University of Santo Tomas - Legazpi

Rawis, Legazpi City

NCM 109.1
Related Learning Experience

Case Presentation

A 6-year-old girl with a long-standing history of

severe asthma and eczema
March 15, 2021
Group 1

Clinical Instructor:
Mrs. Frances Carmi D.
Gonzales, RN, MAN
 PATIENT’S
INFORMATION
CHIEF COMPLAINT:

A 6-year-old girl presented to a

pediatric pulmonary and sleep
medicine clinic regarding
“concerned about the emerging
symptoms of inattention, austistic
features, fatigue, and sleepiness”.
Presenting Signs & Symptoms

Signs

BMI: 23.89 kg/m2 [the 98th percentile for

age]

Enlarged tonsils: (2-3+)

Presenting Signs & Symptoms

Symptoms

Fatigue

Excessive daytime sleepiness (EDS)

Inattention in school developed over a 1-to-2 month period

Weight increase rapidly despite the dietary intervention

Chronic mouth breather

Has difficulty with focusing and staying awake in the clinic

 Demographic Data

Name: Patient A
Age: 6 y.o
Sex: Female
Weight: 23.89 kg/m2 [the 98th
percentile for age]
 Family History:

Notable for obesity

Obstructive sleep apnea (OSA) which

requires continuous positive airway
pressure (CPAP) in her father

Narcolepsy is present in an uncle and a

grandfather
 Patient’s Lifestyle

Patient A daytime sleepiness

seemed to be progressive, and she
would fall asleep suddenly even
when she wanted to be awake.
 Patient’s Lifestyle

Patient A has fallen asleep at school nearly every day

for the past 1-2 months and falls into deep sleep
unless she is kept active. At home she is taking more
naps during the day, falling asleep in the car, and
struggling with schoolwork. Her grades have dropped
significantly over the past few months. Her parents
report that she does not awaken during the night.
Furthermore, She sleeps an average of 9-10 hours per
night but is restless and tosses and turns frequently in
her sleep.
 History of Present/
Past Illness
PRESENT ILLNESS:
Fatigue
Excessive daytime sleepiness
Rapid weight increase

PAST ILLNESS:
The patient has a long-standing history of severe asthma
and eczema presented.
 DIAGNOSIS

NARCOLEPSY
ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY

The affected system of the brain is the Central

Nervous System, particularly the Hypothalamus
which produces neuropeptide hormones known as
Hypocretin.
 ANATOMY AND PHYSIOLOGY

NERVOUS SYSTEM
-Network of cells called neurons that coordinate actions and transmit
signals between different parts of the body.
-Major controlling, regulatory, and communicating
system in the body.
-Together with the endocrine system, the nervous system
is responsible for regulating and maintaining
homeostasis.
-MAIN FUNCTION: To coordinate and control the various
body functions.
 ANATOMY AND PHYSIOLOGY

NERVOUS SYSTEM
-Divided into two regions: CNS & PNS
Central Nervous System
-Composed of the Brain and Spinal cord.
-Broadly subdivided into lower centers, including the spinal cord and
brain stem, that carry out essential body and organ-control functions
and higher centers within the brain that control more sophisticated
information processing, including our thoughts and perceptions.
-Main Function: To process the information received from the
peripheral nervous system.
 ANATOMY AND PHYSIOLOGY

Peripheral Nervous System

-Includes all of the nerves that branch out from the brain and spinal
cord and extend to other parts of the body including muscles and
organs.
-Allows the brain and spinal cord to receive and send information to
other areas of the body, which allows us to react to stimuli in our
environment.
-Divided into two parts: Somatic Nervous System
Autonomic nervous system
PATHOPHYSIOLOGY
OF
NARCOLEPSY
 DOCTOR’S ORDER

Actual Medical Management:

 
-The patient has a long-standing history of severe asthma, she was prescribed with
inhaled corticosteroid (fluticasone, 88 µg, inhaled twice daily), albuterol sulfate (180 µg,
inhaled as needed), and ipratropium bromide (34 µg, inhaled as needed). But the dosage
of inhaled fluticasone was increased to 220 µg twice daily. Montelukast (5 mg daily) and
nasal fluticasone (50 µg) were also added to her regimen.
 
