Fundamentals of nursing

1. Fundamentals of nursing
Topic: exercise, rest and sleep
Presenter :
MACLEANS HANGOMA
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2. Introduction
• Exercises can contribute to more sound and
restful sleep.
• Physical activity increases time spent in deep
sleep.
• Chronic sleep deprivation has been shown to
increase the risks for mental illness.
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3. Introduction cont..
• Deep sleep helps to boost immune
function, support cardiac health and
control stress and anxiety
• Poor sleep and sleep related disorders
have had a significant impact on health.
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4. General objective
• At the end of the lecture/discussion
students should gain knowledge on
exercise, rest and sleep
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5. Specific Objectives
• At the end of the lesson students should be
able to:
• Define Exercise, Rest and Sleep.
• Discuss types of exercise.
• Discuss the importance of exercise
• Discuss the physiology of sleep.
• Discuss the stages of sleep.
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6. Specific Objectives Cont ..
• Outline the general principles of rest and
sleep.
• Discuss factors affecting rest and sleep.
• List the measures to promote rest and sleep
• Outline the rehabilitative measures.
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7. Definitions
• Exercise
• It is a physical or mental activity that you
do to stay healthy or to become strong.
(WHO, 2019).
• This is the performance of physical
exertion for improvement of health or
correction of physical deformity.
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8. Definitions cont’
• Rest
• Refers to a state of relaxation and
calmness, both mental and physical.
• Activity during rest periods can range
from lying down to reading a book to
taking a quiet walk. (D’Arcy, 2008).
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9. Definitions cont’
• Sleep
• Refers to a state of altered consciousness
during which an individual experiences
minimal physical activity and a general
slowing of the body’s physiological
processes.
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10. Types of Exercises
• Passive Exercises: This is the motion
imparted to a segment of the body by
another individual, or a machine or other
outside forces.
• Active Exercises: This is the type of
exercises a patient can do himself or herself.
• This is the motion imparted to a part of the
body by voluntary contraction and relaxation
of its controlling muscles.
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11. Importance of Exercises
• Promotes and develops good muscle tone.
• Stimulates circulation of blood.
• Prevents complications like deep vein
thrombosis.
• Prevents disability especially in burns.
• For better body alignment.
• Prevents constipation by improving and
maintaining the tone of the muscles used for
defecating.
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12. Importance of Exercises cont.
• It promotes the flow of urine and emptying of
the bladder.
• Aids in the prevention of bed sores
• Prevents postural deformation which may occur
due to prolonged joint immobility.
• Stimulates the nervous system resulting in
improved condition and status of the patient.
• It helps to prevent cardiovascular
complications.
• It meets all human basic needs for movement
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13. Importance of Rest and Sleep
• It is essential for the worn out body tissues
from activities to restore themselves.
• Rest facilitates resting of body organs.
• Sleep reduces stress, anxiety and tension.
• Helps the person to regain energy for
concentration, coping and maintaining
interest in daily activities.
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14. Physiology of Sleep
• Sleep is a cyclic physiological process that
alternates with longer periods of wakefulness.
• The sleep-wake cycle influences and regulates
physiological function and behavioural
responses.
• Current theories indicates sleep is thought to
be an active inhibitory process.
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15. Physiology of Sleep cont..
• Control and regulation of sleep may
depend on the interrelationship between
two cerebral mechanisms that
intermittently activates and suppress the
brain’s higher centers to control sleep
and wakefulness.
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16. Physiology of Sleep cont..
• One mechanism causes wakefulness
whereas the other causes sleep. (Cortisol
and melatonin).
• The Ascending reticular Activating System
(RAS) located in the upper brain is believed
to contain special cells that maintain
alertness and wakefulness.
• The RAS receives visual, auditory, pain, and
tactile Sensory stimuli.
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17. Physiology of Sleep Cont…
• Activity from the central cortex (e.g.
emotions or thoughts process) also
stimulates the RAS.
• Wakefulness results from the neurones in
the RAS that releases catecholamine such
as norepinephrine.
• Sleep may be produced by the release of
serotonin from specialised cells in the raphe
sleep system of the pons and medulla.
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18. Physiology of Sleep Cont…
• Whether a person remains awake or falls
asleep depends on a balance of impulses
received from higher centres (thoughts),
peripheral sensory receptors (sound or light
stimuli) and the limbic system (emotions).
• As people try to fall asleep, they close their
eyes and assume relaxed positions. Stimuli to
the RAS decline.
• If the room is dark and quiet activation of the
RAS further declines. At some points the pons
and the medulla takes over causing sleep. 18

