Documentation is the act of recording patient status and care in written or electronic form
Patients responses to interventions and treatments
Important facts about patients health history (including past/present illnesses, examinations, tests, treatments
What is documentation and its use? (p.391)
Communication, continuity of care, quality improvement, planning and evaluation, legal record, professional standards, reibursement and utilization review
What is the purpose of the written record? (391)
Source oriented record systems
Commonly used in hospitals and long-term facilities
Typical source-oriented record includes
Admission data, advance directive, history and physical, provider's orders, progress notes, diagnostic studies, laboratory data, nurses notes, graphic data, rehabi
Problem-Oriented Record System
Are organized around the patient's problem
Consists of four parts
Database, problem list, plan of care, and progress notes (392)
Charting By Expectation
Is a system of charting in which only significant findings or exceptions to standards and norms of care are documented
To use it effectively, you must know and adhere to professional, legal, and organizational guidelines for nursing assessment and interve
Electronic Health Record (EHR) Systems
Consists of records that are entered via computer
Typical combine source-oriented and problem-oriented record styles (393)
Nursing Admission Data Forms
Nursing admission forms is completed at the time the client enters the healthcare system
Baseline assessment is essential because it
May be used as a benchmark to monitor change
Provides information about the clients support systems and helps forecast fut
Discharge summary
Discharge data are obtained with the admission assessment, but are often recorded on a separate form
General principle in nursing - discharge planning begins on admission
Therefore, discharge needs should be evaluated when the patient first enters a healt
Flow Sheets and Graphic Records
Used to do the following
Document assessment and care that are performed frequently, on a recurring schedule, or as part of unit routines (e.g. I&O, weight, hygiene measures, ADLs, and medications)
Perform and document care activities
Allow you to see pat
Checklists
Common normal and abnormal findings are often organized according to body systems
Using a paper form
Nurse checks the box that reflects the current assessment findings
Client care activities, responses, and expectations are recorded in the narrative note
MAR
Contain information about the medications that have been prescribed for the client
Information and format vary by setting, with significant differences between outpatient and inpatient facilities
Inpatient Facilities - medication records contain a list of
Kardex or Client Care Summary
Briefly summarizes patients status and plan of care
Typically pull patient data from multiple areas of the health record (medical diagnosis, prescriptions, treatments, results) (405)
Integrated Plan of Care (IPOC)
Are a combined charting and care plan form
Maps out, day by day, the patient goals, outcomes, interventions, and treatments for a specific diagnosis or condition from admission to discharge
They help administrators predict length of stay and monitor costs
Occurrence reports
A formal record of an unusual occurrence or accident
It is an organizational report used to analyze the event, identify areas for quality improvement, and formulate strategies to prevent future concerns
The overall goal is to create safer processes and pr
Oral reporting
The purpose of giving an oral report is to maintain continuity of care and engage in professional communications
The quality of the report you give and receive influences how you and other plan the shift work
Restrict your oral report to client-focused di
Hand off report
Purpose of handoff report (change-of-shift report or handover report) is to promote continuity of care
Nurse is alerted to clients status, recent status changes, planned activities, diagnostic testing, or concerns that require follow-up
Handoff report sho
Bed side report
Allows you to observe important aspects of client care (appearance, IV pumps, wounds)
Outgoing nurse introduces you to the client (407)
Fave to face oral report
May involve only outgoing and oncoming nurse or the entire oncoming shift (408)
Audio-recorded report
Convenient but time-consuming way to transmit information
Does not allow you to ask questions about the client (408)
PACE format
Is an example of a specifically developed standardized approach to organize data for handoffs
Patient/Problem
Assessment/Action
Continuing/Changes
Evaluation (408)
Transfer report
Transfer reports are given when a patients is transferred from unit to unit or facility to facility
Detained information about the client's health history can be communicated between healthcare professionals or transmitted before transfer (408)
Telephone orders/ prescriptions
Can lead to errors because of differences of pronunciation, dialect, or accent; background noise; poor perception; unfamiliar terminology.
