Sleep pattern disturbance
related to decreased physical activity, fear, anxiety, inability to assume usual sleep position, frequent assessments or treatments, unfamiliar environment, and discomfort resulting from current illness/injury.
|The client will attain optimal amounts of sleep as evidenced by:|
- statements of feeling well rested
- usual mental status
- absence of frequent yawning and dark circles under eyes.
|Nursing Actions and Selected Purposes/Rationales|
- Assess for signs and symptoms of a sleep pattern disturbance (e.g. statements of difficulty falling asleep, not feeling well rested, or interrupted sleep; irritability; disorientation; lethargy; frequent yawning; dark circles under eyes).
- Determine the client's usual sleep habits.
- Implement measures to promote sleep:
- perform actions to reduce fear and anxiety (see Diagnosis 13, action b)
- discourage long periods of sleep during the day unless signs and symptoms of sleep deprivation exist or daytime sleep is usual for client
- perform actions to relieve discomfort if present (e.g. reposition client; administer prescribed analgesics, antiemetics, or muscle relaxants
- encourage participation in relaxing diversional activities during the evening
- discourage intake of foods and fluids high in caffeine (e.g. chocolate, coffee, tea, colas) in the evening
- offer client an evening snack that includes milk or cheese unless contraindicated (the L-tryptophan in milk and cheese helps induce and maintain sleep)
- allow client to continue usual sleep practices (e.g. position; time; presleep routines such as reading, watching television, listening to music, and meditating) whenever possible
- satisfy basic needs such as comfort and warmth before sleep
- encourage client to urinate just before bedtime
- reduce environmental distractions (e.g. close door to client's room; use night light rather than overhead light whenever possible; lower volume of paging system; keep staff conversations at a low level and away from client's room; close curtains between clients in a semi-private room or ward; keep beepers and alarms on low volume; provide client with "white noise" such as a fan, soft music, or tape-recorded sounds of the ocean or rain; have sleep mask and earplugs available for client if needed)
- ensure good room ventilation
- encourage client to avoid drinking alcohol in the evening (alcohol interferes with REM sleep)
- encourage client to avoid smoking before bedtime (nicotine is a stimulant)
- if possible, administer medications that can interfere with sleep (e.g. steroids, diuretics) early in the day rather than late afternoon or evening
- administer prescribed sedative-hypnotics if indicated
- perform actions to reduce interruptions during sleep (80 - 100 minutes of uninterrupted sleep is usually needed to complete one sleep cycle)
- restrict visitors
- group care (e.g. medications, treatments, physical care, assessments) whenever possible.
- Consult appropriate health care provider if signs and symptoms of sleep deprivation persist or worsen.