Assessing Activities of Assessing Activities of Daily Living and Sleep Daily Living and Sleep

PatternsPatterns

Practicum of Health Practicum of Health Science Technology 2009 - Science Technology 2009 -

20102010

ObjectivesObjectives Discuss the importance of balance between Discuss the importance of balance between

activity and sleep in a patient’s lifeactivity and sleep in a patient’s life Describe the factors affecting activities of Describe the factors affecting activities of

daily livingdaily living Identify interview questions used to assess Identify interview questions used to assess

personal care, family responsibility, work, personal care, family responsibility, work, school, recreational, and socialization school, recreational, and socialization activities for an adult and for a child.activities for an adult and for a child.

Describe rapid eye movement sleep and the Describe rapid eye movement sleep and the four stages of non-rapid eye movement four stages of non-rapid eye movement sleepsleep

ObjectivesObjectives

Describe the factors affecting sleepDescribe the factors affecting sleep Compare and contrast disorders of Compare and contrast disorders of

initiating and maintaining sleep, initiating and maintaining sleep, disorders of excessive sleepiness, disorders of excessive sleepiness, disorders of the sleep-wake cycle, disorders of the sleep-wake cycle, and parasomniasand parasomnias

Phrase representative interview Phrase representative interview questions that assess a client’s sleep questions that assess a client’s sleep patternspatterns

IntroductionIntroduction

Maintaining a constant balance Maintaining a constant balance between daily activities and sleep is between daily activities and sleep is vital to the promotion and vital to the promotion and maintenance of physiologic and maintenance of physiologic and psychosocial health.psychosocial health.

Daily activity affects a person’s Daily activity affects a person’s ability to sleep soundly, and in turn, ability to sleep soundly, and in turn, the quality of sleep affects a the quality of sleep affects a person’s ability to carry out daily person’s ability to carry out daily activitiesactivities

Activities of Daily Living Activities of Daily Living (ADLs)(ADLs)

Include five components:Include five components:

- Personal Care- Personal Care

- Family Responsibility- Family Responsibility

- Work or School- Work or School

- Recreation- Recreation

- Socialization- Socialization

Factors Affecting ADLsFactors Affecting ADLs

AgeAge Developmental statusDevelopmental status CultureCulture Physiologic healthPhysiologic health Cognitive functionCognitive function Psychosocial functionPsychosocial function Stress levelStress level Biological rhythmsBiological rhythms

Age & Developmental StatusAge & Developmental Status

A client’s age and developmental status A client’s age and developmental status provide clues to the patient’s interests provide clues to the patient’s interests and abilities, as well as how the patient and abilities, as well as how the patient may react to an inability to perform ADLsmay react to an inability to perform ADLs

When progressing from infancy to When progressing from infancy to adulthood, an individual gradually shifts adulthood, an individual gradually shifts from dependence to independence in from dependence to independence in performing the five ADL componentsperforming the five ADL components

Assess the clients age and Assess the clients age and developmental level when assessing the developmental level when assessing the level of independence and ability to level of independence and ability to assume responsibility for ADLs. assume responsibility for ADLs.

CultureCulture

A person’s culture – learned values, A person’s culture – learned values, beliefs, customs, and behaviors – beliefs, customs, and behaviors – affects interests and roles, sometimes affects interests and roles, sometimes depending on sex.depending on sex.

Remember, a groups values, and Remember, a groups values, and beliefs can change over time, allowing beliefs can change over time, allowing altered roles and relationships.altered roles and relationships.

Determine the influence of a person’s Determine the influence of a person’s cultural heritage as well as any cultural heritage as well as any changes in values and customs when changes in values and customs when assessing ADLsassessing ADLs

Physiologic HealthPhysiologic Health

A patient’s physiologic health A patient’s physiologic health affects the ability to participate affects the ability to participate in ADLs, consider the functional in ADLs, consider the functional status of each body system when status of each body system when performing as assessmentperforming as assessment

Cognitive FunctionCognitive Function

Cognitive function refers to the Cognitive function refers to the process of perceiving, process of perceiving, organizing, and interpreting organizing, and interpreting sensory stimuli to think and sensory stimuli to think and solve problemssolve problems

Mental processes contributing to Mental processes contributing to cognitive function include: cognitive function include: attention, memory, and attention, memory, and intelligence.intelligence.

Cognitive FunctionCognitive Function

An alteration in any aspect of An alteration in any aspect of cognitive function may interfere with cognitive function may interfere with logical thinking or abstract reasoning logical thinking or abstract reasoning and therefore prohibit independent and therefore prohibit independent performance of ADLsperformance of ADLs

During ADL assessment, analyze the During ADL assessment, analyze the patient’s level of cognitive function, patient’s level of cognitive function, then use that information to then use that information to formulate questions and to structure formulate questions and to structure teaching in a manner appropriate to teaching in a manner appropriate to the patientthe patient

Psychosocial FunctionPsychosocial Function

Refers to a person’s ability to Refers to a person’s ability to process past and present process past and present information in a manner that information in a manner that provides a realistic view of provides a realistic view of oneself, one’s life, and othersoneself, one’s life, and others

Process involves a complex Process involves a complex interaction between interaction between intrapersonal and interpersonal intrapersonal and interpersonal behaviorsbehaviors

Intrapersonal BehaviorsIntrapersonal Behaviors

Those caused by an altered self Those caused by an altered self concept or emotional instability concept or emotional instability

Interpersonal BehaviorsInterpersonal Behaviors

Communication problems, Communication problems, impaired social interactions, or impaired social interactions, or dysfunctions in role performancedysfunctions in role performance

Stress LevelStress Level

Stress is a nonspecific, physical Stress is a nonspecific, physical response to any king of demandresponse to any king of demand

The factors that produce stress are The factors that produce stress are called stressors, can originate from called stressors, can originate from within the body or from the within the body or from the environment and can disrupt the environment and can disrupt the body’s equilibriumbody’s equilibrium

Stressors can be physiologic, such as Stressors can be physiologic, such as injury, or psychological, such as the injury, or psychological, such as the loss of a loved one.loss of a loved one.

