Sleep and pain

juniperk's version from 2016-11-20 03:58

Section 1

Question Answer
What is circadian rhythm?rhythm that completes a full cycle every 24 hours; synonym for diurnal rhythm
What is delta sleep?deep sleep, occurring during stage III and especially stage IV in NREM sleep
What is dyssomnias?sleep disorders characterized by insomnia or excessive sleepiness
What is enuresis? involuntary urination; most often used to refer to a child who involuntarily urinates during the night
What is hypersomnia?condition characterized by excessive sleeping, especially daytime sleeping
What is narcolepsy?condition characterized by an uncontrolled desire to sleep
What is non–rapid eye movement (NREM) sleep?non–rapid eye movement that characterizes four stages of sle
What is parasomnias?patterns of waking behavior that appear during sleep (e.g., sleep walking, sleep talking, nocturnal erections)
What is rapid eye movement (REM) sleep?stage that constitutes 20% to 25% of a person’s nightly sleep; person is difficult to arouse during this stage
What is restless leg syndrome (RLS)?a condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs
What is sleep apnea?a condition in which a person experiences the absence of breathing (apnea) or diminished breathing effort (hypopnea) during sleep between snoring intervals
What is sleep cycle?passage through the four stages of NREM sleep (I, II, III, IV), then reversal (IV, III, II), and finally, instead of reentering stage I and awakening, entering REM sleep and returning to stage II
What is sleep deprivation?a decrease in the amount, consistency, and quality of sleep; results from decreased REM or NREM sleep
What is sleep hygiene?nonpharmacologic recommendations like reviewing and changing lifestyles and environment that help an individual get a better night’s sleep
What is somnambulism?sleepwalking
What part of the brain has control centers for several involuntary activities of the body?hypothalamus
In normal adults, the REM state consumes what % of a person’s nightly sleep time?20% to 25%
What is stage 1?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.
What is 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.
What is Stage III?The depth of sleep increases, and arousal becomes increasingly difficult. This stage composes about 10% of sleep.
What is 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.
What happens in 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
How long does a newborn sleep?an average of 16 hours/24 hours; averages about 4 hours at a time.
How long does a Toddler sleep?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.
How long does Preschoolers sleep?Children in this stage generally sleep 9 to 16 hours at night, with 12 hours being the average.
How long does School-Aged Children sleep?Younger school-aged children may require 10 to 12 hours nightly, whereas older children in this stage may average 8 to 10 hours.
How long does Adolescents sleep?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.
How long does Young Adults sleep?The average amount of sleep required is 8 hours, but in fact, many young adults require less sleep.
How long does Middle-Aged Adults sleep?7 to 9 hours. Total sleep time decreases during these years, with a decrease in stage IV sleep.
How long does Older Adults sleep?An average of 7 to 9 hours of sleep is usually adequate for this age group.
What is Cataplexy?sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion
What is acute pain?episode of pain that lasts from seconds to less than 6 months
What is adjuvant?drugs typically used for other purposes, but also used to enhance the effect of opioids by providing additional pain relief
What is breakthrough pain?temporary flare-up of moderate to severe pain that occurs even when the patient is taking around-the-clock medication for persistent pain
What is chronic pain? episode of pain that lasts for 6 months or longer; may be intermittent or continuous
What is cutaneous pain?superficial pain usually involving the skin or subcutaneous tissue
What is dynorphin? the endorphin having the most potent analgesic effect
What is endorphins?morphine-like substances released by the body that appear to alter the perception of pain
What is enkephalins?opioids that are widespread throughout the brain and dorsal horn of the spinal cord and are believed to reduce pain sensation by inhibiting the release of substance P
What is ethnocentrism?belief that one’s own ideas, beliefs, and practices are best, superior, or most preferred to those of others; using one’s cultural norms as the standard to evaluate others’ beliefs
What is gate control theory?theory that explains that excitatory pain stimuli carried by small-diameter nerve fibers can be blocked by inhibiting signals carried by large-diameter nerve fibers
What is intractable?severe pain that is extremely resistant to relief measures
What is modulation?process by which the sensation of pain is inhibited or modified
What is neuromodulators?endogenous opioid chemical regulators that appear to have analgesic activity and alter pain perception
What is neuropathic pain?pain that results as a direct consequence of a lesion or disease affecting abnormal functioning of the peripheral nervous system (PNS) or central nervous system (CNS)
What is neurotransmitters?substances that either excite or inhibit target nerve cells
What is nociceptors?pain receptors
What is nociceptive pain?pain from a normal process that results in noxious stimuli being perceived as painful
What is opioid?more correct term for narcotic analgesics, since these drugs act by binding to opiate receptor sites in the central nervous system
What is phantom pain?sensation of pain without demonstrable physiologic or pathologic substance; commonly observed after the amputation of a limb
If a patient is physical dependence, will they suffer withdrawals if the opioid is suddenly removed or the dose is rapidly decreased?Yes
What is psychogenic pain?pain for which no physical cause can be identified
What is referred pain?pain in an area removed from that in which stimulation has its origin. (heart attack)
What is somatic pain?pain originating in structures in the body’s external wall
What is transduction?activation of pain receptors
What is visceral pain?pain originating in the internal organs in the thorax, cranium, or abdomen
What are three general classes of drugs used for pain relief?Opioid analgesics (all controlled substances; e.g., morphine, codeine, oxycodone, meperidine, hydromorphone, methadone) Nonopioid analgesics (acetaminophen and nonsteroidal anti-inflammatory drugs [NSAIDs]) Adjuvant analgesics (anticonvulsants, antidepressants, multipurpose drugs)
What is a commonly feared side effect of opioid use?Respiratory depression
Name the opioid antagonist that reverses the respiratory-depressant effect of an opioidnaloxone (Narcan)
What type of NSAID is Celecoxib (Celebrex)?COX-2 inhibitors
How can Anesthetic agents be applied? topically to the skin or mucous membranes or injected into the body to produce a temporary loss of sensation and motor and autonomic function in a localized area.
What factors can influence pain?Culture and ethnic variables, family, gender, age, religious beliefs, support people,anxiety and past experiences

