Question

Case Study, Chapter 33, Sleep-Wake Dis Persons With Insomnia and Sleep Prsrders: Nu Problems her mother in to see her primary care provider because she is A patient's daughter brings h her moher's health since the patlent's husband passed away. In gathering the that she is 63 years old and currently unemployed because she and or his upcoming retirement this month with plans to travel and visit a lifelong dream of theirs. She tearfully tells you that this won't be patient's history, she tells you her husband were preparing relatives in Ireland, fufilling happening now because her husband dled from a massive myocardial infarction, which home during the night 7 weeks ago. When asked about her current symptoms, she reports feeling depressed and stressed sleeping since her husband passed away. At this point in the interview, the patient's daughter interupts and states that she is extremely concened about her mother's lack of sleep. She tells you that her mother began taking melatonin 1 week ago because both the patient and her daughter are not big on taking medicine, and we feel more comfortable using natural interventions, like the melatonin. When performing the sleep assessment, the patient provides the following data: she reports she feels depressed and Tost without her husband, she is stressed with handling the legal and financial affairs; she reports she has no energy, and concentrating has been extremely difficut and she feels exhausted all the time, yet when she attempts to lie down to sleep, she is unable to all asleep in bed because that is where her husband died. She also tells you that since beginning the melatonin, she does fall into a light sleep, usually on the couch, but she tends to wake up with a start or jerk, feeling She also admits to now drinking one to two glasses of wine in the evening in an attempt to soothe her nerves and fall asleep; however, it has not seemed to help feeling in the moming. Alt this point, she tells you she is keeping herself going on strong black offee and drinks two 12-cup pots of coffee a day. She and her daughter are both the patient's health and believe she would be better off in the hospital.(Leaming Objectives 6& 7) occurred at with all that has happened," she has lost weight, and she has problems scared and overwhelmed with a profound feeling of dread upon awakening and leaves her with a "heavy, dulr a. Which NANDA nursing diagnosis is most appropriate for this patient? b. What therapeutic interventions would you suggest for this patient?

Answer 1

• Disturbed sleep pattern related to lifestyle disruptions as evidence by reports of difficulty falling and remaining asleep, agitation, anxiety, dozing during the day.
• Assess patients sleeping pattern and help him develop a sleeping plan
• Provide dark, quiet, comfortable environment
• Discourage caffeine or large meal 2 hours before sleeping
• Refer the patient to a social worker
• Warm milk before sleep is adviced
• Offer meals at regular times
• Provide meaningful activities during day time
• Monitor frequency and duration of sleep
• Reduced stimulation and rituals associated with sleep enhance sleep onset
• Encourage patient to participate in certain groups like a person who lost his/her spouse
• Engage in social activities
• Focus on spiritual health which strengthen the mind
• Mintain a sleep diary to determine the clear picture of the sleep
• Education about sleep problem and appropriate sleep hygiene measures
• Advice for cognitive behavioural therapy ( CBT)
• The other therapies are relaxation therapy, stimulus control therapy and sleep restriction therapy
• Refrain from day time napping
• Use bed only for sleeping
• Avoid alcohol in the evening
• Exercise 6 hours before bed time is beneficial