ADNG

Concept Map Assignment

Meredith Grey, SN

Patient Information

Male

25 years old

CNA – works overnights

General appearance is healthy

Reports tiredness, fatigue, and difficulty focusing

Medications: Ritalin and Valium

O2 (98%) BP (118/70) Pulse (81) Resp (18) BMI (25.7)

Senses within normal range with assistance of eyeglasses

Respiratory and cardiovascular sounds normal and regular

Full range of motion

2

Main complaint: sleep issues. Not getting enough. Not feeling rested. Trouble focusing.

2

Medical Diagnosis

Circadian rhythm sleep disorder

(shift work sleep disorder)

According to the National Heart, Lung, and Blood Institute (NIH), circadian rhythm disorders are “problems that occur when your body’s internal clock, which tells you when it’s time to sleep or wake, is out of sync with your environment.  When your sleep-wake cycle is out of sync with your environment, you may have difficulty sleeping, and the quality of your sleep may be poor. Disruptions of your sleep-wake cycle that interfere with daily activities may mean that you have a circadian rhythm disorder.”

This can be caused by aging, genes, and medical conditions, or it can be situational and related to habits, jobs, or travel. Symptoms include sleepiness during the daytime, reduction in being alert, and issues with memory. To diagnose this disorder, doctors may request a sleep study.

Shift work sleep disorder is a form of circadian rhythm sleep disorder caused by shift work and the alteration to the body’s natural sleeping rhythm. Other symptoms include challenges with concentrating, low energy, and headaches.

SWSD increases the chance of work-related accidents, health complaints, and drug and alcohol dependency.

3

4

Shift, on-call, and night work

Frequent changes in routine

Medications

Irritability and mood issues

Work-related errors

Difficulty focusing

Risk Factors

Nursing Diagnosis

Disturbed sleep pattern r/t work-related nonrestorative sleep pattern AEB trouble focusing and feeling unrested and dissatisfied with sleep

5

5

Goal

Patient will have improved sleep and sense of feeling rested at four-week follow-up appointment

Complications to Report to HCP

7

Memory impairment

Cardiovascular pain or irregularity

Alcohol and/or drug dependency

.

Data to Support Nursing Diagnosis

Patient states “I feel tired all the time.”

Patient reflects that he feels fatigued and occasionally has trouble remembering things

Patient reports that he works overnight shifts as a CNA and often picks up extra shifts, resulting in irregular sleep patterns and unpredictable rest throughout that time

8

Diagnostic Exams, Tests, Results Relating to Medical Diagnosis

Patient sleep log and diary

Pittsburgh Sleep Quality Index

Morningness - Eveningness Questionnaire

9

A sleep diary can help identify the issue and monitor the problem. It can also help keep a record of how many overnight shifts the person is working, which can then allow them to reflect on that and determine if that is sustainable.

The Pittsburgh sleep study index is an instrument that psychiatrists can use to measure sleep quality in clients. It’s a self-rated questionnaire which looks at sleep quality and disturbance over the course of a month. The individual is then scored on subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medication, and daytime dysfunction. It was developed in 1989 and published by Buysse et al. (1989).

The morningness-eveningness questionnaire is a self assessment developed by Horne and Ostberg in 1976. It analyzes people’s circadian rhythm. Questions are asked to indicate when they would prefer to sleep, rather than when they do, to assess their natural rhythm. Multiple choice score 16-86. 41 and below indicate evening. 59 and above indicate morning. 42058 indicate intermediate

9

Nursing Interventions with Evaluations

Assess causative factors contributing to disturbed sleep pattern and ascertain potential alterations to sleep pattern to improve sleep quality and restfulness.

Evaluate sleep and degree of dysfunction to ascertain intensity and duration of problems and help patient evaluate sleep expectations.

10

Assist client to establish an optimal sleep/rest pattern by minimizing sleep-disrupting factors and addressing the causative factors resulting in disturbed sleep pattern.

Evaluation 1: Client will understand causes of disturbed sleep and identify potential alterations.

Evaluation 2: Client will understand severity of sleep disfunction and set realistic sleep expectations.

Evaluation 3: Client will establish a plan for sleep/rest that allow for healthy sleep.

10

Rationale for Nursing Interventions

Patient needs to identify cause of sleep disturbance in order to address the primary issue causing problems.

Patient needs to evaluate the intensity and duration of the problem in order to assess the significance and importance of the issue.

In order to improve sleep, patient will need to establish a sleep/rest pattern that addresses the primary issue and causative factors.

11

Patient Education & Discharge Planning Needs

Discuss healthy sleep habits with patient and collaborate on a plan to address the causative issue of sleep disturbance with relevant actions the patient can take at home.

Discuss the appropriateness of over-the-counter, herbal, and prescription sleep aids.

Schedule follow-up visit in four weeks to reassess vital signs and discuss education plan and interventions implemented to address causative issue; follow up on medicinal sleep aids as appropriate.

12

Learning Goals

I need to learn more about how to help someone acquire quality sleep when the issue isn’t a biological inability to sleep or in-home environmental factors but a work-hazard of on-call, overnight, or shift-work. This would help in selecting appropriate nursing interventions that are relevant for the patient’s lifestyle.

13

Thank you!