- The patient has a long-standing history of eczema, she has been prescribed a
moderately aggressive regimen of hydrating bleach baths, moisturizing lotions,
nonsedating antihistamine, and as-needed use of topical hydrocortisone or triamcinolone,
pimecrolimus, and mupirocin. Also, she has been prescribed diphenhydramine (25 mg) to
be used as needed for excessive itchiness, eczema flares, and allergic asthma flares for
her skin condition.
 
 DOCTOR’S ORDER

- The patient was followed up in the clinic approximately every 3 months, owing to the complexity of
her condition.
 
- The patient has increased weight, and she was referred to a dietitian for weight loss strategies.
 
- The patient was referred to a pediatric otolaryngologist for consideration of nocturnal
polysomnography (NPSG) or an adenotonsillectomy.

Ideal Medical Management:

- The possible medications for narcolepsy are stimulants, selective serotonin reuptake inhibitors
(SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and
sodium oxybate (Xyrem).
 MEDICAL MANAGEMENT:
Ideal and Actual
IDEAL: ACTUAL:
-Medical attention - Medications are ordered
for the complexity for the manifested signs
of manifestations and symptoms.
such as asthma and - Bronchoscopy
eczema - Follow up every 3
- Medications for months
narcolepsy - Dietary interventions
- Tests for -Physical examination
diagnosing the - Referred to NPSG or
condition adenotonsillectomy
 Medical Management
Laboratory


Ideal 
Actual
•
Polysomnogram (PSG) and Multiple Sleep
A collaborate with otolaryngologist, a NPSG demonstrates the following:
Latency Test (MSLT)
•

•
A respiratory disturbance index and an apnea-hypopnea index (AHI) of 6.2 per hour
•
Sleep latency of 0.5 minutes and rapid eye movement (REM) latency of 0.5 minutes
•
A sleep efficiency of 87.5%
•
18.2% of total sleep time in stage N1, 36.4% in N2, 29.9% in N3, and 15.5% in
REM sleep
•
An arousal index of 18.6
•
A periodic leg movement index of 6.3
•
Multiple periods of wakefulness scattered throughout the night and six REM periods
•
Otolaryngologist notes:
•
Not tolerated nasal fluticasone well
•
A chronic mouth breather
•
Tonsils are enlarged (3+)
 DRUG STUDY
Generic Brand Dosage Frequency Indications Contraindica Side Adverse Special Nursing
Name Name tions Effects Effects Precautions Considerati
ons

Fluticasone Flonase, 88 µg BID Management of Treatment of Severe or Adrenal Advise the pt 1. Look for
flovent the nasal status ongoing suppression to practice the signs of
symptoms of asthmaticus or nosebleeds; ff: sensitivity to
the medication.
perennial other acute Posterior Check your
nonallergic episodes of Noisy subcapsular progress at 2.Observe the
rhinitis in adult asthma or breathing, cataracts on regular visits level of
and pediatric COPD where runny nose, prolonged with your symptom
patients aged 4 intensive crusting use physician. severity to
years and older. measures are around your determine if the
required; nostrils, Oral If symptoms medication is
Indicated for the redness; candidiasis do not effective or if
maintenance Hypersensitivity improve the dose can be
decreased
treatment of to any of the Sores or Hoarseness within a few
asthma as ingredients of white of voice days or if they 3.Taking
prophylactic these patches in become fluticasone for
therapy preparations your mouth Throat worse, check long term
or throat; irritation with your treatment
doctor. places one at
Fever, chills, risk for a nasal
body aches, Make sure infection or
sores in the
blurred your doctor
nostrils
vision, eye knows if you
pain; have had 4.Advise the
nose surgery, patient that the
Seeing a nose injury, hypothalamic-
halos or an infection pituitary-adrenal
around in your nose (HPA) axis
lights; suppression
Check with can occur when
using
your doctor fluticasone for
immediately long term
if there are treatment
signs of
adverse
effects
Generic
Name
Brand
Name
Dosage DRUG STUDY
Frequency Indications Contraindic
ations
Side Effects Adverse
Effects
Special
Precautions
Nursing
Considerati
ons

