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Rest and Sleep

by Diana Shenefield, PhD
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    00:01 Welcome! Our topic is rest and sleep, and my name is Diana Shenefield. So in this topic, we’re going to talk about the importance of rest and sleep, and how important it is as nurses that we try to help our patients get a good night’s rest. And that we help them to be able to relax so that their body can heal.

    00:22 So, one of the learning outcomes that we can attach to this is to assess the needs.

    00:29 Sometimes our patients come into the hospital and they’ll complain that this isn’t a place of rest.

    00:33 And we know that. But what can we do as nurses to help our patients rest? We know the effects of sleep deprivation. We know the effects of not getting enough sleep or too much sleep.

    00:46 And so, being able to assess our patients who is at risk, maybe what medications are causing problems, or who has a disease process that makes it really hard for them to rest.

    00:56 So, our practice NCLEX question. Which most common cause sleep deprivation in the hospital should the nurse consider when planning care? Again, if you’re thinking about your mind, if you’ve ever worked night shift, sometimes as nurses, we think that when we’re up, everybody is up. And we kind of forget that our patients are trying to sleep at night.

    01:17 So, what can we do? What causes sleep deprivation? Is it fragmented sleep? Is it early awakening, that’s the problem? Is it restless legs? Or is it sleep apnea? Now, all of those things can cause a patient to have problems with sleep, but what is the most common cause of sleep deprivation? Hopefully, you picked A, fragmented sleep.

    01:39 So think about your patient. Think about when you go in and they’re trying to nap and it’s time for vital signs. Lab comes in, they’re taking a nap. Their dietary comes in and you don’t want them to have cold food. Are we letting our patients have long extended periods of sleep? So, why is it important to understand sleep? We know that when patients are sleep deprived, their pain is worse, their nausea vomiting is worse, they can’t relax, their blood pressure goes up, their heart rate goes up. And when you can’t sleep, you sit and think about all the things that are wrong with you.

    02:16 And so it’s hard to get our patients to relax. And how can I evaluate their pain if their pain is exacerbated by the fact that they’re not sleeping? So, as nurses, what do we need to do? One of the things is that we need to work really hard to keep the environment quiet.

    02:33 Now, we know a nurse, if you stay in the hospital just in the hallway and you listen to all the sounds, most of the sounds that you hear are sounds that we need to have. We have bed alarms. We have telemetry alarms. We have call lights, telephones. All of those things are needed to run a safe hospital. But when you’re the patient lying in the bed, all of those noises now become a distraction and become a cause of not being able to sleep.

    03:00 So, what can you do as a nurse? What can we eliminate to make sure that our patients are getting the sleep? What can we do? Promote bedtime routines. Some patients have a definite routine that they do before they go to bed. When they come into the hospital all of the sudden, we change that whole routine. And bedtime routine is one of them. And a lot of times, people have trouble sleeping unless they follow a certain routine. So as nurses, if I don’t assess my patient, if I don’t ask them why they’re having trouble sleeping or is there anything that you do at night to help you get to sleep, then I’m putting my patient at a disadvantage. There’s no reason why. They can’t maybe watch their favorite show or maybe have a warm glass of milk unless it’s contraindicated.

    03:45 But what can we do to keep that routine that they have at home? And then promoting comfort.

    03:51 Back in the day long time ago, we used to give our patients back rubs at night.

    03:56 That was part of the care at night. And I think we’ve gotten away from that a lot. But there’s a lot to be said with being able to help somebody relax before they go to sleep. We know the hospital beds aren’t the beds at home. And sleeping in a different place makes it hard to sleep.

    04:11 The beds aren’t the same beds. That’s not their pillows.

    04:13 So, what can we do? Again, a back rub, keeping their routine the same, are all things that we can do to try to help them be able to sleep. We want to avoid heavy meals. We usually don’t have a problem with that at the hospital, but again, if their tray has been delayed.

    04:31 Heavy meals make it hard to sleep, especially if your patient has GERD or any kind of intestinal problems. What about promoting appropriate activity, encouraging people to not be real active right before bed? And don’t forget about your patients who work the night shift.

