BASIC OF NURSING SKILL SLEEP

DIAN NINGRUM FARAH ICHTYARINIE A M. IMAM HANAFI. H SAREEHA SALAEH

J210102009 J210102010 J210102008 J210100077

S1 INTERNATIONAL NURSING PROGRAM FACULTY OF HEALTH SCIENCE MUHAMMADIYAH UNIVERSITY OF SURAKARTA 2012

PREFACE
Praise and gratitude we prayed to the god the mighty one, of thanks and blessing so that the preparation paper about Sleep in Nursing Process. This paper is prepared to fulfill the task of Basic of Nursing Skill. In preparing this paper we received many referrals from various parties, so please allow us to thank group 4 :
1. Mrs.Winarsih as coordinator of Basic of Nursing Skill. 2. The libraries that have provided a source book in the library. 3. All those who have helped in completing this paper.

In preparing this paper the authors realize is far from perfection, to the authors are looking forward to critiques and suggestions for improvement in subsequent papers. Last but hopefully this paper can be useful and add insight, especially for groups of 3 and for other readers. Surakarta, January 2nd 2012 Writter

i 2

CONTAIN
Hal Preface ...................................................................................................................... Contain...................................................................................................................... CHAPTER I SLEEP................................................................................................. 1.1 Definition of sleep ............................................................................................ 1.2. Type of sleep...................................................................................................... 1.3. Function of sleep................................................................................................ 1.4. Normal sleep pattern and requirement .............................................................. 1.5 Factor affecting sleep.......................................................................................... 1.6. Common sleep disorder ................................................................................... CHAPTER II ............................................................................................................ 2.1 Conclusion........................................................................................................... 2.2 Suggestion .......................................................................................................... REFFERENCES........................................................................................................ i ii 1 1 1 2 2 12 13 14 14 14 15

ii 3

1.1 DEFINITION OF SLEEP Sleep is generally defined as a recurring state of inertia where the sleeper is unresponsive to most stimuli. It differs from unconsciousness in that the individual can be aroused by the introduction of direct stimuli, such as a sudden noise. 1.2 TYPES OF SLEEP Human beings adopt a 24-hour cyclical pattern of sleep and wakefulness known as the circadian rhythm, which usually becomes established, learnt behaviour by the age of 3 months. Sleep is generally considered to have two dimensions: rapid eye movement (REM) sleep, sometimes referred to as paradoxical or dream sleep, and non-REM or orthodox sleep. Both elements are considered to be important for an individuals overall health and well-being. During sleep the metabolic rate decreases, resulting in a reduction in the heart rate, respirations, body temperature and blood pressure. Rest and sleep are considered essential to conserve energy, prevent fatigue, provide respite for the bodily systems, promote healing and relieve tension. The degree of rest an individual needs and/or is able to achieve depends largely on their age and the degree of mental and physical stimulation and relaxation to which they are subject. An ability to relax fully usually results in sleep. Newborn babies generally sleep for about 16 hours a day whilst most adults sleep 69 hours per night approximately one-third of their life making it a fundamental activity of living. Drastically or continually altered rest and sleep cycles disrupt homeostasis, leading to tension, irritability, reduced concentration, hallucinations, reversible personality changes, paranoia and exhaustion.

1.3 FUNCTION OF SLEEP 1

The effect of sleep on the body are not completely understood. Sleep exert psyologic effect on both the nervous system and other structure. Sleep in some way restore normal level of activity and normal balance among parts of the nervous system. Sleep is also necessary for protein synthesis, which allows repair processes to occur. The role of sleep in psychological well being is best noticed by the deterioration in mental functioning related to sleep loss. Persons with inadequate amounts of sleep tend to because emotionally irritable, have poor concentration, and experience difficulty making decisions. 1.4 NORMAL SLEEP PATTERN AND REQUIREMENT

Newborns sleep 16 to 18 hours a day Infants sleep 14 to 15 hours a day Toddlers sleep between 12 to 14 hours a day Preschoolers requires 11 to 13 hours a day School-age Children needs 10 to 11 hours of sleep Adoloscent require 9 to 10 hours of sleep Adults need7 to 9 hours of sleep a night