Taking telephone or verbal prescription may be acceptable in the following situations
Sudden change in patient's con
Verbal orders/prescriptions
Verbal prescriptions are spoken directions for patient care given to you in person, usually during an emergency
Providers should never use verbal communication as a routine method of giving prescriptions (409)
Paper Health Records
To comply with HIPAA requirements, paper health records need to be stored in designated areas accessible only to healthcare providers
Forms used must be efficient, comprehensive, and relevant to the client's healthcare needs
Forms should guide you to docu
Electronic Health Records
-You must have basic computer, mouse, and software skills to document effectively
-Ensure confidentiality and privacy
close the screen, lock the computer, or permanently log off the EHR system
Use privacy filters
Crease a secure password
Change your passw
Cognitive learning
Mental activities for processing incoming information
Learning is not about how many facts you can recall but rather how meaningful the information is and how effectively you can use it as needed
*goal is then to expand their learning beyond simple rememb
Psychomotor Learning (Doing)
performing skills that require both mental and physical activity
Requires the learner to value learning the skill (affective domain) and also implement the skill (cognitive domain)
Strategies and Tools:
Demonstration and return demonstration, simulation m
Affective Learning (Caring):
Changes in feelings, beliefs, attitudes, and values
Considered the "feeling domain"
Strategies and Tools:
Role modeling, group work, storytelling, panel discussion, role playing, one-to-one counseling and discussion, interactive applications, and digital
Behavioral Learning Theory:
Characterized by explicit identification of information to be taught and immediate rewards for correct responses
Has roots in psychology and the belief that the environment influences behavior
Is the essential factor in determining human action
Pavlov, B.
Cognitive theory
Sees learning as a complex cognitive (mental) activity
Learning is an intellectual or thinking process in which the learner structures and process information
Cognitive Theory recognizes the importance of developmental stage and social, emotional, and aff
Humanism
focuses equally on the learner's affective (emotional), cognitive (intellectual), and attitudinal qualities
Emphasises on the learner's active participations and responsibility in the learning process
Learning is thought of as self-motivated, self-initiat
Right time
Is the learner ready, free of pain and anxiety, and motivated?
Have you and the learner developed a trusting relationship?
Have you set aside sufficient time for the teaching session? (888)
Right context
Is the environment quite, free of distractions, and private?
Is the environment soothing or stimulating, depending on the desired effect? (888)
Right goal
Is the learner actively involved in planning the learning objectives?
Are you and the client both committed to reaching mutually set goals of learning that achieve the desired behavioral changes?
Are the family or friends included in planning so that they
Right content
Is the content appropriate for the client's needs?
Is it new information or reinforcement of information that has already been provided?
Is the content presented at the learner's level?
Does the content relate to the learner's life experiences or is it ot
Right method
Do the teaching strategies fit the learning style of the learner?
Do the strategies fit the client's learning ability?
Are the teaching strategies varied? (888)
Motivation
Desire within.
