NURSING CARE PLAN

ASSESSMENT DATA

Sleep
NURSING DIAGNOSIS
Insomnia related to anxiety (as evidenced by difficulty falling and remaining asleep, fatigue, and irritability)

DESIRED OUTCOMES*
Sleep [0004] as evidenced by: Sleeps through the night consistently Feels rejuvenated after sleep No dependence on sleep aids

Nursing Assessment Jack Harrison is a 36-year-old police officer assigned to a highcrime police precinct. One week ago he received a surface bullet wound to his arm. Today he arrives at the outpatient clinic to have the wound redressed. While speaking with the nurse, Mr. Harrison mentions that he has recently been promoted to the rank of detective 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 Height: 185.4 cm (62) Weight: 85.7 kg (189 lb) Temperature: 37.0C (98.6F) Pulse: 80 BPM Respirations: 18/minute Blood pressure: 144/88 mm Hg Diagnostic Data CBC within normal range, x-ray left arm: evidence of superficial soft tissue injury

NURSING CARE PLAN Sleep continued

NURSING INTERVENTIONS*/SELECTED ACTIVITIES

Sleep Enhancement [1850] Determine the clients sleep and activity pattern. Encourage Mr. Harrison to establish a bedtime routine to facilitate transition from wakefulness to sleep. Encourage him to eliminate stressful situations before bedtime. Instruct Mr. Harrison and significant others about factors (e.g., physiologic, psychologic, lifestyle, frequent work shift changes, excessively long work hours, and other environmental factors) that contribute to sleep pattern disturbances. Discuss with Mr. Harrison and his family comfort measures, sleeppromoting techniques, and lifestyle changes that can contribute to optimal sleep. Monitor bedtime food and beverage intake for items that facilitate or interfere with sleep. Security Enhancement [5380] Discuss specific situations or individuals that threaten Mr. Harrison or his family. Assist him to use coping responses that have been successful in the past.

RATIONALE

The amount of sleep an individual needs varies with lifestyle, health, and age. Rituals and routines induce comfort, relaxation, and sleep. Stress interferes with a persons ability to relax, rest, and sleep. Knowledge of causative factors can enable the client to begin to control factors that inhibit sleep.

Knowledge of factors that affect sleep enables the client to implement changes in lifestyle and prebedtime activities. Milk and protein foods contain tryptophan, a precursor of serotonin, which is thought to induce and maintain sleep. Stimulants should be avoided because they inhibit sleep.

Fear is reduced when the reality of a situation is confronted in a safe environment. Awareness of factors that cause intensification of fears enhances control. Feelings of safety and security increase when an individual identifies previously successful ways of dealing with anxiety-provoking or fearful situations.

Anxiety Reduction [5820] Create an atmosphere to facilitate trust. Seek to understand Mr. Harrisons perspective of a stressful situation. Encourage verbalization of feelings, perceptions, and fears. Trust is an essential first step in the therapeutic relationship. Anxiety is a feeling aroused by a vague, nonspecific threat. Identifying the clients perspective will facilitate planning for the best approach to anxiety reduction. Open expression of feelings facilitates identification of specific emotions such as anger or helplessness, distorted perceptions, and unrealistic fears. Maladaptive coping mechanisms are characterized by an inability to make decisions and choices.

Determine the clients decision-making ability.

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 Mr. Harrison about his sleep problem? 2. What suggestions can you make that may help him develop better sleep habits? 3. What are the most common problems that interfere with clients ability to sleep?
See Critical Thinking Possibilities in Appendix A.

*The NOC # for desired outcomes and the NIC # for nursing interventions are listed in brackets following the appropriate outcome or intervention. Outcomes, interventions, and activities selected are only a sample of those suggested by NOC and NIC and should be further individualized for each client.