NURSING CARE PLAN Sleep

1 11/8/06 6:24 PM Page 1180. 1180 UNIT X / Promoting Physiologic Health ter administration, but may be less effective for the treatment of Client with the Sleep Disorder Care Plan Activity TABLE 45 1 Selected Sedative-Hypnotic Sleep maintenance insomnia. Medications Used for Insomnia MEDICATION HALF-LIFE Evaluating Chloral hydrate (Noctec) 7 10 hours Using data collected during care and the desired outcomes de- Eszopiclone (Lunesta) 6 hours veloped during the planning stage as a guide, the nurse judges Ethchlorvynol (Placidyl) 10 20 hours whether client goals and outcomes have been achieved. Data Flurazepam (Dalmane) 47 100 hours collection may include (a) observations of the duration of the Glutethimide (Doriden) 1 12 hours client's Sleep , (b) questions about how the client feels on awak- Lorazepam (Ativan) 10 20 hours ening, or (c) observations of the client's level of alertness dur- Melatonin 1 hour ing the day.

2 Examples of client goals and related outcomes are Temazepam (Restoril) 9 15 hours shown in Identifying NURSING Diagnoses, Outcomes, and Inter- Triazolam (Halcion) hours ventions earlier in this chapter. Zaleplon (Sonata) 1 hour If the desired outcomes are not achieved, the nurse and client Zolpidem (Ambien) hours should explore the reasons, which may include answers to the following questions: Were etiologic factors correctly identified? Sleep or nonrestorative Sleep associated with menopausal symp- Has the client's physical condition or medication therapy MediaLink toms often benefit by the prescription of 10 mg of zolpidem, a low changed?

3 Dose that was documented to be both safe and efficacious in this Did the client comply with instructions about establishing a population. Hypnotics are not appropriate if clients have any regular Sleep wake pattern? symptoms suggestive of Sleep -related breathing disorders, or de- Did the client avoid ingesting caffeine? creased renal and/or hepatic function. Did the client participate in stimulating daytime activities to Table 45 1 presents some of the common medications used avoid excessive daytime naps? for enhancing Sleep and the half-life of these medications. The Were all possible measures taken to provide a restful envi- half-life represents how long it takes for half of the medication ronment for the client?

4 To be metabolized and eliminated by the body; hence, those with Were the comfort and relaxation measures effective? shorter half-lives are less likely to cause residual drowsiness af- NURSING CARE PLAN Sleep ASSESSMENT DATA NURSING DIAGNOSIS DESIRED OUTCOMES*. NURSING Assessment Insomnia related to anxiety Sleep [0004] as evidenced by: Jack Harrison is a 36-year-old police officer assigned to a high- (as evidenced by difficulty Sleeps through the night crime police precinct. One week ago he received a surface bullet falling and remaining asleep, consistently wound to his arm. Today he arrives at the outpatient clinic to have fatigue, and irritability).

5 Feels rejuvenated after Sleep the wound redressed. While speaking with the nurse, Mr. Harrison No dependence on Sleep mentions that he has recently been promoted to the rank of de- aids tective and has assumed new responsibilities. He states that since his promotion, he has experienced increasing difficulty falling asleep and sometimes staying asleep. He expresses concern over the danger of his occupation and his desire to do well in his new position. He complains of waking up feeling tired and irritable. Physical Examination Diagnostic Data Height: cm (6 2 ) CBC within normal range, x-ray Weight: kg (189 lb) left arm: evidence of superficial Temperature: C ( F) soft tissue injury Pulse: 80 BPM.

6 Respirations: 18/minute Blood pressure: 144/88 mm Hg 11/8/06 6:24 PM Page 1181. CHAPTER 45 / Sleep 1181. NURSING CARE PLAN Sleep continued NURSING INTERVENTIONS*/SELECTED ACTIVITIES RATIONALE. Sleep Enhancement [1850]. Determine the client's Sleep and activity pattern. The amount of Sleep an individual needs varies with lifestyle, health, and age. Encourage Mr. Harrison to establish a bedtime routine to facilitate Rituals and routines induce comfort, relaxation, and Sleep . transition from wakefulness to Sleep . Encourage him to eliminate stressful situations before bedtime. Stress interferes with a person's ability to relax, rest, and Sleep .

7 Instruct Mr. Harrison and significant others about factors ( , Knowledge of causative factors can enable the client to begin to physiologic, psychologic, lifestyle, frequent work shift changes, ex- control factors that inhibit Sleep . cessively long work hours, and other environmental factors) that contribute to Sleep pattern disturbances. Discuss with Mr. Harrison and his family comfort measures, Sleep - Knowledge of factors that affect Sleep enables the client to im- promoting techniques, and lifestyle changes that can contribute to plement changes in lifestyle and prebedtime activities. optimal Sleep . Monitor bedtime food and beverage intake for items that facilitate Milk and protein foods contain tryptophan, a precursor of sero- or interfere with Sleep .

8 Tonin, which is thought to induce and maintain Sleep . Stimulants should be avoided because they inhibit Sleep . Security Enhancement [5380]. Discuss specific situations or individuals that threaten Mr. Harrison Fear is reduced when the reality of a situation is confronted in a or his family. safe environment. Awareness of factors that cause intensification of fears enhances control. Assist him to use coping responses that have been successful in Feelings of safety and security increase when an individual identi- the past. fies previously successful ways of dealing with anxiety-provoking or fearful situations. Anxiety Reduction [5820].

9 Create an atmosphere to facilitate trust. Trust is an essential first step in the therapeutic relationship. Seek to understand Mr. Harrison's perspective of a stressful Anxiety is a feeling aroused by a vague, nonspecific threat. Identify- situation. ing the client's perspective will facilitate planning for the best ap- proach to anxiety reduction. Encourage verbalization of feelings, perceptions, and fears. Open expression of feelings facilitates identification of specific emotions such as anger or helplessness, distorted perceptions, and unrealistic fears. Determine the client's decision-making ability. Maladaptive coping mechanisms are characterized by an inability to make decisions and choices.

10 EVALUATION. Outcome met. Mr. Harrison acknowledges his insomnia is a somatic expression of his anxiety regarding job promotion and fear of failing. He states that talking with the police department counselor has been helpful. He is practicing relaxation techniques each night and sleeps an average of 7 hours a night. Mr. Harrison expresses a feeling of being rested upon awakening. APPLYING CRITICAL THINKING. 1. What further information would be helpful to obtain from 3. What are the most common problems that interfere with clients'. Mr. Harrison about his Sleep problem? ability to Sleep ? 2. What suggestions can you make that may help him develop See Critical Thinking Possibilities in Appendix A.