19. Fig 1. Reticular activating
system (RAS)
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20. Stages of Sleep
• Electroencephalograph (EEG) patterns, eye
movements, and muscle activity are used to
identify stages of sleep. The stages of sleep
are classified in two categories: non–rapid
eye movement (NREM) and rapid eye
movement (REM) sleep.
• Stage 1. Is very light sleep. The person
feels drowsy and relaxed. The sleeper can be
readily awakened. This stage lasts for few
minutes. 20

21. Stages of Sleep cont..
• Stage 2. Light sleep during which the
body processes continue to slow down.
• The eyes are generally still, the heart
and respiratory rates decrease slightly,
and the body temperature falls.
• This stage lasts about 10 – 15 minutes.
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22. Stages of Sleep cont..
• Stage 3. Occurs when the respiratory
and the heart rates and other body
processes slow down further because of
domination of the parasympathetic
nervous system.
• The sleeper becomes more difficult to
arouse.
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23. Stages of Sleep cont..
• Stage 4. Signals deep, deep called
delta. The sleeper’s heart and respiratory
rates are 20 – 30% below waking rates.
• sleeper is very relaxed, rarely moves, and
is difficult to arouse.
• During this stage the eyes usually roll
and some dreaming occur.
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24. General Principles of Rest and
Sleep
• Procedures in the ward should be done at
once to avoid disturbance of the patient.
• Tension should be eased by adequate
explanation given to the patient before any
procedure is done.
• Noise should be avoided.
• Limit the number of Visitors
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25. General Principles of Rest and
Sleep cont’
• Physical comfort should be provided to the
patient by ensuring the following:-
• Relive pain
• Empty the bladder before sleep
• Changing of positioning
• Provide dim lighting
• Proper ventilation on the ward.
• Provide adequate warmth.
• Maintain hygiene for instance brushing teeth
before bed time
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26. Factors affecting Rest and
Sleep
• Illness: - increases the need for sleep, but
disease often disrupts normal sleep rhythms.
• Environmental factors: - can either enhance
or impair sleep.
• Lighting, temperature, odors, ventilation, and
noise level can all interrupt the sleep process
when they differ from the norms of the client’s
usual sleep environment.
• Emotional stress:- Anxiety often results in
difficulty falling asleep or staying asleep 26

27. Factors affecting Rest and
Sleep cont’
• Diet: - type of food consumed has an impact
on the quality and quantity of sleep. Foods
high in caffeine, such as coffee, cola, and
chocolate, serve as stimulants and often
disrupt the normal sleep cycle.
• A large, heavy, or spicy meal just before
bedtime may cause indigestion, which will
likely interfere with sleep. Conversely, going
to bed when hungry can also result in sleep
problems 27

28. Factors affecting Rest and
Sleep cont’
• Lifestyle;- having a work schedule that
does not coincide with an individual’s
biological clock (e.g., working at times
other than the day shift).
• Individuals who frequently change work
shifts have a real challenge trying to
stabilize biological rhythms and rest.
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29. Factors affecting Rest and
Sleep Cont…
• Drugs and Other Substances:-Alcohol and
nicotine use can impair sleep. Small amounts
of alcohol may help some people fall asleep;
however, in others alcohol may interfere with
REM sleep, causing very restless and non-
refreshing sleep.
• Nicotine, which is a stimulant, can also
impair the sleep cycle by stimulating the
body, resulting in difficulty falling and staying
asleep 29