Albuterol Proventil 180 µg PRN Treatment and Hypersensitivi Headache, CNS: Advise the pt Tell your patient
Sulfate HFA, Ventolin prevention of ty to milk fever, headache, to practice the that the
HFA, Proair bronchospasm protein and dizziness, dizziness, ff: medication
inhalation
HFA, (acute or albuterol nausea, nausea,
sometimes
severe) . formulations vomiting; vomiting; 1.Consult causes
and your doctor wheezing and
Treatment for adrenergic Chest pain, Respi: and difficulty
wheezing and amines; nervousness, wheezing, pharmacist if breathing
shortness of muscle throat you are
breathing Has history to aches, irritation, allergic to Maintain a beta-
problems such any of its tachycardia; nasal albuterol and adrenergic
as asthma component of irritation, any other blocker
(cardioselective
albuterol; Sore throat, cough, sinus medications; beta-blocker,
runny nose, pain, runny such as
Conditions wheezing, nose; 2. Do not stop atenolol, should
with trouble taking the be used with
overactive breathing; CV: anti- respiratory
thyroid gland, tachycardia, inflammatory distress
diabetes, high Nasal chest pain, medicine,
blood irritation; irregular even if your Administer
pressurized
pressure; breathing; asthma
inhalation drug
Skin rash, seems better, forms during
hives, GU: unless your second half of
burning, Increased doctor tells inspiration
chills; incidence of you to Read
leiomyomas the instructions
3. Tell your that come with
GI: upset patient that respiratory
stomach, the inhalant
constipation; medication Report any
inhalation adverse effects
Skin: Hives, sometimes in respond to
skin rash, causes usual dosage
redness of wheezing and
skin; difficulty
breathing
 DRUG STUDY
Generic Name Brand Dosage Frequency Indications Contraindic Side Adverse Special Nursing
Name ations Effects Effects Precaution Considerati
ons

Ipratropium Atrovent, 34 µg PRN Treatment of Contraindi Dry mouth; CNS: Advise the pt to
practice the ff:
Protect solution
for inhalation from
Bromide Atrovent HFA reversible headache,
bronchospasm cated with Cough; dizziness, 1. Do not use
light.
Use
associated with hypersensit nausea, more of it and do nebulizer
not use it more mouthpiece
chronic ivity to Headache; vomiting;
often than your instead of face
obstructive
pulmonary
atropine or Nausea; Respi:
doctor ordered.
Also, do not stop
mask to avoid
blurred vision or
disease its paradoxical using this aggravation of
medicine without narrow-angle
(COPD). derivatives, Dizziness; bronchospas telling your doctor. glaucoma.
m;
Ipratropium
soy bean or Difficulty nasal 2.Keep the spray
Can
mix albuterol in
bromide is peanut breathing; dryness; or solution away nebulizer for up to
from the eyes 1 hr.
indicated, when allergies epistaxis
used (nasal spray) 3.Do not keep this Ensure adequate
concomitantly
(aerosol). medicine inside a hydration, control
with inhaled Use GU: buccal
car where it could
be exposed to
environmental
temperature to
beta2-agonists, cautiously ulceration extreme heat or prevent
for treatment of with
cold. hyperpyrexia.
reversible GI:
airways narrow- constipation
4. Do not poke
holes in the
Have
the patient void
obstruction as angle canister or throw before taking
in acute and it into a fire, even medication to
glaucoma, if the canister is avoid urinary
chronic asthma. empty. retention
prostatic
hypertroph 5.Do not keep
outdated
y, bladder medicine or
medicine no
neck longer needed.
obstruction
,
pregnancy,
lactation
 DRUG STUDY
Generic Brand Dosage Frequency Indications Contraindi Side Adverse Special Nursing
Name Name cations Effects Effects Precaution Considerati
s ons

