Rest & Activity

the movement of a limb or other part away from the midline of the body

necessary for optimal health

are activities usually performed in the course of a normal day and include things such as ambulating, eating, dressing, bathing, brushing the teeth and grooming.

to walk or move about

to move a limb or other part of the body toward the midline of the body

partial or complete collapse of the lung

wasting of muscles

confinement to be as part of treatment

an internal "clock" that synchronizes our sleep cycles

exercises designed to improve posture, gait and stamina

sudden muscle weakness during intense emotions such as anger, sadness or laughter

a point from which the weight of the body may be considered to act

sleep related breathing disorder

the 24h sleep/wake cycle

combination of all movenments for a ball and socket joint

• a deformed foot that is twisted so that the sole cannot be placed flat on the ground
• typically congenital or a result of polio

a condition of shortening and hardening of muscles, tendons or other tissue, often leading to deformity and rigidity of joints

primary sleep disorders which have origins in different body systems

a blood clot, air bubble,or piece of fatty deposit that has been carried in the blood stream to lodge in a vessel and cause an embolism

a disruptions in daily activities because of sleepiness

activity requiring physical effort; carried out to sustain or improve physical health

the action of moving a limb from bent to a straight position

skin that is soft and hanging loosely

the action of bending

plantar flexion contracture

the cracking or breaking of a hard object

the resistance that one surface encounters when moving over another

a persons manner of walking

• knock-knee
• legs bow in

• bowlegs
• legs bow outward

paralysis of one side of the body

paralysis of one side of the body

to forcefully extend beyond its normal limits

inadequate quantity or quality of sleep

in a state of abnormally high muscle tone

• enlargement of an organ or tissue from the increase in the size of its cells
• excessive growth

not moving, motionless

limitation in independent, purposeful physical movement of the body or of one or more extremities

longer than 24 hrs (period, seasonal)

difficulty falling asleep

muscular action in which tension is developed without contraction of the muscle

muscle action taking place with normal contraction

a structure in the body where 2 parts of the skeleton are fitted together

excessive outward curvature of the spine causing a hunchback

excessive inward curvature of the spine, straightening of the spine

the normal level of firmness or slight contraction in a resting muscle

a dysfunction of the mechanism in the brain which controls sleep and wake states

bedwetting

• 4 stages in a 90 min sleep cycle
• the sleep becomes increasingly deep between 1-4

when muscles or structures of the oral cavity/throat relax during sleeping

• brittle bones
• results of hormonal changes or deficiency in vitamin D or calcium

sleep problems that are more common in children than adults

having toes or feet turned inward

flexion of the foot

the position of a persons body when sitting or standing still

is the awareness of the position of the body and its parts

the maximum amount of movement a a joint

the end of each 90 min sleep cycle

when a person feels mentally relaxed, free from anxiety and physically calm

located in the upper brain stem, controls alertness and wakefulness

Abnormal lateral curvature of the spine

medications that produce a soothing or calming effect

• a cyclical physiological process that alternated with longer periods of wakefulness
• a state of consciousness in which the individual's perception and reaction to the environment is decreased

results from dyssomnia can be caused by meds, shift work, stress, pain or environmental disturbances

Habits or practices associated with sleep

a condition in which the head becomes persistantly turned to one side, often associated with muscle spasms

occur more frequently than 24 hrs

• straining to have a BM
• interferes with blood return to the heart
• increased intrathoracic pressure which decreases venous blood flow that decrease cardiac output; when the strain is released there is an increase in venous blood flow and an increase in cardiac output.

• decreased muscle strength/weakness
• decreases endurance
• decreased stability/ balance
• decreased muscle mass/ disuse atrophy

• Developmental Changes
• Behavioral Changes
• Environmental Issues
• Culture/ Ethnicity
• Family and Social Support

• Progressive loss of bone mass
• muscle mass reduced
• posture changes
• cardio respiratory changes
• changes in activity tolerance

• severe pain
• impaired musculoskeletal system
• generalized weakness
• psychological problems
• infectious processes
• therapeutic restrictions
• unavoidable restrictions
• voluntary restrictions

• orthostatic hypotension
• decrease bp
• hypostatic pneumonia
• thrombus formation

• Skeletal abnormalities
• muscular impairments
• endocrine or metabolic illnesses (diabetes mellitus, thyroid)
• hypoxemia
• decreased cardiac fx
• decreased endurance
• impaired physical stability
• pain
• sleep pattern disturbance
• poor exercise patterns
• infectious processes and fever
• anxiety
• depression
• chemical addiction
• motivation
• age
• sex
• pregnancy

• Psychosocial: encourage visitors; re-orient frequently to date, time and place; encourage hearing aides and glasses; talk about the outside world
• Elimination: turn and position, move and exercise; cough and deep breath ; chest physiotherapy; increase hydration; high fiber diet
• Rest & Activity: body positioning; weight bearing activity; promote independence with ADL's; ROM; ambulate; promote exercise
• Safety: assess skin integrity; provide skin care lubricant; avoid trauma or injury to skin; position; side rails; ambulate w assistance; call bell
• Oxygen: encourage deep breathing; incentive spirometry; turn and position; apply TEDS, SCD; elevate legs;encourage movement and ambulation; avoid valsalva; administer prophylactic anticoagulation therapy
• Nutrition: increase protein intake; increase calories; increase fiber; vitamins and minerals; have pt sit up in bed during and after eating; encourage fluids; maintain IV fluid replacement