Motivation is greatest when clients:
Recognize the need for learning
Believe it is possible to improve their health
Are interested in the information they are being given
Motivation may be based on physical, emotional, and social needs (890
Readiness
Demonstration of behaviors that indicate the learner is both motivated and able to learn at a specific time
You must consider readiness in your planning (890)
Timing
You must present information at a time when the learner is open to learning
Timing is everything
People retain information when they have an opportunity to use it soon after it is presented
Might need more time for learning when complex thinking is requir
Active involvement
Learning is more meaningful when the patient is actively involved in the planning and in the learning activities
Learners retain 10% of what they read, but retain 90% of what they do
Passive learning is not as effective for processing and reading informat
Feedback
information about the learner's performance
Ex: test grade is feedback for students, conveying "you need to work on that content some more"
Ex: "you have successfully maintained a sterile technique (890)
Repetition
Patient is more likely to retain information and incorporate it into his life if the content is repeated
Ex: patients forget what medication are prescribed, reaping the name can help them remember (891)
Learning environment
an ideal environment is private, quiet, physically and psychologically comfortable, and free of distractions
If a separate space is not available, try a quiet corner, pull the curtain, shut the door, and talk close and softly with the patient
Provide good
Scheduling the session
Plan for uninterrupted time to allow you to adequately assess and understand the patient
Uninterrupted time is KEY
Accommodate to the each patient needs (891)
Amount and complexity of context
The more complex or detailed the content is, the more difficult it is for most people to learn and retain
Ex: teaching parents about the need for isolation precautions for the newly diagnosed complex immune disorder of their infant, compared to teaching n
Communication
Central to the teaching and learning process in which teachers and learners exchange information, perceptions, and feelings
Attend carefully to verbal and nonverbal feedback that the client gives
Tells you whether or not the learner is attentive and focus
Preoperational Stage (2-7 years):
Child begins to acquire language skills and find meaning through use of symbols and pictures (892)
Stage of Concrete Operations (7-11 years):
Child learns best by manipulating concrete, tangible objects and can classify objects in two or more ways
Ex: identify a shape as triangle and also green
Logical thinking begins here
Adapt to the perspective of others (892)
Formal Operational Stage (11 years +):
can use abstract thinking and deductive reasoning
Can relate to general concepts to specific situations, consider alternatives, begin to establish values, and try to find meaning in live
Not everyone reaches this stage, including adults (892)
Barriers for teacher
Competing demands on the nurse's time (ex: to prepare for teaching)
Conflicting schedules between the nurse's available time for teaching and the patient's available time to learn
Ineffective coordination of class lecture with clinical experience
Lack of
Barriers for learner
Illness, fatigue, other physical conditions
Low literacy; low health literacy
Environmental not conductive learning
Lack of time to learn
Overwhelming complexity of the condition or treatment to be learned
Lack of support and ongoing positive reinforcemen
ANA code of ethics and teaching
ANA's Code of Ethics for Nurses with Interpretive Statements holds that nurses are responsible for promoting and protecting health, safety, and rights of patient
Patient teaching is essential in fulling that responsibility
Nursing: Scope and Standards for
Lecture
Traditional method of teaching in which one or more presenters orally share the information while learners listen
Use stories, quotes, images, analogies or metaphors, and humor
Use computer-projected slides, streaming video, flip charts, posters, brochure
One-to-One Instruction and Mentoring
One teacher and one learner
Mutual formulate objectives at the beginning of the session
The learner receives printed or audiovisual materials to reinforce the information presented
Used fo patient teaching (906)
Role modeling
Teacher traces by example, demonstrating the behaviors and attitudes the learners should adopt
More effective when the teaching point is congruent with the role model's action
Learning occurs unconsciously as well as intentionally
Considered what you're c
p. 908
How to evaluate learning
Estimated Average Requirement (EAR)
Amount of nutrients estimated to meet daily requirements of half of all healthy individuals within a given age and gender group.
Recommended Dietary Allowance (RDA)
Average daily dietary intake of a nutrient that meets requirements for approximately 98% of healthy people.
Acceptable Macronutrient Distribution Range (AMDR)
Percentage of protein, fat, and carbohydrate associated with reduced risk of chronic disease, provided there is an intake of other essential nutrients
Basal metabolic rate
Measure of the energy used while at rest in a neutral temperature environment. This is the energy required for vital organs such as the heart, liver, and brain to function.