Montelukast Singulair OD Prevention and Contraindicated Body aches or CNS: Suicidal Advise the pt to 1. Encourage
chronic treatment in: pain Behaviors/Thoug practice the ff:  patient and
of asthma, Hypersensitivity. hts, agitation, family to be alert
Management of Difficulty in aggression,  Use Cautiously for emergence of
seasonal allergic breathing anxiety, attention in: Acute attacks signs of adverse
rhinitis, Prevention disturbance; of asthma; effects especially
of exercise-induced Dryness or Phenylketonuria( during early
bronchoconstriction soreness of the Fatigue, chewable tablets antidepressant
in patients 6 yr and throat hallucinations, contain therapy.
older. headache, aspartame);
Loss of voice insomnia, Hepatic 2. Assess
irritability, impairment(may symptoms on a
Pain or
memory need lower day-to-day basis
tenderness
impairment; doses); as changes may
around the eyes
be abrupt. If
and cheekbone Restlessness, Reduction of these symptoms
sleep walking, corticosteroid or rash occurs
Pain, redness, or
weakness; therapy(may notify health care
swelling in the
increase the risk professional.
ear EENT: of eosinophilic
nosebleed, otitis conditions); OB,
stomach pain
(children), Lactation, Pedi:
Stuffy or runny sinusitis Pregnancy,
nose (children). -Resp: lactation,or
cough, children. 1 yr
rhinorrhea. (safety not
established).
GI: abdominal  
pain, diarrhea, Do not confuse
dyspepsia, Singulair with
nausea Sinequan
(children).
 DRUG STUDY
Generic Brand Dosage Frequency Indications Contraindic Side Adverse Special Nursing
Name Name ations Effects Effects Precaution Considerati
on

Diphenhydramine Benadryl 25mg PRN Relief of Hypersensitivit Drowsiness; CNS: Advise the pt to Administer with
symptoms y to depression, practice the ff:  food if GI upset
associated with diphenhydrami Dizziness; dizziness, occurs.
1.This should be
perennial and ne headache, stored at room Administer syrup
Constipation;
seasonal allergic hydrochloride sedation; temperature in form if the
rhinitis; and other stomach upset, paradoxical its original patient is unable
vasomotor antihistamines blurred vision; stimulation in container. to take tablets.
rhinitis; allergic of similar children;
conjunctivitis; chemical Dry 2. Excessive 3. Monitor
EENT: dryness humidity should patient response,
mild, structure. mouth/nose/thr
of mouth, be avoided. and arrange for
uncomplicated oat adjustment of
urticaria and Hypersensitivit thickened 3. This drug may dosage to lowest
angioedema; y; neonates, respiratory not be a good possible effective
lactation. secretion, choice for you if dose.
Amelioration of blurring of you have certain
allergic reactions vision; medical Take as
to blood or conditions. prescribed; avoid
plasma and GU: urinary excessive
retention dosage.
dermatographis
m; adjunctive  Take with food if
GI:
therapy in GI upset occurs.
disturbances
anaphylactic
and blood  Avoid alcohol;
reactions.
dyscrasias serious sedation
could occur.

 Advise patient
that there are
side effects that
may occur. Take
drug with meals
and use frequent
mouth care.
 DRUG STUDY

Generic Brand Dosage Frequency Indications Contraindi Side Adverse Special Nursing
Name Name cations Effects Effects Precaution Consideration

Hydrocortisone Hydrocort, PRN Anaphylaxis; Viral/fungal Acne or CNS: Advise the pt to Monitor signs of
Alphosyl, infections; pimples; depression, practice the ff:  thrombophlebitis
Aquacort,   euphoria, and
  Blistering, 1. Wash your thromboembolism.
Cortef, headache, hands with soap
Acute asthma; burning, Notify physician or
Cortenema,Sol increased and water before nursing staff
Tubercular or crusting,
uCortef   intracranial and after using immediately, and
syphilitic dryness, or pressure this medicine. request objective
lesions; flaking of the
Adrenocortical (children tests  if thrombosis
insufficiency; skin; only):  2.Do not is suspected.
  bandage or
  Irritation; EENT: otherwise wrap
Bacterial the skin being
Monitor and report
infections cataracts, signs of peptic
Tendonitis; Itching, treated unless
unless used in increased directed to do so
ulcer, including
scaling,
conjunction intraocular by your doctor
heartburn, nausea,
  severe vomiting blood,
with pressure.
redness, tarry stools, and
Small joint appropriate 3.Stop using this
soreness, or Derm: acne, medicine and loss of appetite.
arthritis for local chemotherapy. swelling of the  
decreased check with your
infiltration; skin; Report persistent or
wound doctor right
away if you or increased
  healing,
Redness and your child have musculoskeletal
ecchymoses, pain to determine
scaling around a skin rash,
Juvenile fragility, presence of bone or
the mouth; burning,
idiopathic hirsutism, stinging, joint pathology.
arthritis; Thinning of the petechiae. swelling, or
skin with easy irritation on the Monitor personality
  Endo: adrenal skin. changes, including
bruising,
suppression, depression,
Inflammation; especially
hyperglycemia 4.Do not use euphoria,
when used on cosmetics or restlessness,
  the face or other skin care hallucinations
where the skin products on the
Replacement folds together; treated areas
therapy
 DRUG STUDY