    04:47 Maybe they sleep during the day. So, what do we do as nurses? We wake everybody up in the morning. Maybe their routine is to sleep during the day. So, there are certain things that we can adjust. Is there things that maybe don’t have to be done in the morning hours, when they would normally be sleeping? And if needed, we do have medications available to help people sleep. Again, if we can control the routine, if we can help them get relaxed, maybe they don’t need the medications. But we also need to understand that there are medications available that sometimes are needed while the patient is in the hospital. So again, one of the things we need to think about when we’re doing assessment. Is your patient going through any kind of withdraw? Where there’s alcohol withdraw, nicotine withdraw, drug withdraw. When they’re in the hospital, obviously, those things aren’t available to them, and that can cause anxiety.

    05:38 Can also cause a lack of sleep and comfort. Sometimes patients won’t voluntarily tell you. Most patients aren’t going to tell you that they’re addicted to drugs or they’re addicted to alcohol, but you can start seeing those signs and symptoms. And is that the reason they can’t sleep? Do they suffer from insomnia? Did you ask your patient? Maybe they’ve had insomnia for years and they haven’t slept in a long time. One is that something that you can address or that you can help with. But two, expecting them to go to sleep when they haven’t slept for a long time isn’t going to work either.

    06:09 So we need to make sure we’re asking our patients how many hours do they sleep at night.

    06:13 Do they have trouble going to sleep? Do they wake up a lot during the night? Or are they very early risers? All those are things that we can assess on our patient and maybe adjust our care accordingly. Does your patient have to get up multiple times at night to go to the bathroom? If you’ve ever had to get up, you know you get woke up. It’s hard to get back to sleep. So is it something wrong with the patient’s urinary system? Is there a reason why they get up in the middle of the night? And is there a problem that’s not being addressed? What about if your patient have trouble staying up at night and they sleep during the day, do they have their nights and days mixed up? Is it because of shift work or is it because of maybe a head injury or a stroke? Patients that have been in the hospital, if they’ve been confined to a room and we don’t see day and night, if their blinds are pulled, it’s easy to get mixed up on day and night.

    07:07 And so, what can we do to keep them oriented to the time of day? Restless leg is another one.

    07:12 A lot of people have restless legs. Maybe it’s not something that they’re medicated for, but they know at night, they have to get up and walk around. Is it something that we can address? Is it something that we can help with? But we need to ask about it because a lot of people don’t know that restless leg is actually a diagnosis. They may just think that they have wiggly legs or something. So make sure that you’re doing a good assessment.

    07:34 And does your patient on medications, one that keeps them from sleeping? Or are they on medications to help them sleep? How long have they been on it? Are they taking anything over the counter for it, that maybe is contraindicated with the medications that we’re giving them? Again, you need to know about Ambien. Ambien is one of the most common medications that shouldn’t be taken long-term. So if you have a patient that says they’ve been on Ambien for a couple of years, that’s probably a problem too that needs to be addressed.

    08:04 But remember, one of the side effects with Ambien is daytime sleepiness. And so again, then we come into a safety problem. So, being able to educate our patients, making sure that our physicians know that patients are already on these sleeping medicines, and what kind of effects it’s having on their safety and their disease process.

    08:24 So again, think about when you’re at work, wherever you work or think about a time when you were a patient and all the noises in the hospital. And is there ways that we can still provide very good care but allow the patient longer periods of sleep? And when you’re answering NCLEX questions, look for things like clustering your care, promoting sleep, and all of the things that a sleep deprivation does to our patients, whether it makes their pain worse or their nausea vomiting worse, what is it about the sleep deprivation that’s going to make their disease process work? And what can I do as a nurse to help comfort them so that they get the rest that they need? Good luck on NCLEX.


    About the Lecture

    The lecture Rest and Sleep by Diana Shenefield, PhD is from the course Physiological Integrity. It contains the following chapters:

    • Rest and Sleep
    • Tips To Keep in Mind

    Included Quiz Questions

    1. Delirium
    2. Hypoxia
    3. Lethargy
    4. Dementia
    1. Bladder fullness
    2. Ringing in the ears
    3. Hunger
    4. Thirst
    1. Quality
    2. Amount
    3. Depth
    4. Onset

    Author of lecture Rest and Sleep

     Diana Shenefield, PhD

    Diana Shenefield, PhD


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