Meredith Grey

[email protected]

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Concept Map Assignment

Meredith Grey, SN

Patient Information

Male

25 years old

CNA – works overnights

General appearance is healthy

Reports tiredness, fatigue, and difficulty focusing

Medications: Ritalin and Valium

O2 (98%) BP (118/70) Pulse (81) Resp (18) BMI (25.7)

Senses within normal range with assistance of eyeglasses

Respiratory and cardiovascular sounds normal and regular

Full range of motion

2

Main complaint: sleep issues. Not getting enough. Not feeling rested. Trouble focusing.

2

Medical Diagnosis

Circadian rhythm sleep disorder

(shift work sleep disorder)

According to the National Heart, Lung, and Blood Institute (NIH), circadian rhythm disorders are “problems that occur when your body’s internal clock, which tells you when it’s time to sleep or wake, is out of sync with your environment.  When your sleep-wake cycle is out of sync with your environment, you may have difficulty sleeping, and the quality of your sleep may be poor. Disruptions of your sleep-wake cycle that interfere with daily activities may mean that you have a circadian rhythm disorder.”

This can be caused by aging, genes, and medical conditions, or it can be situational and related to habits, jobs, or travel. Symptoms include sleepiness during the daytime, reduction in being alert, and issues with memory. To diagnose this disorder, doctors may request a sleep study.

Shift work sleep disorder is a form of circadian rhythm sleep disorder caused by shift work and the alteration to the body’s natural sleeping rhythm. Other symptoms include challenges with concentrating, low energy, and headaches.

SWSD increases the chance of work-related accidents, health complaints, and drug and alcohol dependency.

3

4

Shift, on-call, and night work

Frequent changes in routine

Medications

Irritability and mood issues

Work-related errors

Difficulty focusing

Risk Factors

Nursing Diagnosis

Disturbed sleep pattern r/t work-related nonrestorative sleep pattern AEB trouble focusing and feeling unrested and dissatisfied with sleep

5

5

Goal

Patient will have improved sleep and sense of feeling rested at four-week follow-up appointment

Complications to Report to HCP

7

Memory impairment

Cardiovascular pain or irregularity

Alcohol and/or drug dependency

.

Data to Support Nursing Diagnosis

Patient states “I feel tired all the time.”

Patient reflects that he feels fatigued and occasionally has trouble remembering things

Patient reports that he works overnight shifts as a CNA and often picks up extra shifts, resulting in irregular sleep patterns and unpredictable rest throughout that time

8

Diagnostic Exams, Tests, Results Relating to Medical Diagnosis

Patient sleep log and diary

Pittsburgh Sleep Quality Index

Morningness - Eveningness Questionnaire

9

A sleep diary can help identify the issue and monitor the problem. It can also help keep a record of how many overnight shifts the person is working, which can then allow them to reflect on that and determine if that is sustainable.

The Pittsburgh sleep study index is an instrument that psychiatrists can use to measure sleep quality in clients. It’s a self-rated questionnaire which looks at sleep quality and disturbance over the course of a month. The individual is then scored on subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medication, and daytime dysfunction. It was developed in 1989 and published by Buysse et al. (1989).

The morningness-eveningness questionnaire is a self assessment developed by Horne and Ostberg in 1976. It analyzes people’s circadian rhythm. Questions are asked to indicate when they would prefer to sleep, rather than when they do, to assess their natural rhythm. Multiple choice score 16-86. 41 and below indicate evening. 59 and above indicate morning. 42058 indicate intermediate

9

Nursing Interventions with Evaluations

Assess causative factors contributing to disturbed sleep pattern and ascertain potential alterations to sleep pattern to improve sleep quality and restfulness.

Evaluate sleep and degree of dysfunction to ascertain intensity and duration of problems and help patient evaluate sleep expectations.

10

Assist client to establish an optimal sleep/rest pattern by minimizing sleep-disrupting factors and addressing the causative factors resulting in disturbed sleep pattern.

Evaluation 1: Client will understand causes of disturbed sleep and identify potential alterations.

Evaluation 2: Client will understand severity of sleep disfunction and set realistic sleep expectations.

Evaluation 3: Client will establish a plan for sleep/rest that allow for healthy sleep.

10

Rationale for Nursing Interventions

Patient needs to identify cause of sleep disturbance in order to address the primary issue causing problems.

Patient needs to evaluate the intensity and duration of the problem in order to assess the significance and importance of the issue.

In order to improve sleep, patient will need to establish a sleep/rest pattern that addresses the primary issue and causative factors.

11

Patient Education & Discharge Planning Needs

Discuss healthy sleep habits with patient and collaborate on a plan to address the causative issue of sleep disturbance with relevant actions the patient can take at home.

Discuss the appropriateness of over-the-counter, herbal, and prescription sleep aids.

Schedule follow-up visit in four weeks to reassess vital signs and discuss education plan and interventions implemented to address causative issue; follow up on medicinal sleep aids as appropriate.

12

Learning Goals

I need to learn more about how to help someone acquire quality sleep when the issue isn’t a biological inability to sleep or in-home environmental factors but a work-hazard of on-call, overnight, or shift-work. This would help in selecting appropriate nursing interventions that are relevant for the patient’s lifestyle.

13

Thank you!

Meredith Grey

[email protected]

image1.png

image2.png

image3.png

image4.png

image8.png

image5.png

image7.png

image6.png

image9.png

image13.png

image14.png