Stress LevelStress Level

Stress is necessary for normal Stress is necessary for normal growth and developmentgrowth and development

It can have negative and positive It can have negative and positive effects on a patient’s ability to effects on a patient’s ability to participate in ADLsparticipate in ADLs

Positive vs NegativePositive vs Negative

Whether a stressor produces positive or Whether a stressor produces positive or negative results depends on several negative results depends on several factors, the first is perception.factors, the first is perception.

Magnitude or the intensity of the stressor Magnitude or the intensity of the stressor affects the patient’s responseaffects the patient’s response

The number of concurrent stressors as The number of concurrent stressors as well as their frequency and duration also well as their frequency and duration also affects the type of responseaffects the type of response

Experience with stress and past coping Experience with stress and past coping measures influence how a patient will measures influence how a patient will face new stressors.face new stressors.

AssessmentAssessment

Stress affects people of all ages Stress affects people of all ages and affects a patient’s stress level and affects a patient’s stress level is essentialis essential

To perform an accurate To perform an accurate assessment, evaluate the assessment, evaluate the characteristics of the stressor, characteristics of the stressor, determine the patient’s perception determine the patient’s perception of the stressor, and discover the of the stressor, and discover the patient’s method of coping.patient’s method of coping.

Biological RhythmsBiological Rhythms

Rhythmic biological clocks, known Rhythmic biological clocks, known as biological rhythms, help as biological rhythms, help patients adjust to the surrounding patients adjust to the surrounding physical environment and maintain physical environment and maintain internal homeostasisinternal homeostasis

Various biological rhythms Various biological rhythms beginning by the third week of life beginning by the third week of life and continuing thereafter, operate and continuing thereafter, operate on cycles of hours, days or months on cycles of hours, days or months

Biological RhythmsBiological Rhythms

One type of rhythm, called a One type of rhythm, called a circadian rhythm, operates on a circadian rhythm, operates on a cycle of approximately 24 hourscycle of approximately 24 hours

Different circadian rhythms help Different circadian rhythms help regulate biological and regulate biological and behavioral activities, including behavioral activities, including sleep and wakefullness, body sleep and wakefullness, body temperature, and hormone temperature, and hormone levels.levels.

Biological RhythmsBiological Rhythms

Many factors contribute to an Many factors contribute to an individuals circadian rhythmindividuals circadian rhythm

- Environmental- Environmental

- Social- Social

Environmental FactorsEnvironmental Factors

Environmental factors such as Environmental factors such as the hours of daylight and the hours of daylight and darkness and the seasons of the darkness and the seasons of the year regulate many daily year regulate many daily actitiviesactitivies

These environmental cues These environmental cues establish the appropriate times establish the appropriate times to eat, work, and relaxto eat, work, and relax

Social FactorsSocial Factors Social factors such as work or school Social factors such as work or school

schedules, household routines, and social schedules, household routines, and social activities also influence circadian rhythmsactivities also influence circadian rhythms

Hospitalization, shift work, or stress can Hospitalization, shift work, or stress can disrupt these circadian rhythms and can disrupt these circadian rhythms and can result in physical illness, psychological result in physical illness, psychological discomfort, or impaired cognitiondiscomfort, or impaired cognition

Disrupted circadian rhythms can Disrupted circadian rhythms can compromise the muscle strength and compromise the muscle strength and coordination required to perform a task or coordination required to perform a task or the attention, memory, and concentration the attention, memory, and concentration needed to complete an activityneeded to complete an activity

Once disrupted, a circadian rhythm may Once disrupted, a circadian rhythm may require up to several weeks to return to require up to several weeks to return to normalnormal

Assessing ADLsAssessing ADLs

During the interview, the health care During the interview, the health care professional uses observation to professional uses observation to gather information on ADLs.gather information on ADLs.

During the interview gather data from During the interview gather data from the patient and family members, and the patient and family members, and focus on their perceptions of the focus on their perceptions of the patient’s ability to perform ADLs, and patient’s ability to perform ADLs, and identify the patient’s and family’s identify the patient’s and family’s goals for functioning.goals for functioning.

Assessing ADLsAssessing ADLs Determine whether the patient and the Determine whether the patient and the

family have realistic views, have developed family have realistic views, have developed attainable goals, and have similar attainable goals, and have similar perspectivesperspectives

Observe the patient performing ADLs when Observe the patient performing ADLs when possiblepossible

Use the assessment to ascertain the Use the assessment to ascertain the patient’s functional status in performing patient’s functional status in performing ADLsADLs

Determine whether the patient can function Determine whether the patient can function independently, if the client requires independently, if the client requires assistance of a person or device, or if the assistance of a person or device, or if the patientpatient depends totally on othersdepends totally on others

Assessing ADLsAssessing ADLs

If the patient needs assistance, If the patient needs assistance, determine the amount and type determine the amount and type requiredrequired

If the patient depends on If the patient depends on devices, inquire about the type devices, inquire about the type of device and its adequacy in of device and its adequacy in resolving the problemresolving the problem

Also evaluate the possible need Also evaluate the possible need for other devicesfor other devices

Questions and RationalesQuestions and Rationales

Personal Care ActivitiesPersonal Care Activities

Do you have any difficulty Do you have any difficulty standing, walking, or standing, walking, or

climbing stairs? Can you climbing stairs? Can you get in and out of a chair? get in and out of a chair? Can you get in and out of Can you get in and out of

bed? What assistive bed? What assistive devices do you use to aid in devices do you use to aid in

mobility?mobility?