Generic Brand Dosage Frequency Indications Contraindi Side Adverse Special Nursing
Name Name cations Effects Effects Precaution Considerat
ions

Triamcinolone Cinolar, PRN Maintenance Hypersensitivit Burning, CNS: Euphoria, Advise the pt to 1. Be aware that
headache, practice the ff:  postural
Kenalog, treatment of y (product itching, insomnia,
Triderm asthma as contains irritation, hypotension may
confusion, 1. Keep this accompany
prophylactic chlorofluorocar dryness, psychosis.
medication in the sodium loss and
therapy. bon folliculitis; container it weight loss.
CV: CHF, edema. 
propellants came in, tightly
May decrease and alcohol) Hypertrichosis, GI: Nausea, closed, and out 2. Adhere to
requirement for acneiform vomiting, peptic of reach of drug regimen; do
or eliminate use Acute attack of eruptions, ulcer.
children. not increase or
of systemic asthma/status hypopigmentat Musculoskeletal: decrease
corticosteroids in asthmaticus. ion, perioral Muscle weakness,
2. To protect established
delayed wound young children regimen and do
patients with dermatitis;
healin; from poisoning, not discontinue
asthma. always lock
Allergic abruptly.
Endocrine: safety caps and
contact Cushingoid immediately 3. Discuss
dermatitis, features, growth
place the adequate diet
maceration of suppression in
children, medication in a with dietitian,
the skin, carbohydrate safe location – patient, and
secondary intolerance, one that is up physician to
infection; hyperglycemia. and away and counter
out of their sight natriuresis,
Special Senses:
Skin atrophy, Cataracts.
and reach. negative
striae and nitrogen
3. Do not let balance, with
miliaria. Hematologic:
Leukocytosis. anyone else use weight loss in
your medication most patients.
Metabolic:
Hypokalemia. 

Skin: Burning,
itching, folliculitis,
hypertrichosis and
hypopigmentation.
 DRUG STUDY

Generic Brand Dosage Frequency Indications Contraindi Side Adverse Special Nursing
Name Name cations Effects Effects Precaution Considerati
ons

Pimecrolimus Elidel   PRN Indicated as Contraindicate Severe burning Skin: Mild burning Advise the pt to Monitor the patient
or warm feeling of practice the ff:  if there are possible
second-line d for use in of treated skin, treated skin; drug interactions
therapy for the children less warts, rash or 1, You should not
short-term and than 2 years of skin lesions; swollen hair use Elidel if you are  Follow the
follicles; allergic to directions on your
non-continuous age
Blistering or pimecrolimus or if prescription label
chronic treatment acne or warts; you have a bacterial carefully
of mild to oozing, or viral skin
moderate atopic burning pain or burning, stinging, infection  Apply pimecrolimus
tingling; tingling, or soreness cream exactly as
dermatitis in non- of treated skin 2. Before using directed. Do not
immunocomprom (especially during Elidel Cream, tell apply more or less
Worsened skin the first few days of your doctor if you of it or more than.
ised adults and
symptoms, treatment); have skin cancer or
children 2 years
swollen any type of skin  Encourage the
of age and older CNS: Headache; infection, patient not to start
glands, sore
who have failed Netherton's or change the
throat; Respi: Cold syndrome. dosage of the
to respond symptoms such as medication before
adequately to Fever, chills, stuffy nose, 3. Avoid applying checking in with the
other topical body aches, sneezing; Elidel Cream to an healthcare
prescription area that may be provider. 
and flu GI: Upset stomach; affected with skin
treatments, or symptoms cancer. Notify the physician
when those Musculo: muscle about the
treatments are pain; or feeling 4. Elidel can lower medication that they
more sensitive to the blood cells that are taking which
not advisable. hot or cold help your body fight may cause possible
temperatures infections. interaction. 

