Chapter 18

Comfort, Rest,and Sleep

COMFORT(state in which a person is relieved of distress) facilitates rest(waking state characterized by reduced activity and mental stimulation) and sleep(state of arousableunconsciousness). A safe, clean, and attractiveenvironment is essential for comfort.The term environment here refers to the room, where the client receives nursing care and its furnishings.

Client Rooms:Client rooms likes bedrooms,and not as was thought the white, sterile environments.Client rooms are now brighter, more colorful, andtastefully decorated. Walls:Blue and colors with blue, such as mauve and lightgreen, promote relaxation, so these color schemes are preferred within health care settings and client rooms.

The floors: in client rooms facilitatethe cleaning of spills.

Lighting:Adequate lighting, both natural and artificial, is important to the comfort of clients and nursing personnel. Hospitals should facilitate exposure tosunlight.Bright artificial light facilitates nursing care but is not comfortableto client. Therefore, most client roomshave multiple lights in various locations with adjustableintensity. Dim light and darkness promote sleep; however,injuries are more likely in dark and unfamiliar environments.

Climate Control, promotes the client’s comfort

TEMPERATURE AND HUMIDITY.

Most clients are comfortable when the room temperature is 20°to23°C. If the environmental temperature becomes greaterthan the skin temperature, sweatin regulates body temperature. If the humidity is high, sweataccumulates and drips from the skin. Many agencies areair-conditioned.

VENTILATION,

In hospitals, openwindows are a fire and safety hazard, and ceiling fansspread infectious microorganisms. Consequently, ventilation usually occurs through a system of air ducts thatcirculate air in and out of each client room.Poorly ventilated rooms and buildings tend to smellbadly. Removing soiled articles, emptying bedpans andurinals, and opening privacy curtains and room doorshelp to reduce odors. Using an air freshener may be uncomfortable for ill clients. Midwives should be careful about their own body and oral hygiene, refrainfrom wearing strong perfume.

Furnishings:Manufacturers of hospital furnishings attempt to designequipment that is both attractive and practical. The bed and its components, mattress and pillow, chairs,

BED: Full or half side rails are attached to the bed frame. The bed sides must be used to provide safety for the client NOT to limit the client than seek nursing assistance. Side \s movement. The hospital bed is adjustable. This means we can raise or lower specific parts of the bed as needed and for more comfort for the client

MATTRESS. A good mattress adjuststo the shape of the body while supporting it. A mattressthat is too soft alters the alignment of the spine, causingsome people to awaken feeling sore from muscle and joint strain.Because mattressesare washed but not sterilized between uses, they are covered with a waterproof coating that withstands cleaningwith strong antimicrobial solutions.

PILLOWS, Pillows primarily are used for comfort, butthey also are used to elevate a part of the body, relieveswelling, promote breathing, or help to maintain a therapeutic position.

BED LINEN. The linen used for most hospital beds includesthe following articles:

•Bottom sheet that is sometimes fitted

•Optional draw sheet that is placed beneath the client’ships

•Top sheet

•Blanket, depending on the client’s preference

•Spread

•Pillowcase

Some hospitals use printed sheets to provide a more home-like atmosphere.Bed linen may not be changedevery day, but any wet or soiled linen is changed as frequently as necessary. Skill 18-2 explains howto make an occupied bed(changing linen while the clientremains in bed). It would be appropriate to changesome linen when providing client care or it is more appropriate to change all linen.

Privacy Curtain, It can be drawn completely around eachclient’s bed. The privacy curtain preserves the client’s dignity and modesty whenever it is necessary to examine orexpose her for care.

Overbed Table, An overbed table is a portable, flat platform positionedover the client’s lap. The height of the table is adjustable. It helps the clientto eat while in bed and to perform personal hygiene orother activities requiring a flat surface. Midwives also usethe overbed table to hold equipment when providingclient care.

Bedside Stand, A bedside stand is actually a small cupboard. It usuallycontains a drawer for personal items and two shelves. Theupper shelf is used to store the client’s clean items such as: bath basin, soapdish, soap, and a kidney-shaped basin (emesisbasin). The lower shelf is used to store dirty items.

Chairs, Generally there is at least one chair per client in eachroom. Hospital chairs usually are straight-backed to facilitate good postural support.

SLEEP AND REST

No matter how comfortable the physical environment orhow attractive and homelike the furnishings, failure topromote rest and sleep may be a problem. Although sleep requirements vary, alterations insleep patterns can have serious physical and emotional results.

Functions of Sleep

In addition to promoting emotional well-being, sleep enhances various physiologic processes. See (Box 18-2, p. 378) to know the negative effects of lack of sleepiness. Sleep function:

•Reducing fatigue •Stabilizing mood •Improving blood flow to the brain •Increasing protein synthesis •Promote immunity

•Promoting cellular growth and repair

•Improving the capacity for learning and memory storage

Factors Affecting Sleep:

Older adults awaken more frequently during thenight for several reasons: pain; smaller bladder capacity,which results in an increased need to urinate; dementia-related sleep problems; side effects from medicationssuch as diuretics and anti-hypertensives; and diminishedproduction of melatonin, thatpromote sleep. Other factors not related to age also affectthe amount and quality of a person’s sleep (Table 18-3, p. 379).

  1. Light: Daylight and darkness influence the sleep–wake cycle. Circadian rhythm(phenomena that cycle on a 24-hour basis) affects sleep. The cycles of wakefulness followed by sleep arelinked to a photosensitive system involving the eyes andthe pineal gland in the brain. Without brightlight, the pineal gland secretes melatonin(hormone thatinduces drowsiness and sleep); light triggers suppressionof melatonin secretion.
  2. Activity:Activity, especially exercise, increases fatigue and theneed for sleep. When physical activity occurs just before bedtime, it has a stimulating rather than relaxing effect.
  3. Environment:Most people sleep best in their usual environment: they adapt to particular pillow, mattress, and blankets, or may be to unique sounds.

