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Sleep Rest Scenarios

What do you think the problem is?
The patient is not getting enough sleep because he is not allowing for enough time to sleep. He is also not having quality sleep when he does sleep because his mind won’t slow down and relax.

What factors are contributing to this problem?
Stress related to the amount of activities he is involved in. He is playing baseball and looking to obtain a scholarship related to that. He has maintaining good grades as well 90%. He is now taken on a major role in the school play. The patient is not aware or admitting the affect these obligations are having on his sleep and health.

How will you help the patient develop a plan for the management of activities to promote sleep?
Provide productive and healthy tools to manage his stress. Because he is a minor, informing and education the family as well. Collaborating with mental health professionals could also help.

Assessment 1: Patient is “getting mad easily”
Assessment 2: Patient is having difficulty focusing. “Studying is harder”
Assessment 3: The patient is “fatigued” all the time.

NANSA-I Nursing Diagnosis: Ineffective Coping r/t Stress overload
Rationale: Fatigued; frequent illness (headaches); inability to ask for help; struggling to meet role expectations, ineffective coping strategies (Ladwig, Ackley, p.292); increase in anger; excessive stress; possibly feeing of pressure (ex: parents and scholarship) (Ladwig, Ackley, p.737).

Related Factors: Inadequate opportunity to prepare for the stress. The patient feels likes he has been under this level of stress “since I was a kid.” He has ineffective tension release strategies (Ladwig, Ackley, p.292). He has repeating stress (Ladwig, Ackley, p.737).

Patient Outcome: By the end of 30 days the patient will verbalize he is falling asleep easer and the patient is getting 6 hours sleep.

Nursing Intervention: Discuss time management tool. Lay out a visual schedule of the patients week to the half out.
Rationale: Organizing and mapping out his schedule will provide a since of control and reduce stress (Treas, Wilkinson, p.255).

Nursing Intervention: Educate the patient on relaxation techniques.
Rationale: Meditation and visualization/imagery can be used to help the patient redirect his thoughts when laying down to sleep (Treas, Wilkinson, 257).

Nursing Intervention: Refer the patient and his family to a counselor for mediated discussion on expectations. Those of the parents and what the patient expects form himself.
Rationale: The patient has expressed that he has always felt like he was this busy and under the same amount of stress. The parents were excited about the scholarship, but may not be aware of the stress that puts on the patient.

References
Ladwig, G. B., Ackley, B. J., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Mosby's guide to nursing diagnosis. St. Louis, MO: Elsevier.
Treas, L. S., Wilkinson, J. M., Barnett, K. L., & Smith, M. H. (2018). Basic nursing: Thinking, doing, and caring. Philadelphia, PA: F.A. Davis Company.




Scenario #2: James Mitchell (Geriatric)
• What do you think is the problem?
• What factors are contributing to this problem?
I think that the problem is sleep apnea. I used STOP and BANG and got a yes for every question he is positive on every question for sleep apnea. The patient is an older male who has hypertension on blood pressure medications to control the HTN, overweight, coronary artery disease and is retired as he falls asleep while watching tv shows probably a sedentary lifestyle since retirement. The patients’ wife must wake him when he stops breathing, he snores and thrashes in his sleep. The patient has all the classic signs for obstructive sleep apnea as he was newly diagnosed. It has also been well established that OSA is associated with poor cardiovascular outcomes like coronary artery disease (CAD), atrial fibrillation, stroke [4] and myocardial injury [5]. (Ahsan, et. Al 2020) I would say has sleep apnea has contributed to some of his other diagnoses such as coronary artery disease (CAD) in conjunction with his lifestyle and weight.
Snoring? (Loudly) The patient tells the nurse his wife tells him he does, so Yes.
Tired? (tired or sleepy during the day) The patient is tired during the day and thinks it is due to his age, Yes.
Observed? (stop breathing during sleep) The patient’s wife states he does, Yes.
Pressure? (Do you have high blood pressure) The patient is taking blood pressure medications for his HTN, Yes.

BMI more than 35 kg/m? His BMI is 40.6, Yes.
Age older than 50? The patient is 80 DOB 4/04/1940, Yes
Neck size large? In your shirt collar 16 inches/40cm or more larger. The nurse measured Neck at 48 cm, yes the neck is large.
Gender? The patient is a Male.

References:
Ahsan, M. J., Latif, A., Fazeel, H. M., Lateef, N., Zoraiz Ahsan, M., Kapoor, V., Batool, S. S., Mirza, M., Ashfaq, Z., Holmberg, M., & Anwer, F. (2020). Obstructive sleep apnea and peripheral vascular disease: a systematic review based on current literature. Journal of Community Hospital Internal Medicine Perspectives (JCHIMP). https://doi.org/10.1080/20009666.2020.1764276
Treas, L.S., Wilkinson, J.M, Barnett, K.L., & Smith, M.H. (2018). Basic nursing: Thinking, doing, and caring (2nd Ed.). Philadelphia, PA: F.A. Davis

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