Nurse's Pocket Guide

NURSING PRIORITY NO.2.To assist client to enhance sleep/rest:
• Recommend limiting intake of chocolate and caffeine/alcoholic
beverages (especially prior to bedtime), which are substances
known to impair falling or staying asleep. Use of
alcohol at bedtime may help individual initially fall asleep,
but ensuing sleep is then fragmented.
• Limit fluid intake in evening if nocturia or bedwetting is a
problem to reduce need for nighttime elimination.
• Recommend appropriate changes to usual bedtime rituals:
Provide quiet environment and comfort measures (e.g., back
rub, washing hands/face, cleaning and straightening
sheets). Promotes relaxation and readiness for sleep.
Explore/implement use of warm bath, comfortable room
temperature, use of soothing music, favorite calming TV
show. Nonpharmaceutical aids may enhance falling
asleep.
Discuss/implement effective age-appropriate bedtime rituals
for infant/child (e.g., soothing bath, rocking, story reading,
cuddling, favorite blanket/toy). Rituals can enhance ability
to fall asleep, reinforce that bed is a place to sleep, and
promote sense of security for child.
• Assist client in use of necessary equipment, instructing as necessary.
Client may use oxygen or CPAP system to improve
sleep/rest if hypoxia or sleep apnea diagnosed.
• Investigate use of sleep mask, darkening shades/curtains,
earplugs, low-level background (white) noise. Aids in blocking
out light and disturbing noise.
• Arrange care to provide for uninterrupted periods for rest.
Explain necessity of disturbances for monitoring vital signs
and/or other care when client is hospitalized. Do as much care
as possible without waking client during night. Allows for
longer periods of uninterrupted sleep, especially during
night.
NURSING PRIORITY NO.3.To promote optimum wellness:
• Assure client that occasional sleeplessness should not threaten
health. Knowledge that occasional insomnia is universal
and usually not harmful may promote relaxation and relief
from worry.
• Encourage regular exercise during day to aid in stress control/release
of energy. Note: Exercise at bedtime may stimulate
rather than relax client and actually interfere with sleep.
• Advise using barbiturates and/or other sleeping medications
sparingly. These medications, while useful for promoting
sleep in the short-term, can interfere with REM sleep.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 629
readiness for enhanced SLEEP