ASSESSMENT S> “Gabi ang trabaho ko sa may Alabang kaya madalas puyat ako.” as verbalized by the client. O>fatigue >restlessness >eyebags >working hours: 10 p.m. to 8 a.m. >sleeps 10 a.m. to 3 p.m. if she has work >sleeps 10 p.m. to 7 a.m. if she has no work
NURSING DIAGNOSIS Disturbed Sleeping Pattern related to frequently changing sleep-wake schedule as evidenced by the working hours of the client.
SCIENTIFIC PLANNING EXPLANATION Change in Long Term sleep- wake Outcome: schedule After 1 week of nursing Decreased REM interventions, the client will Impaired report processing of improvement in information in quality of sleep the brain pattern. Decreased oscillations Disturbed sleeping pattern
REFERENCE: Fundamentals of Nursing by Taylor, page 1178
IMPLEMENTATION Independent: ♥ Provide quiet environment (straighten sheets). ♥ Provide comfort measures (back rub). ♥ Arrange care to provide uninterrupted sleep.
Short Term Outcome: ♥ Recommend Limiting After 2 hours of intake of caffeine and nursing chocolate prior to interventions, sleep. the client will ♥ Explore other sleep state two ways aids. (warm bath or to improve sleep milk) pattern such as providing a quiet environment Collaborative: (straightening ♥ Refer to sleep sheets) and specialist for comfort treatment when measures (back indicated. rub).
SCIENTIFIC RATIONALE -this provides a conducive environment for the client to relax. (Fundamentals of Nursing by Taylor) -this soothes and relaxes the client. (Fundamentals of Nursing by Taylor) -to promote wellness. (Fundamentals of Nursing by Taylor) -Caffeine inhibits sleep (Nutrition and Diet Therapy by Peckenpaugh) -to promote wellness. (Fundamentals of Nursing by Taylor)
-for advise from a specialist. (Fundamentals of Nursing by Taylor)
EVALUATION Outcome Achieved. After 2 hours of nursing interventions, the client stated two ways to improve sleep pattern such as providing a quiet environment (straightening sheets) and comfort measures (back rub).