Nurse's Pocket Guide

disorders, dementia, obesity, pregnancy, menopause, psychiatric
disorders); metabolic diseases (such as hyperthyroidism
and diabetes); prescribed/OTC drugs; alcohol, stimulant/other
recreational drug use; circadian rhythm disorders (e.g., shift
work, jet lag); environmental factors (e.g., noise, no control
over thermostat, uncomfortable bed); major life stressors (e.g.,
grief, loss, finances).
• Note age (high percentage of elderly individuals are affected
by sleep problems).
• Observe parent-infant interactions/provision of emotional
support. Note mother’s sleep-wake pattern. Lack of knowledge
of infant cues/problem relationships may create tension
interfering with sleep. Structured sleep routines based
on adult schedules may not meet child’s needs.
• Ascertain presence/frequency of enuresis, incontinence, or
need for frequent nighttime voidings, interrupting sleep.
• Review psychological assessment, noting individual and personality
characteristics if anxiety disorders or depression
could be affecting sleep.
• Determine recent traumatic events in client’s life (e.g., death
in family, loss of job).
• Review client’s medications, including prescription (e.g.,
beta-blockers, bronchodilators, weight-loss drugs, thyroid
preparations, etc.); OTC products; herbals; to determine if
adjustments may be needed (such as change in dose or time
medication is taken).
• Evaluate use of caffeine and alcoholic beverages (overindulgence
interferes with REM sleep).
• Assist with diagnostic testing (e.g., EEG, full-night sleep studies)
to determine cause/type of sleep disturbance.
NURSING PRIORITY NO. 2.To evaluate sleep pattern and dysfunction(s):
• Observe and/or obtain feedback from client/SO(s) regarding
client’s sleep problems, usual bedtime, rituals/routines, number
of hours of sleep, time of arising, and environmental
needs to determine usual sleep pattern and provide comparative
baseline.
• Listen to subjective reports of sleep quality (e.g., client never
feels rested, or feels sleepy during day).
• Identify circumstances that interrupt sleep and the frequency
at which they occur.
• Determine client’s/SO’s expectations of adequate sleep. Provides
opportunity to address misconceptions/unrealistic
expectations.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 423
INSOMNIA