Nursing Science 101A

Spring 2018
Mod 1 ACTIVITY AND REST
OBJECTIVES: THEORY
At the conclusion of this module, the student will be able to:
1. Define the vocabulary terms found at the beginning of the
assigned readings from Taylor.

2.Describe factors that influence personal hygiene practices.

 Social practices-social groups influence personal hygiene
(frequency of bathing, time of day of bathing, even brushing of
teeth and flossing)

 Personal Preferences-whether to shower or take a tub bath, once

a day or 3xs a day, bath in morning or afternoon or before bed

 Body image-if a pt maintains a neatly groomed appearence

(make-up on everyday, perfume, shampoos hair daily, use their
own toiletries) be sure to get the details of grooming before
making decisions

 Socioeconomic status-be sensitive in considering the pts

economic status influences the ability to reg maintain hygiene

 Health beliefs & Motivation-knowledge about the importance of

hygiene; patient teaching is often needed to foster self-care
hygiene. provide info on a pts health-related issues

 Cultural variables-ppl who are not sensitive to body odor, prefer to

bathe less; do not express disproval; avoid forcing changes
unless it affects the pts health

3.
Discuss conditions that may put a client at risk for impaired oral mucous
membranes.
 ineffective oral hygiene, radiation to head or kneck, dehydration,
trauma (braces, acidic food or drinks, drugs, alcohol) mouth
breather, malnutrition, lack or decreased salivation, medication
4. Describe how hygiene care for the older adult client differs from that
for the younger client.
their skin is thinner and more fragile. Some don't like soap, lotion after
bathing. they get cold faster, some have dentures, depression (feeling of
helplessness)

5. Describe the role of the musculoskeletal and nervous systems in the

regulation of movement.
The skeletal system supports and gives structure to the body. The
muscular system allows for all voluntary and involuntary movement.
However it is the nervous system that is responsible for stimulating the muscles
and causing them to contract. Without the neural impulses of the nervous
system, muscle would simply not work. Via somatic nervous system
6. Describe how to maintain and use proper body mechanics.
Have proper posture, use internal girdle, slide roll, push instead of
lifting, face whatever it is you are lifting. Feet shoulder width. Breaking
down heavy things into parts.

7. Describe principles and techniques for moving and lifting clients that
reduce the nurse’s risk of back injury and muscle strain.
Use proper body mechanics by nbedning at the knees and not exerting
their backs and keep whatever they are lifting close to the center of the
body.

8.
Describe how exercise and activity benefit physiological and
psychological functioning.
 Increased efficiency of the heart
 Decreased heart rate and blood pressure
 Increased blood flow to all body parts
 Improved venous return
 Increased circulating fibrinolysin (substance that breaks up small clots)
 Increased energy, vitality, and general well-being
 Improved sleep
 Improved appearance (body image)
 Improved self-concept
 Increased positive health behaviors

9. Discuss effects of immobility on musculo-skeletal, circulatory,

pulmonary, gastrointestinal, integumentary, and genital/urinary
functioning.
cardiac workload, orthostatic hypotension, and venous stasis, with
resulting venous thrombosis, Immobility (musculoskeletal disuse) leads to
decreased muscle size ( atrophy), tone, and strength; decreased joint mobility and flexibility;
bone demineralization; and limited endurance, resulting in problems with ADLs, increased
mertabolic weight, isturbances in appetite, decreased food intake, altered protein
metabolism, and poor digestion and utilization of food.

10.
Describe the benefits of implementing an exercise program for the
purpose of health promotion.
-physical activity used to condition body, improve health, and maintain
fitness, and therapeutic measure
11.
Discuss appropriate nursing interventions for an immobilized client
(including positioning, range of motion exercises, and use of elastic or
sequential compression stockings).
Positioning•Equipment/devices: Pillows, Mattresses, Adjustable beds,
Bed side rails, Trapeze bar
•Protective Positioning:Fowler’s, Supine or dorsal recumbent, Side-lying
or lateral, Prone. Reposition every 2 hours.
•Range of Motion
•Application of sequential compression devices- used to reduce venous
stasis and deep venous thrombosis after joint replacement.