Stimulus
May be sight, sound, taste, touch, pain, or anything that stimulates a nerve receptor
Brain must receive and process it to make it meaningful
Reception
Process of receiving stimuli from nerve endings in the skin and inside the body
A receptor converts a stimulus to a nerve impulse and transmits the impulse along sensory neurons to the CNS
Adaptation
some receptors remain activated for as long as the stimulus is applied
But most receptors adapt to stimuli, so their responses decline with time
Adaptation explains why over time you become unaware of an unpleasant smell or the persistent sound of somethi
Perception
he ability to interpret the impulses transmitted from the receptors and give meaning to the stimuli
When stimulated, the receptors generate nerve impulses that travel along neural pathways to the spinal cord and brain
Then they are relayed to specialized
Reticular Activating System (RAS):
Located in the brainstem, controls, consciousness and alertness
Neurons of the RAS make connections between the spinal cord, cerebellum, thalamus, and cerebral cortex
These connections relay visual, auditory, and other stimuli that help keep us awake, att
Intensity
Intense stimulus excites more receptors, leading to a stronger response
Ex: bright light can cause you to respond by squinting/shielding your eyes vs. a dim light may cause little reaction (1124)
Contrast
Change/contrast of environment temperature
Ex: outside it's cold and windy, you enter an unheated garage, you instantly feel warmer because the building blocks the wind. You then go inside a room with a blazing fireplace, you will need to remove layers of
Seizure
Abrupt onset of disturbance in electrical activity in the brain�a group of neurons fires abnormally. This results in motor symptoms, such as rhythmic jerking of the limbs. (1130)
Primary generalized seizures
Involve widespread electrical activity on both sides of the brain at once. Most commonly, this type is caused by hereditary factors and low levels of anti seizure medication. (1134)
Partial seizure
Begin with electrical discharge from one side in a limited area of the brain.
Common triggers are ingesting mood-altering substances, infection in the brain or cerebral spinal fluid, tumor, head trauma, sleep deprivation, stress, illness, formation of the
Incidence seizures
Incidence is highest for those younger than age 10 or older than age 65 and higher among males than among females, especially in children
Children 3 months to 6 years have seizures when they have a high fever (1134)
Pain
Unpleasant sensory and emotional experience, due to actual or potential tissue damage
Affects the person's quality of life
Whatever the person says it is (subjective)
Pain is protective, warning to a potential injury (1150)
Cutaneous (Superficial) Pain
Arise in the skin or the subcutaneous tissue (burn or abrasion)
Short-term pain (1150)
Deep somatic pain
ligaments, tendons, nerves, blood vessels, and bones
Ex. fractures, sprains, arthritis, bone cancer (1150)
Visceral pain
Stimulation of deep internal pain receptors
Abdominal cavity, cranium, or thorax
May be local, achy discomfort to more widespread, intermittent, and crampy (1150)
Radiating pain
Starts at the origin but extended to other locations
Gastroesophageal reflux may radiate outward from the sternum to involve the entire upper thorax (1150)
Psychogenic Pain:
Refers to pain that is believed to arise from the mind
No physical cause for pain, but patient perceives it (1150)
Nociceptive pain
Most common type of pain
Occurs when nociceptor respond to stimuli that may be damaging
Thermal, chemical, mechanical stimuli
May result from trauma, surgeon, or inflammation
Two types: visceral and somatic (1151)
Neuropathic pain
Complex chronic pain that occurs when there is an injury to one or more nerves, resulting in painful stimuli
Described as a: burning, numbness, itching, pins and needle pricking pain
Originate from: injury, poorly controlled diabetes, stroke, tumor, alcoh
Intractable pain
Both chronic and highly resistant to relief
Treated w/ multiple methods of pain relief (1152)
The Endogenous Analgesia System
Neurons in the brain-stem activate descending nerve fibers that conduct impulses back to the spinal column. These impulses trigger the release of endogenous opioids and other substances to block the continuing pain impulses and provide pain relief. (1152)
The Gate- Control Theory