RationaleRationale

An alteration in mobility may An alteration in mobility may hinder a patient’s ability to hinder a patient’s ability to engage in other ADLs.engage in other ADLs.

Can you open packages and Can you open packages and containers? Can you use containers? Can you use

utensils for eating? Can you utensils for eating? Can you cut your food? Do you have cut your food? Do you have any other problems feeding any other problems feeding

yourself? What times do you yourself? What times do you usually eat? Who prepares usually eat? Who prepares

your meals? Where do you eat your meals? Where do you eat your meals? With whom do your meals? With whom do

you eat?you eat?

RationaleRationale

These questions help investigate These questions help investigate the patient’s ability to prepare the patient’s ability to prepare meals and to eat independently.meals and to eat independently.

The ability to feed oneself is an The ability to feed oneself is an important personal care activityimportant personal care activity

Can you use the toilet alone, or do Can you use the toilet alone, or do you require assistance? Do you you require assistance? Do you have any problems with bowel or have any problems with bowel or

bladder control? If so, how do you bladder control? If so, how do you manage these problems? Do you manage these problems? Do you

use any assistive devices for use any assistive devices for elimination, such as catheters or elimination, such as catheters or colostomy bags? If so, can you colostomy bags? If so, can you

care for these devices? How have care for these devices? How have elimination problems affected your elimination problems affected your

other activities?other activities?

RationaleRationale

An elimination problem can interfere An elimination problem can interfere with work, school, recreational, and with work, school, recreational, and socialization activitiessocialization activities

These questions give the patient the These questions give the patient the opportunity to discuss problems, opportunity to discuss problems, fears, and anxieties regarding fears, and anxieties regarding elimination, and give the health care elimination, and give the health care provider an opportunity to teach the provider an opportunity to teach the patient or family ways to manage patient or family ways to manage these problems. these problems.

Do you have any difficulties Do you have any difficulties with dressing and grooming? with dressing and grooming? If so, are these problems more If so, are these problems more

pronounced on the left side, pronounced on the left side, the right side, the upper part, the right side, the upper part,

or the lower part of your body? or the lower part of your body? Can you fasten buttons, snaps Can you fasten buttons, snaps

and zippers? Is dressing and zippers? Is dressing easier with certain types of easier with certain types of

clothing?clothing?

RationaleRationale

Musculoskeletal or Musculoskeletal or nueromuscular abnormalities can nueromuscular abnormalities can disrupt fine or gross motor disrupt fine or gross motor coordination, making dressing coordination, making dressing and grooming activities that and grooming activities that adults perform independently adults perform independently difficult for the patientdifficult for the patient

Family ResponsibilitiesFamily Responsibilities

What are your living arrangements? Does your What are your living arrangements? Does your home need structural changes so that you can fulfill home need structural changes so that you can fulfill your family responsibilities and perform ADLs? Do your family responsibilities and perform ADLs? Do

you have any problems with food management, you have any problems with food management, such as shopping or food preparation? Can you such as shopping or food preparation? Can you

complete your own laundry? What type of cleaning complete your own laundry? What type of cleaning can you do? Are you having any difficulties can you do? Are you having any difficulties

managing your money, such as getting to a bank? managing your money, such as getting to a bank? Does your family responsibility include caring for Does your family responsibility include caring for

any sick or disabled persons in the home? If so, do any sick or disabled persons in the home? If so, do you have any difficulties with this role? Do you you have any difficulties with this role? Do you

care for a pet in your home?care for a pet in your home?

RationaleRationale

These questions help investigate the These questions help investigate the structure and composition of the structure and composition of the patient’s family, the patient’s patient’s family, the patient’s developmental status, and the developmental status, and the responsibilities the patient has responsibilities the patient has assumed in the familyassumed in the family

A client who cannot perform usual A client who cannot perform usual family responsibility activities may family responsibility activities may develop role and relationship develop role and relationship problemsproblems

Work and School ActivitiesWork and School Activities

What does your typical day involve? What does your typical day involve? Do you work outside the home? Do you work outside the home?

Where and what type of work do you Where and what type of work do you do? How many hours per week do you do? How many hours per week do you

work? What is your work schedule work? What is your work schedule like? Do you have any conflicts like? Do you have any conflicts

between your work schedule and other between your work schedule and other responsibilities or ADLs? What is your responsibilities or ADLs? What is your

job like? Is work mainly a source of job like? Is work mainly a source of satisfaction or frustration? Do you satisfaction or frustration? Do you

participate in any volunteer work?participate in any volunteer work?

RationaleRationale

These questions help investigate These questions help investigate the type of work the client the type of work the client participates in and the role of participates in and the role of work in the client’s lifework in the client’s life

A client with a heavy, stressful A client with a heavy, stressful work schedule may feel that he work schedule may feel that he or she is neglecting family and or she is neglecting family and self, causing guilt feelings that self, causing guilt feelings that add to the stressadd to the stress

What do you see yourself What do you see yourself doing in the future? How do doing in the future? How do you feel about retirement? you feel about retirement? What plans have you made What plans have you made

for retirement?for retirement?

