NR 226 Exam 2 Study Guide Fundamentals

NR 226 Exam 2 Study Guide Fundamentals – Patient Care Chamberlain College of Nursing

Latest 2023 / 2024

➢ What is circadian rhythm and how does it affect our day and how does it affect our day and night if we change our sleeping habits/job?

 Circadian rhythm: 24hr, day/night cycle

-Circadian rhythms= influence pattern of major biological & behavioral functions; predictable changing of body temp., HR, BP, hormone secretion, sensory acuity & mood depend on maintenance of 24hr.circadian cycle.-When sleep-wake cycle becomes disrupted ( working rotating shifts) = other physiological functions change  anxiety, restlessness, irritability, impaired judgment are common s/s of sleep cycle disturbances.*Failure to maintain and individual’s usual sleep- wake cycle= negatively influences PT’s overall health

➢ Identify the stages of sleep & what happens in each stage:

 NREM= NON-rapid eye movement REM= rapid eye movement

 Stage 1: NREM

• Stage lasts a few minutes; it includes lightest level of sleep.
• Decrease physiological activity begins with gradual fall in vital signs and metabolism.
• Sensory stimuli (ex. Noise) easily arouses person.
• Awakened person feels as though daydreaming has occurred.

*You don’t always remember dreams; ONLY when you are awoken by a disturbance (ex: alarm)

 Stage 2: NREM

• Stage lasts 10-20 minutes
• A period of sound sleep
• Relaxation progresses
• Body functions continue to slow 1 / 3

• Arousal remains relatively easy

 Stage 3 NREM

• Stage lasts 15-30 minutes
• Involves initial stages of deep sleep
• Muscles are completely relaxed
• Vital signs decline but remain regular
• Sleeper is difficult to arouse and rarely moves

 Stage 4 NREM

• Stage lasts approximately 15-30 minutes
• Deepest stage of sleep
• If sleep loss has occurred, sleeper spends a majority of the night in this stage
• Vital signs are significantly lower than during waking hours
• Sleep walking and enuresis (bed-wetting) sometimes occur
• It is very difficult to arouse sleeper

 REM Sleep:

• Begins about 90 minutes after sleep has begun; *Very difficult to arouse the sleeper
• Duration increases with each sleep cycle and averages 20 min.
• Vivid, full-color dreaming occurs; less-vivid dreaming occurs in other stages
• Characterized by: rapidly moving eyes, fluctuating heart & respiration rates, Increased or

fluctuating BP, Decreased skeletal muscle tone, and increase of gastric secretions.*REM sleep necessary for brain tissue restoration & important for cognitive restoration

➢ What bedtime rituals would prevent a person from falling asleep?

• Going to bed fully awake & thinking about other things causes insomnia
• Trying to finish work or resolve family problems before bedtime
• If pt. doesn’t fall asleep within 30 min. Advise pt. to get out of bed and do a quiet activity until

sleepy enough for bed

• Limit caffeine to morning coffee and limit alcohol intake
• Avoid heavy meals for 3 hours before bedtime

➢ What are healthy bedtime rituals?

• Comfortable room temp., proper ventilation, minimal sources of noise, comfortable bed,

proper lighting, sometimes extra pillows are important; Important for person to go to sleep when they feel fatigued or sleepy; Avoid excessive mental stimulation before bedtime. 2 / 3

Relaxation (deep breathing, guided imagery, reading, soft music); Wear loose-fitting nightwear; Void before bed ➢ When performing a sleep assessment, what are some questions you might want to ask?

• What time do you usually get in bed each night?
• How much time does it usually take to fall asleep? Do you do anything special to help you fall

asleep?

• How many times do you awaken during the night? Why?
• What time do you typically wake up in the morning?
• How many hours do you sleep each night?

➢ What are sleep assessments?

• Description of sleep problems; Usual sleep patterns; Physical and psychological illness; Current

lifestyle events; Emotional and mental status; bedtime routines; bedtime environment; behaviors of sleep deprivation; Meds, medical history, observation

➢ Tools for sleep assessment:

• Epworth sleepiness scale (evaluates severity)
• Pittsburgh sleep quality index (assesses quality and sleep patterns)
• Visual analogue scale (best night/worst night sleep)
• Numeric scale (0-10 sleep rating)

➢ Looking at the following sleep diagnosis, what nursing diagnosis would you choose for each patient?**(Be able to define each disorder, along with appropriate outcomes for each as well!!)

• Insomnia: Chronic difficulty falling asleep, frequent awakenings from sleep, and/or a short

sleep/nonrestorative sleep, associated with poor sleep hygiene- the most common sleep- related complaint.

o Narcolepsy: Dysfunction of mechanisms that regulate sleep and wake states

▪ Excessive daytime sleepiness is most common complaint associated with this disorder ▪ During day, patient suddenly feels overwhelming sleepiness and falls asleep; REM occurs within 15 min.

**Nursing Diagnoses for Insomnia and narcolepsy:

• Disturbed sleep pattern R/T excessive daytime sleeping AEB difficulty falling or remaining

asleep.

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