Suggests that the perception of pain does not occur only by direct stimulation of nociceptors. Instead, pain is perceived by the inter-play between two different kinds of fibers- those that produce and inhibit pain. (1152)
C (small, slow) fibers
As slow-pain impulses travel along C fibers from the periphery to the brain, they encounter a "gate" that either allows or blocks the transmission of pain in the brain. If the source of stimulation is non painful, the gate would be blocked to feeling pain
A- delta (large, fast) fibers
Example- hitting your arm against a hard surface and you rub the area instantly almost without thinking. The manual pressure stimulates skin receptors. These send sensory impulses along fast A-delta (large) fibers, which quickly excite inhibitory neurons
Emotion, fear, confusion depression
Discuss factors that influence pain (1153)
Endocrine system
Ongoing pain triggers excessive release of the hormones adrenocorticotropic hormone, cortisol, antidiuretic hormone (ADH), growth hormone, catecholamines, and glucagon. Insulin and testosterone levels decrease. These hormone shifts activate carbohydrate,
Cardiovascular system
Unrelieved pain leads to hypercoagulation (increased clotting) and an increase in heart rate, blood pressure, cardiac workload, and oxygen demand. The combination of hypercoagulation and increased cardiac workload may lead to unstable angina (chest pain),
Musculoskeletal system
Unrelieved pain causes impaired muscle function, fatigue, and immobility. Poorly controlled pain can prevent the patient from performing activities of daily living and engaging in physical therapy. (1154)
Respiratory system
Patients in pain tend to breathe shallowly�to limit thoracic and abdominal movement. This is called splinting. Splinting reduces tidal volume (air exchanged with each breath) and increases inspiratory and expiratory pressures. These changes can lead to pn
Genitourinary system
Unrelieved pain causes release of excessive amounts of catecholamines, aldosterone, ADH, cortisol, angiotensin II, and prostaglandins. These hormones lead to decreased urinary output, urinary retention, fluid overload, hypokalemia, hypertension, and incre
GI system
In response to pain, intestinal secretions and smooth muscle tone increase, and gastric emptying and motility decrease. (1155)
TENS Units A transcutaneous electrical nerve stimulator (TENS)
Consists of electrode pads, connecting wire, and the stimulator. The pads are applied directly to the painful area, which is most often muscle and soft tissue. (1161)
Acupunture
Application of extremely fine needles to specific sites in the body to relieve pain. It is believed to stimulate the endogenous analgesia system. Acupuncture is documented to provide relief from joint pain (Manyanga, Froese, Zarychanski, et al., 2014) and
Acupressure
Stimulates specific sites in the body. However, instead of needles, fingertips provide firm, gentle pressure over the various pressure points. This process may have a calming effect through the release of endorphins. (1161)
Nonopioid analgesics
Include a variety of medications that relieve mild to moderate pain, and chronic and acute pain. Many are available over the counter (e.g., acetaminophen, aspirin, ibuprofen, and naproxen). Most also reduce inflammation and fever.
NSAIDS, Aspirin, Acetami
Adjuvant analgesics
Reduce the amount of opioid the patient requires. Drugs in this category include anticonvulsants, antidepressants, local anesthetics, topical agents, psychostimulants, muscle relaxants, neuroleptics, corticosteroids. Indicated for:
As a primary therapy fo
Opioid anelgesics
Natural and synthetic compounds that relieve pain, although they vary in potency. To some degree, opioids work by binding with pain receptor sites to block pain impulses. (1164)
Asking patients to rate their pain intensity whenever you take a full set of vital signs. The goal is to provide a routine for assessing patient pain on a regular and ongoing basis.
Explain why pain should be considered the fifth vital sign (1155)
Opioid effectiveness
P. 1164
World Health Organization (WHO)
A state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity
Health promotion:process of equipping people to have control over, and to improve, physical, emotional, and social health (912)
Jean watson
Health consists of (1) high level of overall physical, mental, and social functioning; (2) a general adaptive-maintenance level of daily functioning; and (3) the absence of illness (or the presence of efforts that lead to its absence).