  5. Tell your doctor if  Discuss the risks

you have been and benefits with
exposed to any the patient in using
illness, or if you this drug.
have any signs of
infection.  

 
 DRUG STUDY

Generic Brand Dosage Frequency Indications Contraindi Side Adverse Special Nursing
Name Name cations Effects Effects Precaution Considerati
s ons

Mupirocin Bactroban,   PRN Indicated for the Hypersensitivit Blistering, CNS: nasal only: Advise the pt to Watch for signs and
headache. practice the ff:  symptoms of
Bactroban treatment of y to any of its crusting, superinfection
Nasal, and secondarily components irritation,
EENT: nasal Avoid itching or
Centany infected and for itching; only: cough, scratching the
Discontinue the
drug and notify
traumatic skin ophthalmic itching, affected area.
Reddening of physician if signs of
lesions due to use. pharyngitis, Patients should contact dermatitis
susceptible the skin, rhinitis, upper avoid contact develop or if
isolates of canker sores, respiratory tract with other exudate production
cracked; congestion. individuals (e.g., increases.
Staphylococcus
aureus (S. other athletes) Always wash hands
Dry, scaly skin, GI: nausea nasal during the active thoroughly and
aureus) and and altered
pain, swelling, phase of the disinfect equipment
Streptococcus taste.
tenderness, infection.
pyogenes (S.   Use universal
warmth on the Derm: topical
pyogenes) Check that the precautions or
skin; only: burning, isolation procedures
patient and as indicated for
itching, pain, family or
Sores, ulcers, stinging.
specific patients.
or white spots caregivers
understand Monitor any upper
on the lips or respiratory tract
topical
tongue or application irritation,
inside the inflammation,
procedures, cough, or
mouth. adhere to the congestion
recommended following nasal
dosing schedule, administration.
and wash hands
thoroughly after Report severe or
prolonged skin
applying the drug
reactions to the
topically physician

   
 SURGICAL MANAGEMENT

The patient was referred to a pediatric otolaryngologist

for consideration of an adenotonsillectomy.


An adenotonsillectomy is a surgery done to remove the
adenoids and tonsils. An adenotonsillectomy is often
done to patients with obstructive sleep apnea and
tonsillitis.
 NURSING MANAGEMENT
(Independent)
Ideal:
•
Assess past patterns of sleep in normal environment. Monitor patients
sleep pattern and amount of sleep achieved over the past few days
•
Assess patients’ perception of cause of sleep difficulty and possible
relief measures to facilitate treatment
•
Evaluate effects of medications that can disrupt sleeping pattern
•
Instruct patient to follow consistently a daily schedule for retiring and
arising as possible
•
Increase daytime physical activity
•
Discourage pattern of daytime naps
•
Suggest use of soporifics such as milk at night or before bed time
•
Recommend an environment conducive to sleep or rest
•
Provide nursing aid such as comfortable position and relaxation
techniques
•
Teach about possible causes of EDS or disturbed sleeping
patterns and optimal ways to treat them
Actual:
•
Taking full medical history, including the review of medications,
and conducting a physical exam to rule out causes of symptoms.
NURSING MANAGEMENT
(Dependent)
 NURSING MANAGEMENT
Ideal: (Collaborative)
•
Consultation to dietician and nutritionist for nutrition promotion and proper activity and exercise
program.
•
Patient need to be referred to a sleep specialist for further evaluation of condition.
•
Patient may be referred to a pediatric neurologist.
 