• reducing physical activity and oxygen needs of the body
• reducing pain, including po pain or after acute injury to the lower back
• allowing ill or debilitated pt's to rest
• allowing exhausted pt's the opportunity for uninterrupted rest

• Altered mobility r/t
• Impaired Physical Mobility r/t
• ineffective tissue perfusion r/t
• impaired skin integrity r/t
• ineffective airway clearance r/t
• acute pain or chronic pain r/t

• wide base of support
• lower center of gravity
• divide balanced activity bt arms and legs
• face the direction of movement
• rolling, turning or pivoting is less work than lifting
• remove objects that cause friction

• body temp
• heart rate
• blood pressure
• hormone secretion
• sensory acuity
• mood

• RAS: reticular activating system is located in the upper brain stem and receives environmental stimuli to stimulate wakefulness, it releases norepinephrine
• BSR: bulbar synchronizing region is located in the pons and medulla and releases serotonin to help you fall asleep

• decreased HR;
• decreased BP;
• decreased muscle tone

NREM Sleep:

Stage 1: very light sleep, the person is drowsy and relaxed. The eyes roll from side to side, heart and respiration drop slightly, the person can easily be awakened. This stage lasts for a few minutes.

Stage 2: a sound sleep, but the person can still be awakened easily. Relaxation progresses and the eyes are still. The body processes continue to slow, heart, respirations and temp drop slightly. This stage lasts 10-20 minutes.

Stage 3: the person is difficult to arouse. Skeletal muscles are very relaxed and the person is undisturbed by sensory stimuli. Vital signs decrease but are stable, the person barely moves. Lasts 15-30 mins.

Stage 4: the deepest sleep stage, the person is very difficult to arouse. The heart and respiration rates are 20%-30% below waking rates. The person is extremely relaxed and rarely moves. Last 15-30 mins.

REM sleep begins 90 mins or so after falling asleep. the person has active vivid dreams and is difficult to arouse or wake spontaneously. There is REM, and fluctuation of heart, respirations and BP rates. Gastric secretions and brain metabolism increase.

Pre-sleep sleepiness- NREM1- NREM2- NREM3- NREM4- REM sleep- NREM2- NREM3-----

NREM2 is the door stage because it is the entrance/exit for REM sleep

• healing and restoration
• psychological restoration
• physiological restoration
• conservation of energy

• Physiological: ptosis (droopy lids) and blurred vision; fine motor clumsiness; slowed response time; decreased reasoning and judgment; decreased auditory and visual alertness; cardiac arrhythmia's
• Psychological: confusion; disorientation; increased sensitivity to pain; irritability; w/drawn; apathetic; excessive sleepiness; hyperactivity; decreased motivation

• complaints of sleeping difficulties increase with age
• progressive decrease in stage 3 & 4 NREM sleep
• episodes of REM sleep shorten
• increase in the tendency to nap

Hypnotics: Interfere with reaching deeper sleep stages; provide only temporary increase in quantity of sleep; eventually will cause "hangover" during the day; sometimes worsens sleep apnea in the OA

Alcohol: speeds onset of sleep; reduces REM sleep; awakens person during the night and causes difficulty returning to sleep

Caffeine: prevents person from falling asleep; causes person to awaken during the night; interferes with REM sleep

Narcotics: suppresses REM sleep; causes increased daytime drowsiness

• sleep deprivation r/t
• disturbed sleep pattern r/t
• fatigue r/t
• anxiety r/t
• ineffective coping r/t

• regular bedtime schedule
• comfort
• avoid excessive mental stimulation & emotional stress
• avoid caffeinated beverages

• bedtime rituals
• medications
• sleep environment
• changes in sleep patterns

• what time do you go to bed at night?
• what time do you normally fall asleep?
• do you do anything special to help you fall asleep?
• how many times do you awaken during the night? why?
• what is the average number of hrs you sleep during the night?

bc there are people who might physically be at rest but may have emotional worries that keep them from completely resting

• Acute Pain: is protective and has an identifiable cause, it is of short duration and has limited tissue damage and emotional response.
• Chronic Pain: is not protective and serves no purpose, it lasts longer than anticipated and does not always have an identifiable cause.

• AMBIEN: Zolpidem Tartrate
• Action: it binds to the omega-1 receptor resulting in sedation
• Indication: tx of insomnia
• Side Effects: dizziness, drowsiness, headache, nausea, diarrhea, dyspepsia, URTI, headache
• Assessments: note reasons for therapy; assess respiratory fx; assess for depression; monitor and LFT's; evaluate mental status
• Pt Teaching: take as directed; swallow whole, do not chew or crush; do not perform any activities that require mental or physical alertness; avoid alcohol, caffeine and chocolate after 4pm
• RESTORIL: Temazepam
• Action: involves GABA receptors in the CNS
• Indication: tx of insomnia
• Side Effects: drowsiness, dizziness, lightheadedness, incoordination
• Assessments: note reasons for therapy; assess sleep patterns, diet and lifestyle; determine addiction or depression hx
• Pt Teaching: take only as directed; may cause daytime drowsiness; avoid Etoh and CNS depressants; no daytime napping; for short term use only