12. Describe the legal responsibilities and obligation of nurses

concerning the use and supervision of restraints.
the patient must be monitored and assessed at least every hour or
according to agency policy. An inpatient psychiatric patient in restraints
requires continual observation, including specific assessments every 15
minutes. Documentation must reflect the date and time the restraint is
applied, the type of restraint, alternatives that were attempted (including
their results), and notification of the patient’s family and physician.
Include the frequency of assessment, your findings, regular intervals
when the restraint is removed, and nursing interventions. Constant re-
evaluation of the need for the restraint is vital.
13.
Explain the effect the 24-hour sleep-wake cycle has on biological
function.
- Circadian rhythm = 24hr day-night cycle
- Predictable change of body temp, HR, BP, hormone secretion, sensory
acuity, & mood depend on maintenance of 24hr cycle
14.
Discuss the mechanisms that regulate sleep.
- Major sleep center = hypothalamus
- Secretes hyocreatins (orexins) that promote wakefulness & REM sleep
- Prostaglandin D2, L-tryptophan & growth factors control sleep
- Reticular activating system (RAS) contains special cells that maintain
alertness/wakefulness
- Bulbar synchronizing region (BSR) = hypothesized that it releases
serotonin from specialized cells
15.
Describe the physiology and stages of a normal sleep cycle.
BOX 33-1
Characteristics of NREM and REM Sleep
NREM Sleep
Stage I
 The person is in a transitional stage between wakefulness and sleep.
 The person is in a relaxed state but still somewhat aware of the surroundings.
 Involuntary muscle jerking may occur and waken the person.
 The stage normally lasts only minutes.
 The person can be aroused easily.
 This stage constitutes only about 5% of total sleep.
Stage II
 The person falls into a stage of sleep.
 The person can be aroused with relative ease.
 This stage constitutes 50% to 55% of sleep.
Stage III
 The depth of sleep increases, and arousal becomes increasingly difficult.
 This stage composes about 10% of sleep.
Stage IV
 The person reaches the greatest depth of sleep, which is called delta sleep.
 Arousal from sleep is difficult.
 Physiologic changes in the body include the following:
 Slow brain waves are recorded on an EEG.
 Pulse and respiratory rates decrease.
 Blood pressure decreases.
 Muscles are relaxed.
 Metabolism slows and the body temperature is low.
 This constitutes about 10% of sleep.
REM Sleep
 Eyes dart back and forth quickly.
 Small muscle twitching, such as on the face
 Large muscle immobility, resembling paralysis
 Respirations irregular; sometimes interspersed with apnea
 Rapid or irregular pulse
 Blood pressure increases or fluctuates
 Increase in gastric secretions
 Metabolism increases; body temperature increases
 Encephalogram tracings active
  REM sleep enters from stage II of NREM sleep and reenters NREM sleep at
stage II: arousal from sleep difficult
 Constitutes about 20% to 25% of sleep

