Chronic Care Final Set

• insomnia def & cause


  Ongoing inability to sleep despite having the opportunity to sleep. May or may not be an underlying mental or physical disorder present. Insomnia can affect a client’s physical, emotional, and mental health. 
• central sleep apnea


  The reduction of the brain's transmission to the respiratory muscles resulting in the cessation of breathing (opioid use and heart failure).
• OSA


  Recurrent episodes of upper airway collapse and obstruction while sleeping combined with waking from sleep ( inactive tongue, enlarged tonsils, and obesity.)
• polysomnography 


  A test that documents heart rate, blood pressure, breathing, oxyhemoglobin saturation, brain wave patterns, body movements, and snoring patterns.
• narcolepsy


  chronic sleep disorder characterized by sudden sleepiness and sudden periods of sleep. Two types of narcolepsy are distinguished: narcolepsy (NT1) with cataplexy and narcolepsy without cataplexy (NT2). Clients diagnosed with NT1 lack hypocretin in their central nervous system. Hypocretin, a hormone responsible for maintaining alertness, is produced in the hypothalamus. It is less clear why narcolepsy without cataplexy (NT2) occurs.
• hypersomnia


  disorder of excessive daytime fatigue without improvement after more sleep. Although the underlying cause of hypersomnia is often unknown, some cases result from a dysfunctional autonomic nervous system, trauma to the central nervous system, and possibly genetic factors.
• insomnia symptoms


  present as difficulty falling asleep or staying asleep, waking up early, or feeling tired when waking. Many chronic illnesses have been associated with insomnia, such as heart disease, hypertension, endocrine dysfunction, and arthritis. 
• insomnia treatment


  Treatment options include medications, sleep-promoting techniques and lifestyle changes, and cognitive-behavioral therapy.
• OSA symptoms


  snoring, always tired even after sleeping
• narcolepsy s/s


  Clients with narcolepsy have difficulty staying awake. They may also experience nocturnal hallucinations, paralysis while asleep, and vivid dreams.
• narcolepsy treatment


  Treatment options for both types of narcolepsy include medications, psychological counseling, short naps, and support groups.
• hypersomnia s/s


  Clients with hypersomnia have many difficulties, such as poor memory, depression, a short attention span, and irritability. 
• RLS 


  Restless legs syndrome (RLS), also called Willis-Ekbom disease, is an uncontrollable urge to move the legs, which is often accompanied by an uncomfortable sensation.
• RLS s/s


  the manifestations of this neurologic sensorimotor disorder worsen in the evening and at bedtime. RLS often causes sleep disturbance where clients cannot fall asleep or stay asleep. 
• RLS causes


  LS’s actual cause is unknown, but it can occur with iron or vitamin deficiencies and other medical conditions such as multiple sclerosis. RLS tends to run in families, so researchers believe it could be an inherited syndrome.
• Pharm Interventions to Promote Sleep

  GABA agonists, nonbenzodiazepine hypnotics, melatonin, antidepressants, and antihistamines
• Benzodiazepines (pam)


  GABA agonists or benzodiazepines, such as alprazolam, clonazepam, and lorazepam, can cause drowsiness, relax muscles, lessen anxiety, and cause retrograde amnesia. They should be used cautiously in older adult clients with decreased liver and kidney function. Clients can develop physical dependence on benzodiazepines, so these agents are not recommended for long-term use.
• non-benzos (z-drugs)


  Nonbenzodiazepine hypnotics, such as zolpidem, zaleplon, and eszopiclone (also known as the z-drugs), are the most commonly prescribed sleep medications. These medications can cause adverse effects such as gastric discomfort, hallucinations, and memory loss. Nonbenzodiazepine hypnotics have the potential to be abused since higher doses can induce stimulation and euphoria.
• Melatonin


  Controlled-release melatonin is the first-line medication recommended for the older adult. It is cost-effective, non-habit forming, and has few adverse effects.
• OTC Meds

  Although over-the-counter (OTC) medications such as doxylamine, succinate, and diphenhydramine can help clients sleep, clients should be encouraged to discuss their options with their primary health care provider before resorting to these products. OTC sleep aids can cause daytime drowsiness, dry mouth, visual disturbance, difficulty urinating, and constipation.