In addition, sleep rituals(habitual activities performedbefore retiring) induce sleep. Examples include eating alight snack, watching television, reading, and taking a shower. So, any change in the environment orthe activities performed before bedtimenegatively affect aperson’s ability to fall and remain asleep.

  1. Motivation:When a person has no particular reason to stay awake,sleep generally occurs easily. But if the desire to remainawake is strong, such as when you study for exam or waiting to travel, the desire tosleep can be overcome.
  2. Emotions and Moods: Emotions such as anger, fear and anxiety interfere with sleep.
  3. Food and Beverages: Hunger or thirst interferes with sleep. The consumptionof particular foods and beverages also may promote orinhibit the ability to sleep. Food having( L-tryptophan) found in protein foods such as milk anddairy products. For that, drinking warm milk induce sleep. L-tryptophan is also present inmeat , fish, eggs, and, in legumes.Caffeine is present in coffee, tea, chocolate, and most cola drinks.
  4. Illness: Stress, anxiety, and discomfort associated with illnesscan alter normal sleep patterns. In the hospital, noise from equipment,awakened for nursing activities, and disturbed by unfamiliar sounds such as loud talking, elevators, and housekeeping equipment, interfere with the clients\ ability for sleep.
  5. Drugs: Caffeine and alcohol, are nonprescription drugs that affect sleep. Sedatives(المهدئات)(drugs that produce a relaxingand calming effect) promote rest

.Hypnotics are drugs that induce sleep.

Stimulants(drugsthat excite structures in the brain) cause wakefulness(Table 18-4).

Sleep Assessment”

Nursescan obtain a more accurate sleep pattern assessment through sleep questionnaires, sleep diaries, and other examinations. Midwives can gatherdata during interviews, or clients can answer the questions independently,

Diary; A sleep diaryis a daily account of sleeping and wakingactivities. The client or personnel compile the information in a sleep disorder clinic. The client notes the times.

Sleep Disorders:

  1. Insomniamea is difficulty falling asleep, awakening frequently during the night, or awakening early. It resultsin feeling unrested the next day. Usually itresolve in less than 3 weeks. It is considered a sleep disturbance if it occurs over at least 1 month. It is helpful tostart treatment with nonpharmacologic interventions.

(See Client and Family Teaching 18-1, p. 383).

  1. Hypersomnia:is a sleep disorder characterized by feelingsleepy despite getting normal sleep. Two conditions ofhypersomnia are narcolepsy and sleep apnea/hypopneasyndrome.
  1. Narcolepsy; sudden onset of daytime sleep and pathologic manifestations. This differs than “hyper-somnolence”, which is excessive sleeping for long periods. Narcolepsy is accompanied by the following:

•Sleep paralysis—the person cannot move for a few minutes just before falling asleep or awakening

•Cataplexy—sudden loss of muscle tone triggered by anemotional change such as laughing or anger

•Hypnogogic hallucinations—dreamlike auditory or visualexperiences while dozing or falling asleep

•Automatic behavior—performance of routine taskswithout full awareness.

  1. Sleep Apnea/Hypopnea Syndrome: Apnea(cessation of breathing) and hypopnea(hypoventi-lation) are manifestations of a second form of hypersomnia

Thesleeper stops breathing or breathing slows for 10 secondsor longer, ventilationdecreases and blood oxygenation drops, wakenthe client. Consequently, clients with sleepapnea/hypopnea syndrome feel tired after having slept.

  1. Sleep–Wake Cycle Disturbances;results from a sleep schedulethat involves daytime sleeping and interferes with biologicrhythms. It occur among shift workers and jet travelers
  1. Shift Work: Those who work evening or night shifts or who switchfrom one shift to another are especially prone to disturbed sleep–wake cycles. Some experience microsleep,which is unintentional sleep lasting 20 to 30 seconds.Statistics show that shift workers are more prone toerrors and accidents from sleepiness. Most people who work nightshifts never completely adapt to the reversal of day and night activities
  2. Jet Travel; it causes a sudden change in the sleep. Travelers oftendescribe having jet lag,or emotional and physical changesexperienced when arriving in a different time zone. Some travelers re-establish normal sleep–wake cycles,
  1. Parasomnia; Parasomniasare conditions associated with activitiesthat cause arousal or partial arousal. They are not life-threatening, but they disturb others in the household.

Some examples ofparasomnias include the following:

•Somnambulism(sleep-walking)

•Nocturnal enuresis(bedwetting)

•Sleep-talking

•Nightmares and night terrors

•Bruxism(grinding of the teeth)

•Restless legs syndrome(movement typically in the legs or any other body part occasionally in the arms or other body parts] torelieve disturbing skin sensations)

Eventually, sleep deprivation affects the person’slife, damaging work productivity and personal relation-ships. The midwife must assess the sleep pattern of the clients, any promoting or disturbing factors. Midwife must facilitate the client’s sleep through providing comfort and providing facilitating factors such as inhibiting day time naps, offering warm milk before sleep, discourage acidity before sleep, providing the proper environment and helping the client to practice pre sleep rituals. Also, the midwife is required to minimize any disturbing factors such as decreasing pain, relieving anxiety, decrease noise and avoid stimulant medication. Caffeinated drinks should be discouraged also. Please see table and nursing care plan p 386.

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