical and psychological illness, current life events, emotional and mental status, bedtime routines, bedtime environment, behaviors of sleep deprivation.
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Common nursing diagnoses related to sleep problems
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Anxiety, ineffective breathing pattern, acute confusion, compromised family coping, ineffective coping, insomnia, disturbed sensory perception, sleep deprivation.
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The 24 hour day-night cycle is known as
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Circadian rhythm
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What substance could a patient take to promote normal sleep patterns
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L-tryptophan (a natural protein found in milk, cheeses, and meats that aides in the production of melatonin)
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Irritability, hyperactivity, and decreased motivation are symptoms of
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sleep deprivation
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