Monitoring an individuals sleep and rest patterns Monitoring a clients sleep and rest patterns is undertaken to identify usual and current ability, to identify actual and potential problems and to facilitate the evaluation of medical treatment and nursing interventions. Equipment Clock Care records or appropriate chart for recording, if required

Procedure Rationale Ensure adequate understanding of the To reduce anxiety, promote client coneed to monitor sleep and rest patterns operation and obtain informed consent (if appropriate) If appropriate introduce the concept of a To encourage active involvement in the sleep diary whereby the client care process selfdocuments periods of sleep, rest, activity and wakefulness Unobtrusively observe throughout 24 hours the client To increase the potential for accuracy NB Whilst care should be taken not to disturb sleeping patients during observation, it is important to ensure that the patient is indeed sleeping and not just lying with their eyes closed or in a state of unconsciousness Accurately record periods of sleep, rest To determine whether a balance is being and levels of activity achieved Compare your perceptions of the clients To maintain a partnership approach and sleep and rest pattern with the clients increase the potential for accuracy, as misconceptions can occur. Remember, a few minutes awake at night can sometimes seem like hours, particularly if you are cold, lonely, worried or anxious. Also the quality of sleep is as equally important as quantity. If the patient does not feel refreshed or rested then this needs to be addressed Monitoring the respiratory rate and Breathing is usually slower, deeper and pattern can often assist in determining rhythmical during sleep whether the client is actually asleep Record amount and patterns of sleep and Legal requirement to maintain

rest. Ask the client to keep a diary of documentation and safeguard client their perception of the amount of sleep through good communications

and rest they believe they are getting, and compare findings Report any discrepancies or sleep and To facilitate care planning rest deficit If a balance between activity and rest is To ensure optimum care not being achieved, reassess the client and amend the care plan accordingly in consultation with the client and other members of the multidisciplinary team Assisting individuals to achieve a balance between activity and rest Sleep and rest are essential human needs. Assisting individuals to achieve a balance between rest and activity is therefore a crucial nursing intervention. The strategies to promote relaxation and facilitate sleep and rest are given below. Equipment As appropriate for the selected intervention. Strategies to promote relaxation and Rationale facilitate sleep and rest Promote a feeling of control over the situation the client finds him-/herself in Provide an environment conducive to sleep and rest by: Ensuring privacy and dignity Ensuring lighting is subtle Controlling room temperature Ensuring good ventilation Speaking quietly and avoiding unnecessary conversation in the vicinity of resting clients To reduce environmental stimuli To increase feelings of worth To maintain and increase clients level of independence

 Wearing soft-soled shoes as telephones, alarms, machinery, banging doors and movement of equipment Giving prompt care Prioritizing care needs Planning care delivery to coincide with periods of wakefulness Making sure the bed/chair is clean,

A quiet environment increases the

Reducing environmental noise such likelihood of rest and sleep

Reduces stress and anxiety To reduce disturbances Comfort is conducive to sleep and rest

dry and comfortable Adhere to clients established pre-sleep Promotes psychological well-being rituals/routines Minimize stress and anxieties Promotes psychological well-being Administer pain relief as prescribed, and Promotes comfort evaluate effectiveness Encourage client to empty bladder To reduce the potential for waking before retiring Reduce fluid intake prior to retiring To reduce the need to wake to urinate Encourage the client to avoid caffeine To reduce internal stimuli products such as tea, coffee and chocolate. Hot milky drinks can help induce sleep Encourage the client to avoid alcohol Alcohol is a stimulant Discourage the client from eating To reduce metabolism and to promote immediately prior to retiring and eating comfort heavy meals late at night Discourage inappropriate daytime To reduce the risk of an inverted

napping sleeping pattern Encourage daily exercise in keeping with To achieve a balance between rest clients Abilities and activity Provide appropriate daytime mental and To induce tiredness physical stimulation Educate the client regarding the need for To aid independence a balance between activity and rest, and 5