  When pharmacologic therapy is necessary, a sleep specialist should evaluate clients for sleep
• Interprofessional Collab for Sleep

  When pharmacologic therapy is necessary, a sleep specialist should evaluate clients for sleep apnea or chronic lung disease with nocturnal hypoxia before a sedative is prescribed.
• Nurse Role in Sleep Interventions

  Nurses must also ensure their clients’ safety by monitoring for adverse effects of medications and practicing the rights of medication administration.
• Non-pharmacologic Interventions


  Clients can explore many nonpharmacologic interventions to improve sleep, including acupuncture, thermotherapy, and massage. Massage also assists in the relaxation of muscles, improvement of circulation, and fatigue
• Contraindications of Non-pharm interventions

  Contraindications to massage include clients with burns, wounds, and on medications to thin their blood (warfarin). While clients are in the hospital, nurses can recommend that they practice guided imagery, mindfulness, meditation, and music therapy. 
• Nurse role in non-pharm interventions

  1. Teach clients to silently repeat mantras

  2. Practice restful breathing

  3. Visualize restful images
• Complementary alternative therapies (CAT)


  Therapies used alongside conventional medicine
• Clients must be educated on good sleep habits, since sleep medications should not generally be used for an extended period
• Implementing good sleep habits

  1. Follow a healthier diet

  2. Exercise at a different time

  3. Go to sleep earlier

  4. Eliminate caffeine

  5. Eliminate use of electronic devices before going to bed
• Nurse and client collaboratively develop a plan of care

  Tailored to the client's lifestyle and living arrangements
• Tailoring the plan of care to the client's lifestyle and living arrangements

  Increases the likelihood that the client will follow the plan
• Evaluation of the plan

  1. Follow-up calls

  2. Scheduled appointments
• Nursing Interventions to Promote Comfort

  Promoting comfort necessitates easing the client’s mental and physical distress through empathy, warmth, compassion, and respect. As a nurse, it is important to encourage clients to stay positive when faced with difficult decisions and procedures.
• Assessment of Nurse


  Following an assessment, a positive plan of care should be developed. The nurse should listen to the client’s unique concerns and symptoms and address them accordingly and truthfully. Permit clients to make informed choices concerning their care, which makes them feel valued, respected, and heard.
• Implementations of Nurse

  • During implementation of the plan, the client should be made to feel assured and safe.
  • The nurse can accomplish this goal by answering questions honestly and being present and supportive of the client’s physical and emotional needs.
  • Sometimes it only takes a fluff of a pillow or just being present to listen.
  • Suggest watching television or listening to music to help ease a client's mind, and remember to check on clients often—showing them you are available and ready to meet their needs.
• • Informing clients decreases their fear of the unknown and stress, and prepares them for the next step in their health care journey.
  • Presenting information empathetically and kindly will promote comfort, trust, and confidence in their health care team.

  Providing empathetic care and continuously evaluating clients’ needs and concerns will prepare them for what may be forthcoming, avoid a negative perspective, and promote comfort.
• dietary alterations to reduce risk of colorectal cancer

  • Diet can also contribute. Low dietary intake of vegetables, fruits, whole grain fiber, and calcium increases colorectal cancer risk. In contrast, increased alcohol consumption and processed and red meat intake are additional risk factors.
  • Plant-based, high-fiber diets that are moderate to low in red meat with minimal processed meat and alcohol
• What is the difference between hospice and palliative care?

  Hospice: only for prognosis <6 months, types of diseases are limited, no curative therapiesPalliative: for any disease at any stage and still curative therapies
• What types of patients are commonly referred to palliative care?

  CHF, COPD, CAD, stroke, CKD, cancer, dementia
• What are the steps of the pain ladder?

  Step 1: non-opioid + adjuvantStep 2: low to moderate opioid + adjuvantStep 3: severe opioid + adjuvant
• In what patients should morphine be avoided?

  CKD and ESRD