30. Factors affecting Rest and
Sleep Cont…
• Many medications (both prescription and over
the counter) cause fatigue, sleepiness,
restlessness, agitation, or insomnia, thus
affecting the quality and quantity of rest and
sleep.
• Cultural: - some patient fears the hospital
environment as stranger (procedures, light,
and uniform for nurse). Cultural or ethnic
customs may have an impact on a client’s
ability to achieve rest and sleep.
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31. Factors affecting Rest and
Sleep Cont…
• Degree of Comfort- Comfort is a highly
subjective experience.
• The nurse must assess the degree to which
the client’s physical and psychological needs
have been met.
• Whenever basic needs are unmet, the
person experiences discomfort, which leads
to physiological tension, resultant anxiety,
and potential impairments in sleep and rest.
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32. Recommended hours of
sleeping
• Neonate (birth to 1 month) sleeps in 3 to 4
hour intervals for a total of about 16 to 20
hours a day.
• Infant (1month to 2 years) averages
about 12 to 16 hours of sleep a day with
naps 2 to 3 times during the day.
• Toddlerhood (2 to 3 years) average sleep
is 12 to 14 hours at night with 1 to 2 naps
during the day.
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33. Recommended hours of
sleeping cont’
• Pre-school child (4 to 6 years) sleeps approximately
10 to 12 hours a day. Daytime napping decreases or
ceases, unless cultural norms dictate otherwise.
• School-age child (7-8years) sleep 10 to 12 hours of
sleep daily
• Adolescents sleep about 8 to 10 hours a day and
often decide their bedtime routines and hours.
• Middle-age adult sleeps about 6 to 8 hours a day
• Older adult - sleeps 5 to 7 hours a day.
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34. Measures to Promote Rest
and Sleep
• Eliminate noise
• Patients should not be hungry, provide a snack
where possible, for instance a glass of milk.
• Give water to patients who may need it at night
for instance full the jugs and put them within
reach of patient.
• Prepare the patient by giving a bedpan or urinal.
• Blankets should be adequate for warmth because,
a well-made and clean bed promotes sleep.
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35. Measures to Promote Rest
and Sleep cont’
• Prescribed medications should be given
early to help patients sleep for instance
analgesics for pain.
• Tell the patient to be free to ask for help.
• Give the patient a soothing bath.
• Reading or watching a movies.
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36. Rehabilitative measures
• sleep can be enhanced by the following
measures;
• Encourage client to establish a bed time routine
and a regular sleep pattern to help induce
sleep.
• Clients should limit intake of caffeine, nicotine
and alcohol before bed time because they are
stimulants and may cause difficulties in falling
asleep, and alcohol fragment sleep.
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37. Rehabilitative measures cont’
• Clients should avoid stressful concerns before bed
time because this may stimulate them and
prevent sleep.
• They should adjust the environment, that is
controlling noise, temperature and lighting in the
bed room to provide a conducive environment to
sleep
• Clients should avoid exercises 2-3hours before
bed time because they stimulates the client and
prevent sleep.
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38. Summary
• We have come to the end of our Lecture/
Discussion. We have defined exercise as a
physical or mental activity that you do to stay
healthy or to become strong; Rest as a state
of relaxation and calmness, both mental and
physical.
• Activity during rest periods can range from
lying down to reading a book to taking a quiet
walk and Sleep as a state of altered
consciousness during which an individual
experiences minimal physical activity and a
general slowing of the body’s physiological
38

39. Summary cont..
• We have also discussed about the importance
of the rest and sleep which facilitates resting
of body organs. The principles of sleep such
as never go to sleep with an empty stomach,
full bladder or after a heavy fatty meal.
• Sleep pattern is regulated by the
diencephalon structures and the reticular
activating system and we further discussed on
the four stages of sleep, factors that affect
sleep such as emotional stress. 39

40. Evaluation
• What is exercise, rest and sleep?
• What are the types of exercises?
• What is the importance of exercises?
• What is the importance of sleep?
• What are the principles of rest and
sleep?
• What measures can be carried out to
promote rest and sleep?
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41. Assignment
• What are the factors that influence rest
and sleep? Due next class
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42. References
• Ramont, Niedringhaus, Towle. (2006).
Comprehensive Nursing Care, 5th edition.
Santa Ana California Corinthian College Inc.
• Patricia K. Ladner, DeLaune .C. (2008).
Fundamentals of Nursing Standards &
Practice 4th Edition. William Carey University
United Kingdom.
• World Health Organization (2019). Physical
Activity.
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