Actual:
•
Patient was referred to a pediatric otolaryngologist for consideration of nocturnal
polysomnography (NPSG) or an adenotonsillectomy. The otolaryngologist notes that she has not
tolerated nasal fluticasone well, that she is a chronic mouth breather, and that her tonsils are
enlarged (3+). An NPSG is ordered to help clarify matters.
 DATE ASSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE
OBJECTIVE SUBJECTIVE

March 15, 2021 “The symptoms Fatigue related to Fatigue is a After 8 hours of Ascertain the Using an -Patient verbalized
of fatigue, poor physical subjective complaint nursing patient belief about appropriate feelings
excessive condition and with both acute and intervention, what is causing quantitative of increased
The NPSG chronic conditions. It
demonstrates the daytime nonrestorative the patient will: his/her fatigue.: scoring scale, 1 to energy and
sleepiness is the self-recognized  
following: sleep pattern. severity, changes in 10 for example, improved
(EDS), and lack state in which an -Verbalize
  severity over time, can aid the patient wellbeing.
- A respiratory of attention in individual increased
experiences an aggregating factors or to formulate the
disturbance index and school developed energy and  
an apnea-hypopnea Deficient overwhelming alleviating factors and amount of fatigue
over a 1- to 2- Knowledge, improved the frequency. experienced.  It is
index (AHI) of 6.2 per sustained sense of -Patient
month period, related to drug wellbeing. important to
hour exhaustion and   demonstrates a
  and action and side conclude if the
decreased capacity -Be more active more positive and
- Sleep latency of 0.5 effects. for physical and patient’s level of happier attitude
minutes and rapid eye her weight   fatigue is constant
mental work that is than before the
movement (REM) started to Risk for Injury, -Be able to or if it varies over
not relieved by rest. interventions were
latency of 0.5 minutes increase rapidly related to know the cause time.
  However, it is applied
despite the drowsiness of fatigue.
-A sleep efficiency of important to know
dietary secondary to that fatigue is not the
87.5% -The patient or  
 
intervention.” effects of drug same as tiredness.
  legal guardian Assess the patient’s Fatigue can
-18.2% of total sleep   Tiredness is -Patient is able to
  will ability to perform restrict the
time in stage N1, 36.4% temporary. Fatigue is Demonstrate identify factors
in N2, 29.9% in N3, “daytime associated with a ADLs, instrumental patient’s ability to that aggravate and
  knowledge of
and 15.5% in REM sleepiness variety of physical activities of daily participate in self- relieved
drug therapy
sleep seemed to be living (IADLs), and care and do his or
 
and psychological and side effects. her fatigue.
progressive, and conditions. An   demands of daily her role
-An arousal index of she would fall
18.6 overwhelming, -The patient living (DDLs). responsibilities in  
-A periodic leg
asleep suddenly sustained sense of will be able to the family and
even when she exhaustion and verbalize the -Patient is able to
movement index of 6.3. society, such as
  wanted to be decreased capacity risk of injury record aggravating
during the state working outside
-,Multiple periods of awake.” for physical and factors that led
of drowsiness the home.
wakefulness scattered mental work at the to determining
throughout the night usual level. relieving factors
and six REM periods.
  -
 
 INTERVENTION
Determine presence of sleep disturbances
Observe physiological reaction to activities such as any alterations in BP,
respiratory rate, or heart rate
Evaluate need for individual assistance.
Assess the patient’s nutritional ingestion for adequate energy sources and
metabolic demands.
Assess the patient’s typical level of exercise and physical movement.
Assess the patient’s sleep patterns for quality, quantity, time taken to fall
asleep and feeling upon awakening and observe alteration in thought
processes or behaviors.
Assess the patient’s routine recommendation and over-the-counter drugs.
Aid the patient with developing a schedule for daily activity and rest.
Emphasize the importance of frequent rest periods.
Encourage verbalization of feelings about the impact of fatigue.
Aid the patient develop habits to promote effective rest/sleep patterns.
RATIONALE
Fatigue can be a consequence of sleep deprivation. 
Tolerance varies significantly, depending on the phase of the disease progression,
nutrition condition, fluid balance, and quantity or sort of opportunistic diseases
that patient has been subjected to.
Established realistic activities with the patient and encourage forward movement. 
Fatigue may be a symptom of protein-calorie malnutrition, vitamin deficiencies, or
iron deficiencies.
Increased physical exertion and inadequate levels of exercise can add to fatigue.
Changes in the patient’s sleep pattern may be a contributing factor in the
development of fatigue. Numerous factors can exacerbate fatigue, together with
sleep deprivation, emotional distress, side effects of drugs, and progressing CNS
disease.
Fatigue may be a medication side effect or an indication of a drug interaction. The
nurse must perform particular notice to the patient’s utilization of beta-blockers,
calcium channel blockers, tranquilizers, alcohol, muscle relaxants, and sedatives.
A plan that balances periods of activity with periods of rest can aid the patient
complete preferred activities without contributing to levels of fatigue
Acknowledgement that living with fatigue is both physically and emotionally
challenging helps in coping.
Promoting relaxation before sleep and providing for several hours of uninterrupted
sleep can contribute to energy restoration.
DATE ASSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE
OBJECTIVE SUBJECTIVE