RationaleRationale

These questions help investigate These questions help investigate the patient’s point of view of the patient’s point of view of retirement, including alterations retirement, including alterations in ADLs caused by retirementin ADLs caused by retirement

Are your going to school? Are your going to school? If so, where and for what If so, where and for what

purpose? What do you like purpose? What do you like most about school? What most about school? What

do you like least about do you like least about school? Do you have any school? Do you have any

difficulties balancing school difficulties balancing school activities with other life activities with other life

responsibilities?responsibilities?

RationaleRationale

These questions help investigate the These questions help investigate the nature and demands of any nature and demands of any schoolwork in which the client schoolwork in which the client participates, and help assess the participates, and help assess the effects of school on other activitieseffects of school on other activities

A patient’s whose school activities A patient’s whose school activities interfere with personal care interfere with personal care activities, family responsibilities, or activities, family responsibilities, or work activities may benefit from work activities may benefit from counselingcounseling

Recreational ActivitiesRecreational Activities

What do you do when you are What do you do when you are not working or in school? How not working or in school? How

so your days off differ from so your days off differ from your work or school days? your work or school days?

How much recreational time do How much recreational time do you have in a day and in a you have in a day and in a

week? Are you satisfied with week? Are you satisfied with the amount of recreational time the amount of recreational time and what do you do during that and what do you do during that

time? time?

Rationale:Rationale:

These questions help investigate These questions help investigate the type, amount, timing, and the type, amount, timing, and purpose, and benefits of the purpose, and benefits of the client’s recreational and physical client’s recreational and physical exercise activities. A decrease exercise activities. A decrease in the usual activity levels may in the usual activity levels may results from a physical disorder, results from a physical disorder, and may lead to an emotional and may lead to an emotional problem, such as depression.problem, such as depression.

Socialization ActivitiesSocialization Activities

What kinds of things do you do What kinds of things do you do when you are alone? Can you use when you are alone? Can you use a phone, write clearly, and see well a phone, write clearly, and see well

enough to enjoy reading or enough to enjoy reading or watching television? Do you have watching television? Do you have any close friends? Who would you any close friends? Who would you confide in if you had a problem? confide in if you had a problem? Do you depend on your family to Do you depend on your family to

help? Do you belong to any social help? Do you belong to any social groups?groups?

Rationale:Rationale:

These questions help investigate These questions help investigate the client’s role in society, the the client’s role in society, the structure of the client’s social structure of the client’s social network, and any barriers to network, and any barriers to socialization the client may have. socialization the client may have. Illness, relocation, or the loss or Illness, relocation, or the loss or change of job can disrupt the change of job can disrupt the client’s usual social network, client’s usual social network, leading to social isolation, leading to social isolation, loneliness, and depression.loneliness, and depression.

Sleep PatternsSleep Patterns

What is sleep?What is sleep?

Sleep is defined as a recurrent, Sleep is defined as a recurrent, altered state of consciousness altered state of consciousness that occurs for sustained that occurs for sustained periods.periods.

What are some factors that What are some factors that promote rest?promote rest?

Conditions for Proper RestConditions for Proper Rest

Physical Comfort:Physical Comfort: Eliminate sources of physical Eliminate sources of physical

irritationirritation Control painControl pain Control room temperatureControl room temperature Maintain proper anatomical alignmentMaintain proper anatomical alignment Remove environmental distractionsRemove environmental distractions Provide adequate ventilationProvide adequate ventilation

Conditions for Proper RestConditions for Proper Rest

Freedom from worry:Freedom from worry: Make own decisionsMake own decisions Participate in personal healthParticipate in personal health Have knowledge needed to Have knowledge needed to

understand health problems and understand health problems and implicationsimplications

Practice restful activities regularlyPractice restful activities regularly Know that the environment is safeKnow that the environment is safe

Conditions for Proper RestConditions for Proper Rest

Sufficient Sleep:Sufficient Sleep: Obtain hours of sleep needed to Obtain hours of sleep needed to

feel refreshedfeel refreshed Follow good sleep hygiene habitsFollow good sleep hygiene habits

Sleep RegulationSleep Regulation

The control and regulation of The control and regulation of sleep may depend on the sleep may depend on the interrelationship between two interrelationship between two cerebral mechanisms that cerebral mechanisms that intermittently activate and intermittently activate and suppress the brain’s higher suppress the brain’s higher centers to control sleep and centers to control sleep and wakefulness.wakefulness.

Reticular Activating System Reticular Activating System (RAS)(RAS)

Located in the upper brain stemLocated in the upper brain stem Contains special cells to maintain Contains special cells to maintain

alertness and wakefulnessalertness and wakefulness Receives visual, auditory, pain, and Receives visual, auditory, pain, and

tactile sensory stimulitactile sensory stimuli Activity from the cerebral cortex also Activity from the cerebral cortex also

stimulates the RASstimulates the RAS Wakefulness results from neurons in Wakefulness results from neurons in

the RAS that release catecholamines the RAS that release catecholamines such as norepinephrinesuch as norepinephrine

Bulbar Synchronizing Bulbar Synchronizing Region(BSR)Region(BSR)

Sleep is produced by the release of Sleep is produced by the release of serotonin from specialized cells in the serotonin from specialized cells in the pons and medial forebrain.pons and medial forebrain.

Whether a person remains awake or Whether a person remains awake or falls asleep depends on a balance of falls asleep depends on a balance of impulses received from higher impulses received from higher centers, peripheral sensory centers, peripheral sensory receptors, and the limbic systemreceptors, and the limbic system

As people try to fall asleep stimuli to As people try to fall asleep stimuli to the RAS declines and at some point the RAS declines and at some point the BSR takes over. the BSR takes over.

