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NCLEX & CGFNS Practice Questions
Disturbed Sleep Pattern
  • Actual
  • Risk for (Potential)

Related To: [Check those that apply]

  • Pain/discomfort
  • Environmental barrier (e.g. noise, temperature)
  • Anxiety/fear
  • Depression
  • Medications
  • Excessive or inadequate stimulation
  • Abnormal physiological status or symptoms (dyspnea, hypoxia, neurological dysfunction, and others)
  • Normal changes associated with aging
  • Insufficient privacy

As evidenced by: [Check those that apply]

  • Verbal complaints of difficulty falling asleep
  • Awakening earlier or later than desired
  • Interrupted sleep
  • Verbal complaints of not feeling rested
  • Restlessness
  • Irritability
  • Dozing
  • Yawning
  • Altered mental status
  • Difficulty in arousal
  • Change in activity level
  • Altered facial expression (e.g., blank look, fatigued appearance)

Patient’s Diagnosis: –
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Objective/Expected Outcome;The patient will:

  • achieves optimal amounts of sleep as evidenced by: rested appearance, verbalization of feeling rested and improvement in sleep pattern.
  • Others

Note: you need to indicate time frame/target as objective must be measurable.

Nursing Interventions Scientific Rationale
Assess past patterns of sleep in normal environment: amount, bedtime rituals, depth, length, positions, aids, and interfering agents. Sleep patterns are unique to each individual.
Assess patient's perception of cause of sleep difficulty and possible relief measures to facilitate treatment. Knowing the specific etiologic factor will guide appropriate therapy.
Document nursing or caregiver observations of sleeping and wakeful behaviors. Often, the patient's perception of the problem may differ from objective evaluation.
Identify factors that may facilitate or interfere with normal patterns Knowledge of its role in health/wellness and the wide variation among individuals may allay anxiety, thereby promoting rest and sleep.
Evaluate timing or effects of medications that can disrupt sleep. In both the hospital and home care setting, patients may be following medication schedules that require awakening in the early morning hours.
Instruct patient to follow as consistent a daily schedule for retiring and arising as possible. This promotes regulation of the circadian rhythm, and reduces the energy required for adaptation to changes.
Instruct to avoid heavy meals, alcohol, caffeine, or smoking before retiring. Though hunger can also keep one awake, gastric digestion and stimulation from caffeine and nicotine can disturb sleep.
Instruct to avoid large fluid intake before bedtime. For patients may need to void during the night.
Increase daytime physical activities as indicated To reduce stress and promote sleep.
Instruct to avoid strenuous activity before bedtime. Over-fatigue may cause insomnia.
Discourage pattern of daytime naps unless deemed necessary to meet sleep requirements or if part of one's usual pattern. Napping can disrupt normal sleep patterns. However the elderly do better with frequent naps during the day to counter their shorter night-time sleep schedule.
Suggest use of soporifics such as milk. Which contains L-tryptophan that facilitates sleep.
Explain the need to avoid concentrating on the next day's activities or on one's problems at bedtime. Obviously, this will interfere with inducing a restful state.
Suggest using hypnotics or sedatives as ordered; evaluate effectiveness. Use of hypnotic medications should be thoughtfully considered and avoided if less aggressive means are effective because of their potential for cumulative effects and generally limited period of benefit.
Provide nursing aids (e.g., back rub, bedtime care, pain relief, comfortable position, relaxation techniques). To promote rest.
Organize nursing care. To promote minimal interruption in sleep or rest.

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