Key Takeaways
- Sleep cycles include NREM stages 1-3 and REM sleep, each serving different restorative functions
- Sleep hygiene practices include consistent schedule, optimal environment, and limiting stimulants
- Cluster nursing care at night to minimize sleep interruptions
- Use non-pharmacological comfort measures before or alongside medications
- PQRST is a systematic method for comprehensive pain assessment
Rest, Sleep, and Comfort Measures
Rest and sleep are essential for healing, immune function, and overall well-being. LPN/VNs must understand sleep physiology, recognize sleep disturbances, and implement interventions that promote restorative rest while managing pain through various comfort measures.
Sleep Physiology
Sleep occurs in cycles of approximately 90 minutes, alternating between two main types:
| Sleep Stage | Characteristics | Importance |
|---|---|---|
| NREM Stage 1 | Light sleep, easily awakened | Transition to sleep |
| NREM Stage 2 | Deeper sleep, eye movement stops | Physical restoration begins |
| NREM Stage 3 | Deep sleep, slow delta waves | Physical restoration, growth hormone release |
| REM Sleep | Rapid eye movement, dreaming, muscle atonia | Memory consolidation, cognitive restoration |
Normal Sleep Duration by Age:
- Infants: 14-17 hours
- Toddlers: 11-14 hours
- School-age: 9-11 hours
- Adults: 7-9 hours
- Older adults: 7-8 hours (often fragmented)
Common Sleep Disorders
| Disorder | Description | Key Interventions |
|---|---|---|
| Insomnia | Difficulty falling/staying asleep | Sleep hygiene, relaxation, medications if needed |
| Sleep Apnea | Breathing pauses during sleep | CPAP/BiPAP, weight loss, positional therapy |
| Narcolepsy | Excessive daytime sleepiness, sudden sleep attacks | Scheduled naps, stimulant medications |
| Restless Leg Syndrome | Uncomfortable leg sensations, urge to move | Movement, iron supplementation, medications |
| Circadian Rhythm Disorders | Sleep-wake cycle disruption | Light therapy, melatonin, schedule adjustment |
Sleep Hygiene Education
Teach patients these evidence-based sleep hygiene practices:
- Maintain consistent sleep schedule - Same bedtime/wake time daily, including weekends
- Create optimal sleep environment - Dark, quiet, cool (65-68°F)
- Limit screen time - No electronic devices 1 hour before bed
- Avoid stimulants - No caffeine 6+ hours before bed, limit alcohol
- Exercise regularly - But not within 3-4 hours of bedtime
- Limit naps - If needed, keep to 20-30 minutes before 3 PM
- Reserve bed for sleep - Avoid working, watching TV in bed
- Wind-down routine - Relaxing activities before bed (reading, bath)
Hospitalized Patient Sleep Considerations
Hospital environments often disrupt sleep. Nursing interventions include:
- Cluster care activities to minimize nighttime interruptions
- Dim lights during night hours
- Reduce noise levels (silence alarms promptly, lower voices)
- Provide earplugs and eye masks if desired
- Maintain patient's normal sleep routines when possible
- Assess and treat pain before bedtime
- Limit fluids before sleep to reduce nocturia
Non-Pharmacological Pain Management
LPN/VNs implement various comfort measures that complement medication therapy:
| Intervention | Mechanism | Nursing Actions |
|---|---|---|
| Heat Application | Vasodilation, muscle relaxation | Warm packs, heating pads (check temperature, protect skin) |
| Cold Application | Vasoconstriction, reduced inflammation | Ice packs (20 min max, protect skin) |
| Positioning | Reduces pressure, supports alignment | Pillows, bed positioning, specialty surfaces |
| Massage | Relaxation, circulation, gate control | Back rub, hand/foot massage (check contraindications) |
| Distraction | Refocuses attention | Music, TV, conversation, reading |
| Relaxation | Reduces muscle tension, anxiety | Deep breathing, guided imagery, progressive relaxation |
| TENS Unit | Electrical stimulation blocks pain signals | Apply electrodes as ordered, check skin |
Pain Assessment
Accurate pain assessment guides intervention:
Pain Assessment Scales:
- Numeric Rating Scale (NRS): 0-10 (0 = no pain, 10 = worst pain)
- Wong-Baker FACES: Visual faces for children, cognitive impairment
- FLACC Scale: Face, Legs, Activity, Cry, Consolability (for nonverbal patients)
PQRST Pain Assessment:
- P = Provocation/Palliation (What makes it better/worse?)
- Q = Quality (Sharp, dull, burning, aching?)
- R = Region/Radiation (Where is it? Does it spread?)
- S = Severity (0-10 scale)
- T = Timing (When did it start? Constant or intermittent?)
Rest and Activity Balance
Promote therapeutic rest while preventing complications of immobility:
- Plan activities to allow rest periods
- Prioritize essential tasks when energy is limited
- Teach energy conservation techniques for chronic illness
- Balance activity with rest during recovery
- Assess for signs of fatigue (vital sign changes, pallor, weakness)
A patient reports difficulty sleeping in the hospital. Which intervention should the LPN/VN implement first?
Which sleep stage is most important for memory consolidation and cognitive restoration?
An LPN/VN is using the PQRST method to assess a patient's pain. What does the "Q" represent?