She also refers to
Betty neuman
Health: an expression of living energy available to an individual; energy is displayed on a continuum, with high energy (wellness) at one end and low energy at the opposite end
Myers, Sweeney, and witmer
Wellness: a way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated by the individual to live more fully within the human and natural community (912)
Synthesis
Health promotion: finding ways to help individuals develop a state of physical, spiritual, and mental well-being
Health promotion activities are useful to all individuals, whether well or sick, because ther encourage optimal function
Health promotion is m
Primary prevention
Activities designed to prevent or slow the onset of disease
Eating healthy foods, exercising, wearing sunscreen, obeying seat belt laws, keeping up with immunizations (912)
Secondary prevention
Screening activities and education for detecting illnesses in the early stages
Breast self examination, testicular exams, regular physical examinations, blood pressure and diabetes screenings, and tuberculosis skin test (912)
Tertiary prevention
Stopping the disease from progressing and returning the individual to the pre-illness phase; rehabilitation is the main intervention during this level
Focuses on helping recover from surgery, preventing complications of surgery, and helping to regain stre
Conception to birth
Health promotion focus: education about pregnancy; abstinence from alcohol, cigarettes, and illicit drugs; nutrition, including folic acid and iron requirements; exercise to maintain strength and muscle tone and to control weight gain; parenting education
Infancy
Health Promotion Focus: nutrition (breast/bottle); intro of solid foods; place infant on back to sleep w/o pillow to reduce the risk of SIDS; sensory stimulation; safety; motor vehicle safety; oral health
Health screening: hearing evaluation; screening fo
Toddler and prescholer
Health Promotion Focus: adequate supervision; safety, including storage of poisons; toilet training; motor vehicle safety; nutrition, immunizations; oral health; sleep and rest
Health Screening: annual examinations; growth and development; cognitive skill
School age
Health Promotion Focus: nutrition; physical activity; safety; sexuality; stranger danger; oral health
Health Screening: annual examinations; growth and development; cognitive skills; abuse
Health screening activities
p. 923
Reduce stress and anxiety
Why is sleep important? (1267)
REM (non-rapid eye movement) sleep
Restful phase of sleep in which physiological function is slow
Also called slow-wave sleep because it is characterized by the presence of delta waves
The parasympathetic branch of the autonomic nervous system becomes progressively more dominant during eac
REM (rapid eye movement) sleep
Essential for mental and emotional restoration
The brain becomes highly active and brain waves resemble those of a person who is fully awake
More spontaneous awakening occur during this stage than any other
Loss of REM sleep impairs memory and learning
A
Sleep cycles
Cycling between REM and NREM sleep produces restorative rest
The NREM/REM sleep cycle repeats 4-6 times throughout the night, depending on the total amount of time spent sleeping
Each cycle lasts up to 90-100 minutes
The first REM period may last only abo
NI (NREM)
Typical Brain Wave Type:
Alpha waves with occasional low-frequency theta waves
Characteristics:
Transition between wakefulness and sleep
Slow eye movements
Light sleep=can be awakened easily
Relaxed but aware of surroundings
Groggy, heavy lidded
Regular,
NII (NREM)
Typical Brain Wave Type:
Theta waves, K-complexes, and sleep spindles
Characteristics:
Light sleep=easily aroused
Temperature, heart rate, and BP decreased slightly
Accounts for about half of total sleep time (1271)
NIII
Typical Brain Wave Type:
Delta waves, sawtooth waves
Characteristics:
Deep sleep=difficult to rouse; if awakened in this stage, may be confused
Parasympathetic nervous system predominates: temperature, pulse, respirations, and BP slow even more
Skeletal m
REM
Typical Brain Wave Type:
5-30 minutes (usually at least 20-30)
Characteristics:
Highly active sleep with spontaneous awakenings
Less restful than NREM sleep
Eyes move rapidly and small muscles twitch
Essential for mental and emotional restoration
Metaboli
Circadian rythyms
Biorhythm based on the day-night pattern in a 24 hr cycle
Regulated by a cluster of cells in the hypothalamus of the brainstem that responds to changing levels of light
Affects our overall level of functioning (1269)
Age, lifestyle, physical activity, diet
What factors affect sleep? (1272)
Dyssomnias
