Question

Ackley: Nursing Diagnosis Handbook, 12th Edition Lecture Notes Problem-Based Learning/Critical Thinking Case Study-Ms. Ambrose_Insomnia Case Scenario "I don't know how much longer I can keep this up," thought Susan, "these awful nights of not sleeping. I didn't get to sleep last night until 2 AM, and then I had to be up at 5:30 AM for clinical rounds. That's not enough sleep. I feel like I'm stumbling through the day." She said a silent prayer that she would not harm anyone during her clinical shift and continued driving to the hospital. Nursing Assessment Susan Ambrose is a 35-year-old nursing student, a single mother with two children, and she works part-time as a nursing technician at night in the local hospital. Over a period of 6 months, Susan has had increasing problems sleeping. She has had trouble getting also, at times, waking up in the middle of the night. She is feeling exhausted most of the time now and is having trouble functioning and studying for her courses. Her friends tell her to just see her physician for sleeping pills. In addition, she is now in what is thought to be the hardest semester in her nursing program. Her grade is presently a 2.5, but she is used to getting 3.5s and 4.0s. In addition, her youngest child has developed chronic ear infections. sleep at night and to A. ASSESS Identify the significant symptoms by underlining them in the assessment. List those symptoms (those you have underlined) that indicate the client has a health problem. Group the symptoms that are similar. B. DIAGNOSE 1. Select possible nursing diagnoses for this client Do this by looking at the list of nursing diagnoses in, the book, Ackley/Ladwig Nursing Diggnosis Handbook: An Evidence-Based Guide to Planning Care or by accessing the ca nlan constructor at the EVOLVE SITE and viewing nursing diagnoses listed there Possible nursing diagnoses: 2. Validate the possible nursing diagnoses. I0 hy Mosby, an imprint of Ele

i did’nt get answers for B,C,D can someone help please

Answer 1

B.

a. The appropriate nursing diagnosis for the present case is:

1. Disturbed Sleep Pattern
2. Anxiety
3. Ineffective individual coping
4. Impaired gas exchange
5. Risk for Injury
6. Self-concept disturbance

b. Related factors for the present scenario,

• Anxiety
• Chronic stress
• Depression
• Emotional or physical discomfort
• Environmental variations
• Excessive stimulation

The complete nursing diagnosis for the present case is :

1. Disturbed sleep pattern related to anxiety

2. Anxiety related to chronic stress

3. Ineffective individual coping related to depression

4. Impaired gas exchange related to emotional discomfort

5. Risk for injury related to environmental variations

6. Self-concept disturbance related to excessive stimulation

C. Plan NOC outcomes:

INDICATOR	1	2	3	4	5
Hours of sleep		x
Sleep Pattern		x
Sleep Quality		x
Sleep Efficiency		x
Feels Rejuvenated after Sleep	x
Sleeps consistently through the night	x

Nursing Interventions:

Nursing Interventions	Rationale
Educate the patient on the proper food and fluid intakes such as avoiding heavy meals, alcohol before bedtime.	Having full meals just before bedtime may produce gastrointestinal upset and hinder sleep onset.
Encourage patient to take milk	L-tryptophan is a component of milk which promotes sleep
Instruct the patient to follow a consistent daily schedule for rest and sleep.	Consistent schedules facilitate regulation of the circadian rhythm and decrease the energy needed for adaptation to changes.
Prevent the patient from thinking about the next day’s activities or any distracting thoughts at bedtime.	Providing a designated time for these concerns allows the patient to “let go” of these problems at bedtime.
Eliminate any activities that are not important.	This measure facilitates minimal interruption in sleep or rest.
Help the patient understand the main cause of sleeping difficulties.	Misconceptions and myths about sleep exist. Wrong notions about sleep disturbances may cause fear and anxiety.