FUNDAMENTALS OF NURSING

2.  Rest
 Rest is a condition in which the body is in a decreased state of
activity without physical emotional stress and freedom from anxiety.
 Sleep
 Sleep is a state of rest accompanied by altered level of consciousness
and relative inactivity, and perception to environment are decreased.

3.  The cyclic nature of sleep is thought to be controlled by Centers
located in the brain and by Circadian Rhythms.
 Reticular activating system (RAS) located at the brain stem and
Cerebral Cortex plays an important role in sleep wake cycle.
 Sleep begins with the activation of the pre optic area of the anterior
hypothalamus.
 Sleep promoting neurons act over wake promoting neurons by
releasing Gamma Amino Butyric Acid (GABA).
 The inhibition of wake promoting neurons results in intensifying
sleep process.

4.  Another key factor to sleep is exposure to darkness.
 Darkness and preparing for sleep (e.g., lying down, decreasing noise)
cause a decrease in stimulation of the RAS.
 During this time, the Pineal gland in the brain begins to actively
secrete the natural hormone Melatonin, and the person feels less
alert.
 With the beginning of daylight, Melatonin is at its lowest level in the
body and the stimulating hormone, Cortisol , is at its highest
causing wakefulness.

5.  It is a sort of 24-hour internal biological clock.
 The term circadian is from the Latin “circa dies”, meaning “about a
day.”
 Biological rhythms exist in plants, animals, and humans.
 In humans, these are controlled from within the body and
synchronized with environmental factors, such as light and
darkness.

6.  Electroencephalogram (EEG) patterns, eye movements and muscle
activity are used to identify stages of sleep.
 The stages of sleep are classified into two stages:
1. Non Rapid Eye Movement (NREM) Sleep
o Stage 1
o Stage 2
o Stage 3
o Stage 4
2. Rapid Eye Movement Stage(rem) Sleep.

7. EEG

8.  First stage of sleep is known as NREM sleep.
 About 75% to 80% of sleep during a night is NREM sleep.
 It consists of four stages:
o Stage 1
o Stage 2
o Stage 3
o Stage 4

9.  Stage lasts a few minutes.
 It includes lightest level of sleep.
 Gradual fall in vital signs and metabolism.
 General slowing of EEG frequency.
 Eyes tend to roll slowly from side to side.
 Sensory stimuli such as noise easily arouses person.
 Sleeper may deny he is sleeping.

10.  Stage lasts 10 to 20 minutes.
 It is a period of sound sleep.
 Relaxation progresses.
 Further slowing of EEG.
 Absent eye ball movements.
 Body functions continue to slow.
 Arousal remains relatively easy.

11.  Stage lasts 15 to 30 minutes.
 It involves initial stages of deep sleep.
 Muscles are completely relaxed.
 Large slow waves in EEG .
 Vital signs decline but remain regular.
 Sleeper is difficult to arouse and rarely moves.

12.  Stage lasts approximately 15 to 30 minutes.
 It is the deepest stage of sleep.
 If sleep loss has occurred, sleeper spends considerable portion of
night in this stage.
 Vital signs are significantly lower than during waking hours.
 Further slowing of EEG.
 Sleepwalking and enuresis (bed-wetting) sometimes occur.
 It is very difficult to arouse sleeper.

13.  Stage usually begins about 90 minutes after sleep has begun.
 Dreaming occurs in this stage.
 Stage is typified by rapidly moving eyes, fluctuating heart and
respiratory rates, increased or fluctuating blood pressure, loss of
skeletal muscle tone, and increase of gastric secretions.
 EEG pattern resembles that of awake state.
 It is very difficult to arouse sleeper.

16.  Conservation of energy
 Restoration of tissues and growth
 Thermoregulation
 Regulation of emotions- sleep deprivation causes emotional
disorders like irritability, anxiety, depression etc.
 Neural maturation
 Memory and learning- there will be information transfer between
cerebral cortex and hippocampus during sleep

17.  Newborn: 16-18 hours /day
 Infants: 12-14 hours
 Toddlers: 10-12 hours
 Preschool: 11-12 hours
 School-Age: 8- 12 hours
 Adolescents: 8-10 hours
 Adult: 6-8 hours • Elders: 6 hours

18.  Both the quality and the quantity of sleep are affected by a number
of factors.
 Sleep quality is a subjective characteristic.
 Quantity of sleep is the total time the individual sleeps.
1. Age
2. Illness
- Illness that causes pain or physical distress (e.g., arthritis, back-
pain) can result in sleep problems.
- E.g. Respiratory conditions, Pain, need to urinate during the night

19. 3. Environment
- Environment can promote or hinder sleep
- Any change—for example, noise in the environment—can inhibit
sleep.
- The absence of usual stimuli or the presence of unfamiliar stimuli
can prevent people from sleeping.
- Discomfort from environmental temperature (e.g., too hot or cold)
and lack of ventilation can affect sleep.

