Tuesday, November 13, 2018

Nursing Diagnosis Disturbed Sleep pattern

Nursing care Plans Disturbed Sleep pattern. NANDA Nursing Diagnosis Definition Disturbed Sleep pattern Time-limited disruption of sleep

Disturbed Sleep pattern Characteristics:
Prolonged awakenings, sleep maintenance insomnia, self-induced impairment of normal pattern, sleep onset more than 30 minutes, early morning insomnia, awakening earlier or later than desired, verbal complaints of difficulty falling asleep, verbal complaints of not feeling well-rested, increased proportion of Stage 1 sleep, dissatisfaction with sleep, less than age-normed total sleep time, three or more nighttime awakenings, decreased proportion of Stages 3 and 4 sleep, decreased ability to function

Related Factors:
Daytime activity pattern, Thinking about home, Body temperature, Temperament, Dietary, Childhood onset, Inadequate sleep hygiene, Sustained use of antisleep agents, Circadian asynchrony, Frequently changing sleep-wake schedule, Depression, Loneliness, Frequent travel across time zones, daylight/darkness exposure, grief, anticipation, shift work, delayed or advanced sleep phase syndrome, loss of sleep partner, life change, preoccupation with trying to sleep, periodic gender-related hormonal shifts, biochemical agents, fear, separation from significant others; social schedule inconsistent with chronotype, aging-related sleep shifts, anxiety, medications, fear of insomnia, maladaptive conditioned wakefulness, fatigue, boredom

Nursing Outcomes Nursing care Plans Disturbed Sleep pattern
  • Sleep
  • Rest
  • Well-Being
  • Psychosocial Adjustment: Life Change
  • Quality of Life
  • Pain Level
  • Comfort Level

Client Outcomes
  • Wakes up less frequently during night
  • Awakens refreshed and is not fatigued during day
  • Falls asleep without difficulty
  • Verbalizes plan to implement bedtime routines

NIC Interventions (Nursing Interventions Classification)

  • Sleep Enhancement
Nursing Interventions nursing care Plans Disturbed Sleep pattern
  • Assess client's sleep patterns and usual bedtime rituals and incorporate these into the plan of care.
  • Determine current level of anxiety, if client is anxious.
  • Assess for signs of new onset of depression: depressed mood state, statements of hopelessness, poor appetite.
  • Observe client's medication, diet, and caffeine intake. Look for hidden sources of caffeine, such as over-the-counter medications.
  • Provide measures to take before bedtime to assist with sleep.
  • Provide pain relief shortly before bedtime and position client comfortably for sleep.
  • Keep environment quiet. 
  • Do a careful history of all medications including over-the-counter medications and alcohol intake.
  • If client is waking frequently during the night, consider the presence of sleep apnea problems and refer to a sleep clinic for evaluation.
  • Evaluate client for presence of depression or anxiety.
  • Encourage social activities.
  • Suggest light reading or TV viewing that does not excite as an evening activity.
  • Increase daytime physical activity. Encourage walking as client is able.
  • Avoid use of hypnotics and alcohol to sleep.
  • Reduce daytime napping in the late afternoon; limit naps to short intervals as early in the day as possible.
  • Use soothing sound generators with sounds of the ocean, rainfall, or waterfall to induce sleep, or use "white noise" such as a fan to block out other sounds.
  • Determine if client has a physiological problem that could result in insomnia such as pain, cardiovascular disease, pulmonary disease, neurological problems such as dementia, or urinary problems. 
  • Observe elimination patterns. Have client decrease fluid intake in the evening, and ensure that diuretics are taken early in the morning.
  • If client continues to have insomnia despite developing good sleep hygiene habits, refer to a sleep clinic for further evaluation.

Client/Family Teaching for Disturbed Sleep pattern
  • Teach the following guidelines for good sleep hygiene to improve sleep habits: Go to bed only when sleepy, When awake in the middle of the night, go to another room, do quiet activities, and go back to bed only when sleepy, Use the bed only for sleeping not for reading or snoozing in front of the television, Avoid afternoon and evening naps, Get up at the same time every morning, Recognize that not everyone needs 8 hours of sleep, Move the alarm clock away from the bed if it is a source of distraction.
  • Encourage client to avoid coffee and other caffeinated foods and liquids and also to avoid eating large high-protein or high-fat meals before bedtime.
  • Advise client to avoid use of alcohol or hypnotics to induce sleep.
  • Ask client to keep a sleep diary for several weeks.
  • Teach relaxation techniques, pain relief measures, or the use of imagery before sleep.
  • Teach client need for increased exercise.
  • Encourage client to develop a bedtime ritual that includes quiet activities such as reading, television, or crafts.

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