March 17, Parents report Narcolepsy is a Within 8 Assess sleep Each individual  The client will
2021 that the client Disturbed chronic sleep hours of pattern has different be able to
does not Sleep Pattern disorder nursing disturbances and pattern of identify
awaken during
r/t lifestyle
characterized by interventions, help develop a sleep. appropriate
the night. No overwhelming child will sleeping plan. Information interventions
snoring, disruption identify
evidenced by daytime about this topic to promote
choking, drowsiness and appropriate provides sleep
snorting, fallen asleep at interventions
school and sudden attacks of baseline data
gasping, or sleep. People to promote for evaluating The patient
apnea, and dropping of sleep
grades with narcolepsy means to responses to
She sleeps an
average of 9-
often find it improve the intervention
Having 10 hours per difficult to stay patient’s sleep. and actions
difficulty night but is awake for long performed
focusing and restless and periods of time,
staying awake in tosses and regardless of the
circumstances. Review The patient’s
the clinic.. turns
frequently in Narcolepsy can psychologic perception may
 
her sleep. cause serious assessment, noting differ from the
 
disruptions in individual and objective
your daily personality evaluation.
routine. characteristics.
 INTERVENTION
Assist with diagnostic testing (EEG, sleep studies)
Observe and obtain feedback from client/ SOs regarding usual bedtime
routines, number of hour of sleep, time of arising and environmental needs.
Listen to subjective reports of sleep quality.
Observe physical signs of fatigue
Arrange care to provide for uninterrupted periods of rest, especially allowing To help client have undisrupted, longer sleep
for longer periods of sleep at night when possible. Do as much care as possible
without waking client.
Provide quite environment and comfort measure.
Discuss/implement effective age-appropriate bedtime rituals (favorite
blanket/toys)
Recommend limiting intake of chocolate/milk specially prior to bedtime.
Referred to sleep specialist/laboratory for treatment when indicated.
RATIONALE
EEG is used to measure the electrical activity of the brain. EEG can help diagnose
a number of conditions like sleep disorders.
To determine usual sleep pattern and provide comparative baseline.
It vary and differ from objective report for sleep quality
Disrupt sleep duration and quality adds distress and tension
A lot of people sleep better in cool, dark, quite environment
to enhance client ability to fall asleep, reinforce the bed is a place to sleep and
promote sense of security for a child
to reduce need for night time elimination
This might help when the clients snore or gasp for air while she sleep. Have a hard
time falling asleep or staying asleep Throughout the night. Feel tired during the
day even if she slept the night before. Can’t perform her daily activities because
she’s too tired.
 REHABILITATION

Home management

• Instruct patient as well as the attending family members to follow the proper administration of the regiments and
treatment plan at home. (In giving health teaching include the five rights of medication administration.)

• Advice patient to maintain a regular sleep/wake schedule and follow strict health diet plan as advice by a
dietician.

• Advice patient to schedule naps during the day. (20-30 minutes) and encourage to spend time to exercise
regularly- at least 20 minutes per day.

• Discuss to the patient what aggravates their symptoms

• Encourage patient to try talking to friends, family and school mates

• Remind the importance of follow-up check-ups with healthcare provider

• Refer patients and family to a psychotherapist