16.
Compare and contrast the sleep requirements of different age groups
and define the considerations necessary for geriatric clients.
BOX 33-2
Developmental Patterns of Sleep
Newborns and Infants
Sleep Pattern
 Newborn: Sleeps an average of 16 hours/24 hours; averages about 4 hours at
a time.
 Each infant’s sleep pattern is unique. On average, infants sleep 10 to 12 hours
at night, with several naps during the day.
 Usually by 8 to 16 weeks of age, an infant sleeps through the night.
 REM sleep constitutes much of the sleep cycle of a young infant.
Nursing Implications
 Teach parents to position infant on the back. This is the only safe sleeping
position for infants less than 1 year old. Sleeping in the prone position
increases the risk for sudden infant death syndrome (SIDS).
 Advise parents that eye movements, groaning, grimacing, and moving are
normal activities at this age.
 Encourage parents to have infant sleep in a separate area rather than their
bed.
 Caution parents about placing pillows, crib bumpers, quilts, stuffed animals,
and so on in the crib because this may pose a suffocation risk.
Toddlers
Sleep Pattern
 Need for sleep declines as this stage progresses. May initially sleep 12 hours
at night with two naps during the day and end this stage sleeping 8 to 10
hours a night and napping once during the day.
 Toddlers may begin to resist naps and going to bed at night.
 They may move from crib to youth bed or regular bed at around 2 years.
Nursing Implications
 Establish a regular bedtime routine (e.g., reading a story, singing a lullaby,
saying prayers).
 Advise parents of the value of a routine sleeping pattern with minimal
variation.
 Encourage attention to safety once child moves from crib to bed. If child
attempts to wander out of room, a folding gate may be necessary across the
door of the room.
Preschoolers
Sleep Pattern
 Children in this stage generally sleep 9 to 16 hours at night, with 12 hours
being the average.
 The REM sleep pattern is similar to that of an adult.
 Daytime napping decreases during this period, and by the age of 5 years,
most children no longer nap.
  This age group may continue to resist going to bed at night.
Nursing Implications
 Encourage parents to continue bedtime routines.
 Advise parents that waking from nightmares or night terrors (awakening
screaming about 20 minutes after falling asleep) are common during this
stage. Waking the child and comforting the child generally helps. Sometimes
use of a night light is soothing.
School-Aged Children
Sleep Pattern
 Younger school-aged children may require 10 to 12 hours nightly, whereas
older children in this stage may average 8 to 10 hours.
 Sleep needs usually increase when physical growth peaks.
Nursing Implications
 Discuss the fact that the stress of beginning school may interrupt normal
sleep patterns.
 Advise that a relaxed bedtime routine is most helpful at this stage.
 Inform parents about child’s awareness of the concept of death possibly
occurring at this stage. Encourage parental presence and support to help
alleviate some of the child’s concerns.
Adolescents
Sleep Pattern
 Sleep needs of teenagers vary widely, but the average requirement is 9 to 10
hours. The growth spurt that normally occurs at this stage may necessitate
the need for more sleep; however, the stresses of school, activities, and part-
time employment may cause adolescents to have a restless sleep.
Adolescents tend to go to bed later than younger children and adults, but
early morning start times for high school frequently require an early
awakening time. This can result in an average of only 7 to 7.5 hours of sleep a
night.
 Many adolescents do not get enough sleep.
Nursing Implications
 Advise parents that their adolescents’ complaints of fatigue or inability to do
well in school may be related to not enough sleep. Excessive daytime
sleepiness (EDS) may also make the teenager more vulnerable to accidents
and behavioral problems.
Young Adults
Sleep Pattern
 The average amount of sleep required is 8 hours, but in fact, many young
adults require less sleep.
 Sleep is affected by many factors: physical health, type of occupation,
exercise. Lifestyle demands may interfere with sleep patterns.
 REM sleep averages about 20% of sleep.
Nursing Implications
 Reinforce that developing good sleep habits has a positive effect on health,
particularly as a person ages.
 If loss of sleep is a problem, explore lifestyle demands and stress as possible
causes.
 Suggest use of relaxation techniques and stress-reduction exercises rather
than resorting to medication to induce sleep. Sleep medications decrease REM
sleep, may be habit forming, and frequently lose their effectiveness over time.
Middle-Aged Adults
Sleep Pattern
 Total sleep time decreases during these years, with a decrease in stage IV
sleep.
 The percentage of time spent awake in bed begins to increase.
 People become more aware of sleep disturbances during this period.
Nursing Implications
 Encourage adults to investigate consistent sleep difficulties to exclude
pathology or anxiety and depression as causes.
 Encourage adults to avoid use of sleep-inducing medication on a regular basis.
Older Adults
Sleep Pattern
 An average of 7 to 9 hours of sleep is usually adequate for this age group.
 Sleep is less sound, and stage IV sleep is absent or considerably decreased.
Periods of REM sleep shorten.
 Elderly people frequently have great difficulty falling asleep and have more
complaints of problems sleeping.
 Decline in physical health, psychological factors, effects of drug therapy (e.g.,
nocturia), or environmental factors may be implicated as causes of inability to
sleep.
Nursing Implications
 A comprehensive nursing assessment and individualized interventions may be
effective in the long-term care of this age group.
 Emphasize concern for a safe environment because it is not uncommon for
older people to be temporarily confused and disoriented when they first
awake.
 Use sedatives with extreme caution because of declining physiologic function
and concerns about polypharmacy.
 Encourage people to discuss sleep concerns with their physicians.