Sleep StagesSleep Stages

Most adults fall to sleep in about Most adults fall to sleep in about 15min, experience two to three 15min, experience two to three brief arousals during the night, brief arousals during the night, and then awake 6 to 10 hours and then awake 6 to 10 hours laterlater

During sleep a person moves During sleep a person moves about every 15 to 30 minutes, about every 15 to 30 minutes, remains immobile for 10 to 30 remains immobile for 10 to 30 minutes, and then moves againminutes, and then moves again

Sleep StagesSleep Stages

Movement and short arousals Movement and short arousals often occur with changes in sleep often occur with changes in sleep stagesstages

Two types of sleep occur:Two types of sleep occur:- Rapid eye movement (REM)- Rapid eye movement (REM)- Non-rapid eye movement - Non-rapid eye movement (NREM) – occurs in 4 stages(NREM) – occurs in 4 stages

Sleep stages occur in a repetitive Sleep stages occur in a repetitive cycle throughout the night.cycle throughout the night.

Sleep StagesSleep Stages

Most adults Most adults experience four experience four to six complete to six complete sleep cycles per sleep cycles per nightnight

NREM Sleep: Stage 1NREM Sleep: Stage 1

Marks the transition between sleep Marks the transition between sleep and wakefullnessand wakefullness

Eyes move in a slow, rolling Eyes move in a slow, rolling fashion; thinking slows; reactions fashion; thinking slows; reactions to external stimuli decrease; and to external stimuli decrease; and movement becomes episodic and movement becomes episodic and involuntaryinvoluntary

Constitutes 5 – 10% of normal sleepConstitutes 5 – 10% of normal sleep

NREM Sleep: Stage 2NREM Sleep: Stage 2

Occurs within 1 to 7 minutes of Occurs within 1 to 7 minutes of the onset of sleepthe onset of sleep

Thinking becomes fragmentedThinking becomes fragmented If awakened from this stage, If awakened from this stage,

people correctly report they people correctly report they have been sleepinghave been sleeping

Constitutes approximately 50% Constitutes approximately 50% of nightly sleepof nightly sleep

NREM Sleep: Stage 3 and 4NREM Sleep: Stage 3 and 4

30 to 45 minutes after the onset 30 to 45 minutes after the onset of sleepof sleep

Last 15 to 30 minutesLast 15 to 30 minutes During this period, people are During this period, people are

difficult to arouse, and once difficult to arouse, and once awake, may need a few moments awake, may need a few moments to become alert and orientedto become alert and oriented

Compose 10 to 20% of nightly Compose 10 to 20% of nightly sleepsleep

REM Sleep: Dreaming SleepREM Sleep: Dreaming Sleep

Occurs approximately 75 to 90 Occurs approximately 75 to 90 minutes after sleep onsetminutes after sleep onset

Has decreased or absent muscle toneHas decreased or absent muscle tone Displays rapid eye movementDisplays rapid eye movement Person experiences dreams, thinks Person experiences dreams, thinks

illogical or bizarre thoughtsillogical or bizarre thoughts Body temperature drops, and the Body temperature drops, and the

respiratory rate, heart rate, and respiratory rate, heart rate, and blood pressure changeblood pressure change

Occupies 20 – 25% of nightly sleepOccupies 20 – 25% of nightly sleep

Factors that affect sleep Factors that affect sleep patterns:patterns:

AgeAge ExerciseExercise SmokingSmoking CaffeineCaffeine AlcoholAlcohol DietDiet EnvironmentEnvironment Emotional factorsEmotional factors Physical illnessPhysical illness

AgeAge

Sleeping patterns change over lifespanSleeping patterns change over lifespan Spend less time sleep as you get olderSpend less time sleep as you get older Infants sleep 16 – 20 hours a dayInfants sleep 16 – 20 hours a day 6 months old – 16 hours a day6 months old – 16 hours a day Age four 10 – 12 hoursAge four 10 – 12 hours Age ten 9 – 10 hoursAge ten 9 – 10 hours Adolescence – 7.5 hoursAdolescence – 7.5 hours Adults – few problems until age 35Adults – few problems until age 35 Older adults – increase sleep in daytimeOlder adults – increase sleep in daytime

ExerciseExercise

May inhibit May inhibit sleep if right sleep if right before bedtimebefore bedtime

Little evidence Little evidence that exercise that exercise improves sleepimproves sleep

SmokingSmoking

Tobacco alters Tobacco alters normal sleep normal sleep patternspatterns

Smokers require Smokers require almost twice the almost twice the amount of time to amount of time to fall asleep than non-fall asleep than non-smokerssmokers

Lighter sleep with Lighter sleep with more frequent more frequent arousalsarousals

CaffeineCaffeine

Decrease the Decrease the amount and amount and quality of sleepquality of sleep

Elderly patients Elderly patients experience a experience a reduction in reduction in sleep by 2 sleep by 2 hourshours

AlcoholAlcohol

Decreases arousals Decreases arousals during the first half during the first half of the night, and of the night, and increases the number increases the number of arousals during of arousals during the second halfthe second half

Decreases REM sleep Decreases REM sleep and makes it more and makes it more fragmentedfragmented

DietDiet

A person gaining A person gaining weight may sleep weight may sleep longer and deeper longer and deeper than normalthan normal

A person losing weight A person losing weight may sleep for shorter may sleep for shorter periods of time and periods of time and may have more may have more fragmented sleepfragmented sleep