Section 2

Question Answer
What is a anxiolytic?they can prevent feelings of tension or fear. drug used to depress the central nervous system (CNS); prevents the signs and symptoms of anxiety
What is a barbiturate?former mainstay drug used for the treatment of anxiety and for sedation and sleep induction; associated with potentially severe adverse effects and many drug–drug interactions, which makes it less desirable than some of the newer agents
What is a benzodiazepine?drug that acts in the limbic system and the reticular activating system to make gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, more effective, causing interference with neuron firing; depresses CNS to block the signs and symptoms of anxiety; and may cause sedation and hypnosis in higher doses
Name 3 Benzodiazepines Used as Anxiolytic–Hypnotics:alprazolam, clonazepam, diazepam
Name 2 Barbiturates Used as Anxiolytic–Hypnotics:phenobarbital, butabarbital
Name 3 Other Anxiolytic and Hypnotic Drugs:buspirone, diphenhydramine, zolpidem
What is alprazolam (Xanax) used for?Anxiety, panic attacks
What is chlordiazepoxide (Librium) used for?Anxiety, alcohol withdrawal, preoperative anxiolytic
What is clonazepam (Klonopin) used for?Panic disorders, restless leg syndrome, seizure disorders
What is clorazepate (Tranxene) used for?Anxiety, alcohol withdrawal, partial seizures
What is diazepam (Valium) used for?Anxiety, alcohol withdrawal, muscle relaxant, antiepileptic, antitetanus, preoperative anxiolytic
What is lorazepam (Ativan) used for?Anxiety, preanesthesia anxiolytic
What is midazolam used for?Sedation, anxiety, conscious sedation for short procedures; continuous sedation of intubated or mechanically ventilated patients
What is temazepam (Restoril) used for?Hypnotic, treatment of insomnia
The benzodiazepines are well absorbed where and when is peak time?gastrointestinal (GI) tract, with peak levels achieved in 30 minutes to 2 hours
Abrupt cessation of these drugs may lead to a withdrawal syndrome characterized by?nausea, headache, vertigo, malaise, and nightmares.
What is the peak time for Barbiturates?20 to 60 minutes.
Barbiturates are metabolized where?in the liver
What is phenobarbital (Luminal) used for?Sedative–hypnotic, control of seizures, preanesthetic
Drugs that are used to alter a patient’s response to the environment are calledanxiolytics.
The benzodiazepines are the most frequently used anxiolytic drugs becausethey are anxiolytic at doses much lower than those needed for sedation or hypnosis.
Barbiturates cause liver enzyme induction, which could lead to?rapid metabolism and loss of effectiveness of other drugs metabolized by those enzymes.
The benzodiazepines react with what?GABA receptor sites in the RAS to cause inhibition of neural arousal.
A pediatric patient is prescribed phenobarbital preoperatively to relieve anxiety and produce sedation. After giving the injection, you should assess the patient for?paradoxical excitement.
A fibers are what?large-diameter nerve fibers that carry peripheral impulses associated with touch and temperature to the spinal cord
A-delta fibers are what?small-diameter nerve fibers that carry peripheral impulses associated with pain to the spinal cord
C fibers are what?unmyelinated, slow-conducting fibers that carry peripheral impulses associated with pain to the spinal cord
ergot derivative is what type of drug?relieves or prevents migraine headaches
What is the gate control theory?theory that states that the transmission of a nerve impulse can be modulated at various points along its path by descending fibers from the brain that close the “gate” and block transmission of pain information and by A fibers that are able to block transmission in the dorsal horn by closing the gate for transmission for the A-delta and C fibers
What do narcotic agonists do?drugs that react at opioid receptor sites to stimulate the effects of the receptors
What do narcotic agonists–antagonists do?stimulate certain opioid receptors but block other such receptors.
What is narcotic antagonists?They block the effects of the opioid receptors and are often used to block the effects of too many opioids in the system.
What is the spinothalamic tract?nerve pathway from the spine to the thalamus along which pain impulses are carried to the brain
What are triptans?selective serotonin receptor blocker that causes a vascular constriction of cranial vessels; used to treat acute migraine attacks
Which drug Adjunct treatment of alcohol or narcotic dependence in adults?naltrexone (ReVia)
Which drug is used for the Diagnosis of narcotic overdose, reversal of opioid effects?naloxone (Narcan)
According to the gate control theory, paincan be blocked or intensified by gates in the CNS.
Injecting a narcotic into an area of the body that is chilled can be dangerous becausean excessive amount may be absorbed all at once.
The triptans are a class of drugs that bind to selective serotonin receptor sites and causecranial vascular constriction.
The only triptan that has been approved for use in treating cluster headaches as well as migraines issumatriptan.
What is elective surgery?surgery that is recommended but can be omitted or delayed without catastrophe
What is embolus?blood clot, foreign body, or air in the circulatory system; plural form is emboli

Section 3

Section 4