17.
Discuss characteristics of common sleep disorders.
Dyssomnias are sleep disorders characterized by insomnia or excessive
sleepiness. Parasomnias are patterns of waking behavior that appear
during sleep.
Dyssomnia- Insomnia is characterized by difficulty falling asleep,
intermittent sleep, or early awakening from sleep.
Hypersomnia is a condition characterized by excessive sleep,
particularly during the day.
Narcolepsy is a condition characterized by an uncontrollable desire to
sleep.
Sleep apnea, generally referred to as sleep-disordered breathing (SDB),
is a condition in which a person experiences the absence of breathing
(apnea) or diminished breathing efforts (hypopnea) during sleep
between snoring intervals.
People with restless leg syndrome (RLS) cannot lie still and report
unpleasant creeping, crawling, or tingling sensations in the legs.
Parasomnias:
Somnambulism or sleepwalking
REM Behavior Disorder (RBD) is characterized by “acting out” dreams
while asleep
sleep terrors are more common in children and occur during the
deepest stages of sleep.
Bruxism is grinding of one’s teeth
Enuresis is urinating during sleep or bedwetting.
18.
Identify possible non-pharmacological nursing interventions designed to
promote normal sleep cycles for clients of all ages.
Restricting the intake of caffeine, nicotine, and alcohol, especially later
in the day
Avoiding mental and physical activities after 5 PM that are stimulating
Avoiding daytime naps
Eating a light carbohydrate/protein snack before bedtime
Avoiding high fluid intake in the evening so as to minimize trips to the
bathroom during the night
Sleeping in a cool, dark room
Eliminating use of a bedroom clock
Taking a warm bath before bedtime
Trying to keep the sleep environment as quiet and stress-free as
possible (Hedges & Ruggiero, 2012)

19.
Differentiate between anti-anxiety, sedative and hypnotic drug effects.
Hypnotics and sedatives induce sleep The difference between
sedatives and hypnotics, then, is usually the amount of the dose as
sedatives need a higher dose; antianxiety drugs reduce anxiety and
tension. However, the sleep produced by hypnotics is an unnatural
sleep. All these drugs disturb either REM or NREM sleep to some
degree.
20.
Identify medications that may cause the client to suffer insomnia.
Drugs that decrease REM sleep include barbiturates, amphetamines,
and antidepressants(Prozac and Zoloft). Diuretics, antiparkinsonian
drugs, some antidepressants and antihypertensive, steroids,
decongestants, caffeine, and asthma medications are seen as
additional common causes of sleep problems.
21.
State the generic and trade names, normal dosage, actions, side
effects, and nursing
implications of the following:

Ambien (zolpidem)a sedative for isomnia are often prescribed to
promote sleep in older adults because there is less residual sleepiness.
(5mg)

 Can cause paranoid or suicidal ideation and impair memory, judgment, and
coordination. Combining with other substances, particularly alcohol, can slow
breathing and possibly lead to death.
Dalmane (flurazepan): hypnotic agent
It can treat difficulty sleeping (insomnia).
Can cause paranoid or suicidal ideation and impair memory, judgment,
and coordination. Combining with other substances, particularly alcohol,
can slow breathing and possibly lead to death.
30 mg

Ativan (lorazepam)
 Sedative / antianxiety
It can treat seizure disorders, such as epilepsy. It can also be used before surgery
and medical procedures to relieve anxiety.
Can cause paranoid or suicidal ideation and impair memory, judgment, and
coordination. Combining with other substances, particularly alcohol, can slow
breathing and possibly lead to death.
2 to 3 mg/day
Restoril (temazepan). Sedative
It can treat insomnia.
Can cause paranoid or suicidal ideation and impair memory, judgment, and
coordination. Combining with other substances, particularly alcohol, can slow
breathing and possibly lead to death.

short-term treatment of insomnia (generally 7 to 10 days). ( 15mg)