EnvironmentEnvironment

Noise is the most disruptiveNoise is the most disruptive Occasional loud noise is more Occasional loud noise is more

disruptive than a constant noisedisruptive than a constant noise Episodic noise disrupts sleep and Episodic noise disrupts sleep and

increases the amount of Stage 1 sleepincreases the amount of Stage 1 sleep When temperature rises above 75°F When temperature rises above 75°F

individuals have reduced REM and individuals have reduced REM and Stage 3 and 4 Sleep, wake more often, Stage 3 and 4 Sleep, wake more often, move more frequently, and sometimes move more frequently, and sometimes have a greater dream recallhave a greater dream recall

EnvironmentEnvironment

Cool temperatures below 54°F, Cool temperatures below 54°F, can produce unpleasant and can produce unpleasant and emotional dreamsemotional dreams

Sleep improves in quiet Sleep improves in quiet surroundings, in a comfortable surroundings, in a comfortable bed, and without light and noisebed, and without light and noise

Familiar surroundings also Familiar surroundings also facilitate sleepfacilitate sleep

Emotional FactorsEmotional Factors

Mood and Mood and expectations expectations strongly influence strongly influence sleep patternssleep patterns

Acute and chronic Acute and chronic stress can stress can increase arousal increase arousal and inhibit sleepand inhibit sleep

Physical IllnessPhysical Illness

Any illness that Any illness that cause pain, cause pain, physical physical discomfort, or discomfort, or mood problems, mood problems, such as anxiety such as anxiety or depression or depression can result in can result in sleep problems.sleep problems.

Examples:Examples:

Respiratory diseaseRespiratory disease Coronary heart diseaseCoronary heart disease HypertensionHypertension NocturiaNocturia Restless leg syndromeRestless leg syndrome Peptic ulcer diseasePeptic ulcer disease

Drugs and SubstancesDrugs and Substances

Many drugs Many drugs and substances and substances have an affect have an affect on the amount on the amount and quality of and quality of sleep patient’s sleep patient’s receive.receive.

Sleep DisordersSleep Disorders

NarcolepsyNarcolepsy

Characterized by abnormal sleep Characterized by abnormal sleep tendencies and pathologic tendencies and pathologic manifestations of REM sleepmanifestations of REM sleep

Brief attacks of sleep occur many Brief attacks of sleep occur many times a day, during times of times a day, during times of physical inactivity or when least physical inactivity or when least expectedexpected

Sleep ApneaSleep Apnea

Characterized by transient Characterized by transient failure to breathe during sleepfailure to breathe during sleep

Three types: 1) central; 2) Three types: 1) central; 2) obstructive; and 3) mixed;obstructive; and 3) mixed;

Clients with any type of sleep Clients with any type of sleep apnea that is untreated are at apnea that is untreated are at risk for sudden cardiac arrestrisk for sudden cardiac arrest

Central Sleep ApneaCentral Sleep Apnea

Occurs when the client experiences Occurs when the client experiences inadequate airflow through the nose inadequate airflow through the nose and mouth from an absence of and mouth from an absence of inspiratory effortinspiratory effort

Ventilatory drive disappears, and Ventilatory drive disappears, and nerve impulses to the respiratory nerve impulses to the respiratory muscles ceasemuscles cease

Breathing recurs when nerve output Breathing recurs when nerve output resumesresumes

Obstructive Sleep ApneaObstructive Sleep Apnea

Occurs when the client’s diaphragm Occurs when the client’s diaphragm and chest wall move with changes and chest wall move with changes in intrathoracic pressure, but no air in intrathoracic pressure, but no air flows through the mouth or noseflows through the mouth or nose

The upper airway collapses, The upper airway collapses, obstructing movement, and blood obstructing movement, and blood oxygenation decreasesoxygenation decreases

Episode terminates when arousal Episode terminates when arousal restores muscle tone or when restores muscle tone or when increasing respiratory efforts increasing respiratory efforts reopen the airwayreopen the airway

Mixed Sleep ApneaMixed Sleep Apnea

Takes place when central and Takes place when central and obstructive sleep apneas occur obstructive sleep apneas occur in a single episode of airflow in a single episode of airflow ccessation.ccessation.

InsomniaInsomnia

Inability to sleepInability to sleep May be transient or chronicMay be transient or chronic Subjective phenomenonSubjective phenomenon Most often affects female, Most often affects female,

elderly, neurotic patients, thin, elderly, neurotic patients, thin, smokers or people who drink smokers or people who drink alcoholalcohol

Transient InsomniaTransient Insomnia

Refers to insomnia of less than 3 Refers to insomnia of less than 3 weeks in durationweeks in duration

Usually occurs with a brief Usually occurs with a brief illness, life crisis, new baby, illness, life crisis, new baby, bereavement, hypnotic bereavement, hypnotic withdrawal, travel or temporary withdrawal, travel or temporary sleep deprivation.sleep deprivation.

Rapid recovery usually occurs Rapid recovery usually occurs after a sleep disruption of 2 – 3 after a sleep disruption of 2 – 3 weeksweeks

Chronic InsomniaChronic Insomnia

May continue through lifeMay continue through life Advanced age, medical, Advanced age, medical,

behavioral, and psychiatric behavioral, and psychiatric problems frequently cause problems frequently cause prolonged difficulties in prolonged difficulties in obtaining restful sleep obtaining restful sleep

May accompany another sleep May accompany another sleep disorder, such as sleep apneadisorder, such as sleep apnea

BruxismBruxism

Teeth grinding during sleepTeeth grinding during sleep Can cause Temporomandibular Can cause Temporomandibular

Joint Disorder which can cause Joint Disorder which can cause joint pain, clicking or popping of joint pain, clicking or popping of joint, headaches, chronic ear joint, headaches, chronic ear painpain

EnuresisEnuresis

Chronic bedwettingChronic bedwetting Involuntary urination during Involuntary urination during

sleep in an individual with sleep in an individual with normal bladder controlnormal bladder control

Most children gain bladder Most children gain bladder control by 3-4 years old; not control by 3-4 years old; not considered abnormal until they considered abnormal until they are 5 and over.are 5 and over.