Difficulty falling or staying asleep, early awakening, or excessive sleepiness
Insomnia, sleep-wake schedule (circadian) disorders, sleep apnea, restless leg syndrome, hypersomnia, and narcolepsy (1273)
Parasomnias
Patterns of waking behavior that appear during sleep
Sleepwalking (1273)
Incidence
Most common sleep disorder
Prevalent in women and adults older than 60, those who suffer from chronic medical and psychiatric illness (depression, anxiety, hypertension, obesity, cancer, thyroid disorders), shift workers
In young adults, difficulties of s
Restless leg syndrome
Disorder of the CNS characterized by an uncontrollable movement of the legs while resting or before sleep onset (1274)
Sleep deprivation
Not actually a sleep disorder, but rather a human response to prolonged sleep disturbances (1274)
Hypersomnia
Excessive sleeping, especially in the daytime
People with excessive daytime sleepiness doze, nap, and fall asleep at times and in situations when they need or wish to be awake or alert (1274)
Sleep apnea
Periodic interruption in breathing during sleep-an absence of air flow through the nose or mouth can potentially lead to serious health problems
Episodes may occur several or a hundred times a night and may last up to 1minute or longer
During periods of a
Obstructive Sleep Apnea
Reports of at least 5 witnessed breathing interruptions or awakenings due to gasping or choking events per hour
Typically the soft tissue of the pharynx and soft palate or other structures in the throat area collapse and construct the airway during sleep,
Central sleep apnea
Complete suspension of breathing resulting from a dysfunction in central respiratory control
Only about 10% of sleep apnea is central in origin
People tend to awaken during sleep and therefore experience daytime sleepiness (1275)
Snoring
Hallmark sign of Obstructive Sleep Apnea, but does not necessarily indicate it
Can reduce the quality of sleep for the bed partner
Results when the muscles at the back of the mouth relax during sleep, obstruct the airway, and vibrate with each breathe
Obs
Narcolepsy
Chronic disorder caused by the brain's inability to regulate sleep-wake cycles normally
Distinction between being asleep and being awake is blurred
At various times, the person with narcolepsy experiences a sudden, uncontrollable urge to sleep lasting fro
Parasomnias
Sleepwalking (somnambulism)
Occurs during stage III of NREM sleep, usually 1-2 hrs after the person falls asleep
Sleeper leaves the bed and walks about, with little awareness of surroundings
He may perform what appear to be conscious motor activities (bru
Sleep talking
Occurs during NREM sleep, just before REM stage
Does not usually interfere with the person's rest but may be disturbing to others (1276)
Bruxism
Grinding and clenching of the teeth and usually occurs during stage II NREM sleep
It can eventually erode tooth enamel and loosen the teeth
The noise can be disruptive to others (1276)
Rest
Condition in which the body is inactive or engaging in mild activity, after which the person feels refreshed
A person at rest is calm, at ease, relaxed, and free of anxiety and stress
People rest by doing things that they find calming and relaxing
Sleep
Cyclically occurring state of decreased motor activity and perception
Body functions slow, and metabolism falls by 20-30% so the body conserves energy
Sleep is characterized by: altered consciousness: A sleeping person is unaware of the environment and re
Assessment of a patient with disorder
It is important to assess usual sleep patterns and rituals for all patients who are being admitted to the hospital or seeking help for a sleep problem
A brief assessment for all patients should include questions about the following:
Usual sleeping pattern
Sleep diary
Provides very specific information on your patient's patterns of sleep
Allows you to identify trends in sleep/wakefulness and associate behaviors interfering with sleep
You will usually ask the patient to keep the diary for 14 days
Remind him that it is i
Actigraph
An application on a mobile device or worn on the wrist that estimates a person's sleep and wake patterns, including time spent in various sleep stages
Sleep study
Test that observes what happens in the body during sleep
It is most useful in detecting sleep apnea and other sleep disorders, such as narcolepsy, night terrors, and periodic limb movement disorder
Polysomnography
One of the most common sleep studies performed in a sleep lab, records brain wave activity, eye movement, oxygen and co2 levels, vital signs, and body movements during the sleep phase
Diagnostics to diagnose common sleep disorders
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