correct any misconceptions Offer to stay with the client until they To reduce fear and anxiety fall asleep, or provide an alarm or monitoring system Provide cutaneous stimulation such as Aids relaxation offering a warm bath, cold compress or massage Employ appropriate relaxation To ensure compatibility with clients

techniques as agreed with the client and wishes, condition and other treatments rest of the multidisciplinary team (see Table 12.1). NB Complementary therapies should be used with caution as many are as yet unproven Administer sedation as prescribed and To prevent harm monitor effect. NB This should be an intervention of last To induce sleep resort as many sedatives, hypnotics and anxiolytics have undesirable side effects and can be addictive Monitor clients pattern, quantity and To aid evaluation and reassessment of quality of sleep and rest care needs

For children night-time sleep patterns are often hard to establish, and times for going to bed are often arranged around family routines. To avoid angering parents it is therefore important to stick to the childs established bedtime, as reestablishing the pattern later may be very troublesome. From the age of about 4 months a child needs less and less sleep during the day, until about the age of 4 years when no daytime sleep is required. Adhering to daytime sleep patterns is as important as night-time patterns as the child will become irritable and cross if sleep is denied. It may also then be

difficult to get the child to sleep later. Signs of a child being ready for sleep include incessant crying, unco-operative behaviour and irritability. Finally, as a point of note, waking in the night during nightmares or for a drink is quite common in children and can also occur in ill adults, particularly older clients and those suffering from depression, where early morning waking may also be manifest. In these cases reassurance should be given as these clients are often confused and disorientated. Assessing an individuals needs in relation to sleep and rest Remember that assessment of an individuals sleep and rest patterns is only part of a holistic nursing assessment and should not be undertaken in isolation without reference to or consideration of the clients other activities of living. Specific points to consider when assessing an individuals sleep and rest patterns include: Physical Age of client: the older person tends to sleep less, spend more time in bed and have comparatively less REM sleep Gender: men have more disturbances in sleep than women Hunger/thirst/diet Frequency of micturition Any pain and/or discomfort? Presence of cough or other breathing difficulties? Do they have any itching or cramp? Influence of body position, for example unable to sleep on back/side Daytime napping Degree of daytime activity/exercise Physical illnesses that may inhibit sleep and rest, for example thyrotoxicosis (overactive thyroid gland), sleep apnoea Quantity and quality of sleep and rest Sleep diary Early waking or inability to return to sleep? 7

What is the clients normal pre-sleep routine? Do they normally use any particular relaxation techniques? Have they been using any hypnotics or sedation? Are they on any other medications that might affect their ability to sleep and rest? Do they have an established sleep pattern? Does the patient awaken in the night? If so, why and how often? Are they able to get back off to sleep easily? Psychological Is the client under any stress? Anxiety often causes difficulty in getting off to sleep If a child, do they have a comforter, for example a teddy bear or blanket? Depression can cause early waking Do they experience hysteria or irritability? Are they confused or disorientated? Fear of sleeplessness Fear of dying Loss of partner Changes in time zones Bedtime rituals, for example normal time for retiring Boredom/excitement Dreams/nightmares Feelings of security/insecurity/loss of control Sociocultural Health beliefs/values Do they normally sleep indoors or outside? In a bed or on the floor? Do they seem obsessed about the need for sleep? Do they sleep alone or with a partner? 8

Are they able to sleep in the presence of others? Disturbances by babies or small children? Do they normally sleep in the day or night? Environmental Temperature too hot or cold Lights too light or dark Type of bed, chair, bedding Amount of daytime stimuli Monotony Noise Incompatible institutional schedules of activity/rest Where do they normally sleep? Politico-economic Limited finances Employed/unemployed Type of employment physical/sedentary Shift work Poor heating Poor diet Past history Any related/unrelated illness, for example clinical depression? Recent long-distance travel between different time zones Family difficulties Client/carer expectations Techniques used to relax clients Relaxation technique Aromatherapy Uses Some are particularly useful if the client