Night TerrorsNight Terrors

Cause a sudden fearful partial Cause a sudden fearful partial arousal from sleep during Stage arousal from sleep during Stage 3 and 43 and 4

Upon awakening in the morning, Upon awakening in the morning, the client has no memory of the the client has no memory of the episodeepisode

Affect children more often than Affect children more often than adultsadults

SomnambulismSomnambulism

SleepwalkingSleepwalking Occurs at least once in Occurs at least once in

approximately 15% of all approximately 15% of all children between ages 5 and 12 children between ages 5 and 12

Most children outgrow this Most children outgrow this behavior within 1 to 3 yearsbehavior within 1 to 3 years

Adults rarely sleepwalkAdults rarely sleepwalk

AssessmentAssessment

Assessment is aimed at Assessment is aimed at understanding the understanding the characteristics of any sleep characteristics of any sleep problem and the client’s usual problem and the client’s usual sleep habits so that ways for sleep habits so that ways for promoting sleep can be promoting sleep can be incorporated into nursing care.incorporated into nursing care.

Visual Analog ScaleVisual Analog Scale

Sleep HistorySleep History

Description of patient’s sleep Description of patient’s sleep problemproblem

Prior or usual sleep patternPrior or usual sleep pattern Bedtime routines and sleeping Bedtime routines and sleeping

environmentenvironment Use of sleep and other Use of sleep and other

prescription medications and prescription medications and OTC drugsOTC drugs

Sleep HistorySleep History

Pattern of dietary intake and Pattern of dietary intake and amount of substance(s) that amount of substance(s) that influence sleepinfluence sleep

Symptoms experienced during Symptoms experienced during waking hourswaking hours

Concurrent physical illnessConcurrent physical illness Recent life eventsRecent life events Current emotional and mental Current emotional and mental

status.status.

Description of Sleeping Description of Sleeping ProblemsProblems

Nature of the ProblemNature of the Problem Signs and SymptomsSigns and Symptoms Onset and DurationOnset and Duration SeveritySeverity Predisposing FactorsPredisposing Factors Effect on ClientEffect on Client

PlanningPlanning

Formulate diagnosis or nursing Formulate diagnosis or nursing diagnosis to determine plan of diagnosis to determine plan of care for patient.care for patient.

Sleep pattern disturbance, Sleep pattern disturbance, difficulty falling asleep related difficulty falling asleep related

to:to:

Noisy environmentNoisy environment Arthritis painArthritis pain

Sleep pattern disturbance, Sleep pattern disturbance, frequent awakening related to: frequent awakening related to:

Concern over loss of jobConcern over loss of job Barbituate dependencyBarbituate dependency

Risk for injury related:Risk for injury related:

to acts of sleepwalking 2to acts of sleepwalking 2°° SomnambulismSomnambulism

Ineffective family coping: Ineffective family coping: compromised related to:compromised related to:

Spouse’s/family’s poor Spouse’s/family’s poor understanding of narcolepsyunderstanding of narcolepsy

Self-Esteem disturbance Self-Esteem disturbance related to:related to:

Incidents of bed wettingIncidents of bed wetting

Altered thought processes Altered thought processes related to:related to:

Sleep deprivationSleep deprivation

Impaired gas exchange during Impaired gas exchange during sleep related to:sleep related to:

Altered oxygen supplyAltered oxygen supply

Ineffective breathing pattern Ineffective breathing pattern related to:related to:

Tracheobronchial obstructionTracheobronchial obstruction

Goals of care plan:Goals of care plan:

Client obtains sense of restfulness Client obtains sense of restfulness and renewed energy following sleep.and renewed energy following sleep.

Client establishes a healthy sleep Client establishes a healthy sleep pattern.pattern.

Client understands factors that Client understands factors that promote or disrupt sleeppromote or disrupt sleep

Client assumes self-care behaviors to Client assumes self-care behaviors to eliminate factors contributing to the eliminate factors contributing to the sleep disturbance.sleep disturbance.

ImplementationImplementation Environmental controlsEnvironmental controls- HomeHome- HospitalHospital Promoting bedtime routinesPromoting bedtime routines Promoting comfortPromoting comfort Establishing periods of rest and sleepEstablishing periods of rest and sleep Controlling physiologic disturbancesControlling physiologic disturbances Stress reductionStress reduction Bedtime snacksBedtime snacks Pharmacological ApproachesPharmacological Approaches

Health Promotion Through Health Promotion Through Health EducationHealth Education

Instruct client to try to exercise Instruct client to try to exercise daily and avoid vigorous exercise daily and avoid vigorous exercise 2h prior to bedtime2h prior to bedtime

Caution clients against sleeping Caution clients against sleeping long hours during weekends or long hours during weekends or holidays to prevent disturbance holidays to prevent disturbance of normal sleep-wake cycleof normal sleep-wake cycle

The bedroom should only be for The bedroom should only be for sleepingsleeping

Health Promotion Through Health Promotion Through Health EducationHealth Education

Instruct the client to avoid worrisome Instruct the client to avoid worrisome thinking and to use relaxation thinking and to use relaxation techniques if necessarytechniques if necessary

If client has trouble going to sleep If client has trouble going to sleep instruct them to do a quiet activity instruct them to do a quiet activity until they feel sleepy enough to go until they feel sleepy enough to go back to bedback to bed

Instruct client to make sure Instruct client to make sure environment is conducive to sleepenvironment is conducive to sleep

Instruct client to avoid heavy meals Instruct client to avoid heavy meals for 3h prior to bedtime; a light snack for 3h prior to bedtime; a light snack is okayis okay

EvaluationEvaluation

Determine if patient achieved Determine if patient achieved goals according to evaluation goals according to evaluation criteriacriteria

If goals were not achieved what If goals were not achieved what needs to be adjusted in the needs to be adjusted in the implementation to help patient implementation to help patient achieve goals.achieve goals.