20. - Light levels can be another factor.
- Another influence includes the comfort and size of the bed.
- A person’s partner who has different sleep habits, snores, or has
other sleep difficulties may become a problem for the person also.
4. Lifestyle
- Following an irregular morning and night time schedule can affect
sleep.
- Night shift workers frequently obtain less sleep than other
workers and have difficulty falling asleep.

21. 5. Emotional Stress
- Stress is considered to be the major cause of short-term sleeping
difficulties .
- A person preoccupied with personal problems (e.g., school- or job-
related pressures, family or marriage problems) may be unable to
relax sufficiently to get to sleep.
6. Stimulants and Alcohol
- Caffeine-containing beverages act as stimulants of the central nervous
system (CNS).

22. - Drinking beverages containing Caffeine in the afternoon or
evening may interfere with sleep.
- Even though alcohol induces sleep, it disturbs REM sleep causing
irritability.
7. Diet
- Certain foods induces sleep.
- Ex: the L- tryptophan present in the milk induces sleep.

23. 8. Smoking
- Nicotine has a stimulating effect on the body, and smokers often
have more difficulty falling asleep than non smokers.
- Smokers can be easily aroused.
9. Motivation
- Motivation can increase alertness in some situations
- Ex: During the time of examination Browsing internet in the late
night

24. 10. Medications
- Beta-blockers have been known to cause insomnia.
- Narcotics, such as morphine, are known to suppress REM sleep
and to cause frequent awakenings and drowsiness.
- Most Hypnotics suppresses REM sleep

25.  Insomnia is described as the inability to fall asleep or remain asleep.
 Difficulty falling asleep
 Waking up frequently during the night
 Difficulty returning to sleep
 Waking up too early in the morning
 Unrefreshing sleep
 Daytime sleepiness
 Difficulty concentrating
 Irritability

26.  Hypersomnia refers to conditions where the affected individual
obtains sufficient sleep at night but still cannot stay awake during
the day.
 Narcolepsy is a disorder of excessive daytime sleepiness caused by
the lack of the chemical hypocretin in the area of the CNS that
regulates sleep.
 Sleep Apnea is characterized by frequent short breathing pauses
during sleep.

27.  Sleep deprivation
A prolonged disturbance in quality and quantity of sleep can lead to
a syndrome called as sleep deprivation.
Individual may develop-
Attention and concentration deficits
Reduced vigilance
Distractibility
Reduced motivation
Fatigue
Diplopia and dry mouth.

28.  Parasomnias
Something abnormal occurs during sleep itself, or during the times
when the client is falling asleep or waking up.

29. 1. Sleep-Wake Pattern
 Maintain a regular bedtime and wake-up schedule
 Eliminate day time naps. If naps are taken, limit to 20 minutes or
less twice a day
 Instruct the client to go to bed when sleepy.
 Use warm bath and relaxation techniques
 If unable to sleep in 15 to 30 minutes, get out of bed and pursue
some relaxation activity.

30.  Establish a regular, relaxing bedtime routine before sleep such as
reading, listening to soft music, taking a warm bath, or doing
some other quiet activity.
 Avoid dealing with office work or family problems before bedtime
 Get adequate exercise during the day to reduce stress, but avoid
excessive physical exertion at least 3 hours before bedtime.

31. 2. Environment:
 Create a sleep-conducive environment that is dark, quiet,
comfortable, and cool.
 Keep noise to a minimum; block out extraneous noise as necessary
with white noise from a fan, air conditioner.
 Sleep on a comfortable mattress and pillows.
 Listen to relaxing music
 Increase exposure to bright light during the day

32. 3. Diet:
 Limit alcohol, caffeine, and nicotine in late afternoon and evening
 Consume carbohydrates or milk as a light snack before bedtime.
 Avoid heavy and spicy foods. Heavy or spicy foods can cause
gastrointestinal upsets that disturb sleep
 Decrease fluids 2 to 4 hours before sleep

33. 4. Medications:
 Use sleeping medications only as a last resort
 Minimize the usage of medicines as much as possible because
many contain antihistamines that cause daytime drowsiness.
 Take analgesics 30 mins before bedtime to relieve aches and pains.
 Consult the health care provider about adjusting other
medications that may cause insomnia.