is anxious or overstimulated. Others can help reduce pain and discomfort in some individuals and promote a feeling of well-being. Care must be taken, however, to ensure that their use is compatible with the clients condition and current orthodox treatment This can help clients readjust any Behavioural conditioning maladaptive behaviours/coping mechanisms that might be inhibiting sleep and rest Aids ventilation and circulation, and Deep breathing exercises reduces the individuals potential to develop a chest infection, whilst having a calming effect Whilst involving varying degrees of physical activity, which should be determined in consultation with other Physical exercise/sport members of the multidisciplinary team, exercise can actually aid sleep and rest by providing an alternative stimulus to the brain and musculature Some herbs such as lavender and camomile are thought to combat stress and thus aid rest and sleep in some Herbal medicines individuals. Care must be taken, however, to ensure that their use is compatible with the clients condition and current orthodox treatment Can be useful for clients who are stressed or in pain or Discomfort Dependent on the material selected, can be used to stimulate or relax the 10

Massage Music therapy

Reading

individual Dependent on the material selected, can stimulate or relax the individual Encourages systematic relaxation and is useful in clients who are stressed or anxious Useful for individuals who find it difficult to switch off mentally Can be used to refresh the body and mind at stressful times

Relaxation tapes

Visualization techniques Yoga

1.5 FACTOR AFFECTING SLEEP A. Factors that affect sleep may be inhibitory or enhancing, and be: physical, arising from alteration in the structure, function or processes of the body systems, for example pain (inhibitory) or warmth (enhancing)

psychological, for example anxiety and stress (inhibitory) or sociocultural, for example mixed-sex wards/bays (inhibitory) or in environmental, for example noise that may be inhibitory, such as a politico-economic, for example financial problems (inhibitory) or

contentment (enhancing) ones own home (enhancing)

loud bang, or enhancing, as in soothing music financial security (enhancing). B. Both of quality and the qauantity of sleep are affected by a number of factors. Sleep quality is a subjective characteristic and is often determined by whether a person wakes up feeling energetic or not. Quantity of sleep is the total time the individual sleep.

11

Illness : illness that causes pain or physical distress ( e.g., arthritis, back pain ) can result in sleep problems. Environment : environment can promote or hinder sleep. Any change for examples, noise in the environment can inhibit sleep. Lifestyle : following an irreguler and nighttime schedule can affect sleep. Emotional stress : stress is considered by most sleep experts to be the number one cause of short term sleeping difficulties. Stimultans and alcohol : caffeine containing beverages act as stimultans of the central nervous system. Drinking beverages containing caffeine in the afternoon or evening may intefere with sleep.

Diet, Smoking : nicotine has a stimulting effect on the body, and smokers often have more difficulty falling asleep than nonsmokers do. Motivation : motivation can increase alertness in some situations ( e.g., atired person can probably stay alert while attending an interesting concern or surfing the Web late at night )

Medications.

1.6 COMMON SLEEP DISORDER Circadian rhythm Early morning waking Sleep cycle Regularly waking at an early hour and being unable to go back to sleep. A recognized symptom of clinical depression Hypersomnia Regularly sleeping more than 89 hours per day. Often associated with weakness, fatigue, learning and memory difficulties Insomnia to do so The inability to sleep despite the desire and/or need

12

Jet lag Disruption of the circadian rhythm due to travelling through different time zones Sleep automatism Sleep diary activity Sleep latency Sleep apnoea Somnambulism Somnolent Taking a long time to get to sleep Periods of interrupted breathing when asleep Sleep walking Sleepy or drowsy Sleep walking A record of periods of sleep, rest, wakefulness and

2.1 CONCLUSION Sleep is a basic human need. which is influenced by many factors of age, environment, etc..if the sleep needs are not met properly then there will be sleep disorders such as insomnia, narcolepsy, hypersomnia, sleep apnea, insufficient sleep, and parasomnias. there aresome things you can do to meet the needs of a person's sleep. 2.2 SUGGESTION more clear in describing the material more resources more neatly in preparing papers more compact in the task each member of the group should be more koorperatif

13

14

REFERENCES

www.bbc.co.uk/science/humanbody/sleep/articles/whatissleep.shtml http://faculty.washington.edu/chudler/sleep.html Fundamental of nursing eight edition,2008. kozier and erbs.USA

15