PharmacologyPharmacology

Instructions:Instructions:

Complete the information Complete the information requested for the following requested for the following drugs.drugs.

Document where you found your Document where you found your information in APA format.information in APA format.

What is a What is a Benzodiazepine?Benzodiazepine?

Temazepam (Generic Name)Temazepam (Generic Name)Restoril (Brand Name)Restoril (Brand Name)

Drug Description –Drug Description – Classification –Classification – Indications for use –Indications for use – Dosage administration –Dosage administration – Mechanism of action –Mechanism of action – Side Effects/Adverse Reactions –Side Effects/Adverse Reactions – Drug Abuse and Dependence –Drug Abuse and Dependence – Drug Interaction(s) - Drug Interaction(s) -

Temazepam (Generic Name)Temazepam (Generic Name)Restoril (Brand Name)Restoril (Brand Name)

Warnings/Precautions –Warnings/Precautions – Laboratory Test(s) – Laboratory Test(s) – Contraindications –Contraindications – Overdose treatment –Overdose treatment – Drug Route –Drug Route – Availability –Availability –

What is a What is a Barbiturate?Barbiturate?

Zolpidem tartrate (Generic Name)Zolpidem tartrate (Generic Name)Ambien (Brand Name)Ambien (Brand Name)

Drug Description –Drug Description – Classification –Classification – Indications for use –Indications for use – Dosage administration –Dosage administration – Mechanism of action –Mechanism of action – Side Effects/Adverse Reactions –Side Effects/Adverse Reactions – Drug Abuse and Dependence –Drug Abuse and Dependence – Drug Interaction(s) - Drug Interaction(s) -

Zolpidem tartrate (Generic Name)Zolpidem tartrate (Generic Name)Ambien (Brand Name)Ambien (Brand Name)

Warnings/Precautions –Warnings/Precautions – Laboratory Test(s) – Laboratory Test(s) – Contraindications –Contraindications – Overdose treatment –Overdose treatment – Drug Route –Drug Route – Availability –Availability –

Medical TerminologyMedical Terminology

Instructions:Instructions:

Look through the power point and Look through the power point and identify the key terms that are identify the key terms that are important for you to know.important for you to know.

Write them down in your Write them down in your notebook.notebook.

Medical AbbreviationsMedical Abbreviations

ac = before mealsac = before meals ad lib = as desired, at libertyad lib = as desired, at liberty alt h = alternate hoursalt h = alternate hours aq = wateraq = water bid = twice a daybid = twice a day bin = twice a nightbin = twice a night C = celsiusC = celsius cap or caps = capsulecap or caps = capsule cc = cubic centimetercc = cubic centimeter comp. = compoundcomp. = compound cm = centimetercm = centimeter

VIP of the WeekVIP of the Week

Nathaniel KleitmanNathaniel Kleitman

Instructions: Research this person and Instructions: Research this person and write the following in your interactive write the following in your interactive notebook.notebook.

Who is he? Describe him as a person.Who is he? Describe him as a person. What significance did he have to What significance did he have to

medicine, science, or health care?medicine, science, or health care? How can you utilize his contribution How can you utilize his contribution

in your profession?in your profession? How did his contribution affect the How did his contribution affect the

world?world?

Critical ThinkingCritical Thinking

Answer the following questions:Answer the following questions:

What factors would need to be What factors would need to be included in an education plan for a included in an education plan for a patient taking benzodiazepines?patient taking benzodiazepines?

What nonpharmacologic measures What nonpharmacologic measures should accompany the adminstration should accompany the adminstration of sleep medication?of sleep medication?

If a patient has symptoms of If a patient has symptoms of insomnia, what type of sleep hygiene insomnia, what type of sleep hygiene habits might you recommend?habits might you recommend?

Case Study:Case Study:

Mrs. Wills visits the community Mrs. Wills visits the community health clinic for a routine visit. health clinic for a routine visit. She is 78yo. During the health She is 78yo. During the health history she tells you that she history she tells you that she normally spends about 7 hours in normally spends about 7 hours in bed at night. She states that bed at night. She states that frequently it takes her ½ hour or frequently it takes her ½ hour or longer to fall asleep. Mrs. Wills is longer to fall asleep. Mrs. Wills is concerned. concerned.

Question:Question:

What would you as the What would you as the healthcare provider assess healthcare provider assess regarding her sleep-wake regarding her sleep-wake patterns? patterns?

What counseling might be What counseling might be appropriate?appropriate?

Case Study:Case Study:

Mr. John is a 55yo sheet metal Mr. John is a 55yo sheet metal worker who works the evening worker who works the evening shift. He typically drinks three shift. He typically drinks three to four beers before going to to four beers before going to bed. He normally sleeps about 6 bed. He normally sleeps about 6 hours a nigh after he goes to bed hours a nigh after he goes to bed around 1am. It is common for around 1am. It is common for him to arise during the night to him to arise during the night to urinate. His favorite way to relax urinate. His favorite way to relax is watching TV in bed.is watching TV in bed.

Question:Question:

As the healthcare provider what As the healthcare provider what would you assess regarding Mr. would you assess regarding Mr. John’s sleep history? John’s sleep history?