Assessment

Diagnosis

Inference

Planning

Interventions

Rationale

Evaluation

Subjective:

Disturbed
sleeping pattern
related to
interruptions for
therapeutics
monitoring, other
generated
awakening, and
excessive
stimulation(noise
and lighting)

Circadian clock
system
(responsible for
regulating sleepwake cycle)

After 24 hours or
nursing
interventions,
patient will be
able to achieve
optimal amount of
sleep as
evidenced by
rested
appearance,
verbalization of
feeling rested and
improvement in
sleep pattern.

Assess client's
sleep patterns
and usual
bedtime rituals
and
incorporate
these into the
plan of care

Usual sleep
patterns are
individual; data
collected through
a comprehensive
and holistic
assessment are
needed to
determine the
etiology of the
disturbance

After 24 hours of
nursing
interventions, goal
met. Patient was
able to project a
rested
appearance,
verbalize feeling
rested and
demonstrate
improvement in
sleep pattern.

I find it difficult to
sleep at night,
even in the day
especially with all
the interruptions
since Im being
monitored, as
verbalized by the
patient

Objectives:
Dark circles
under the eyes
Yawning
Restlessness
Irritability
Prolonged
awakenings

Sleep homeostasis

alterations of the
circadian
timekeeping
system and/or a
misalignment
between
endogenous
circadian rhythm
and exogenous
factors that affect
sleep timing
(interruptions for
therapeutics
monitoring, other
generated
awakening, and
excessive
stimulation(noise
and lighting)

Observe
client's
medication,
diet, and
caffeine intake.
Look for
hidden sources
of caffeine,
such as overthe-counter
medications.

Provide
measures to
take before
bedtime to
assist with
sleep (e.g.,
quiet time to

Difficulty sleeping
can be a side
effect of
medications such
as
bronchodilators;
caffeine can also
interfere with
sleep.

Simple measures
can increase
quality of sleep.
Carbohydrates
cause release of

disturbance in
sleep-wake
generating or
timing
mechanisms

Disturbed sleep
pattern

allow the mind

to slow down,
carbohydrates
such as
crackers, or a
back massage)

Assess sleep
pattern
disturbances
that are
associated
with specific
underlying
illnesses

Perform as
much care as
possible
without waking
the client, and
do as much
care as
possible while
the patient is
still awake

Provide pain
relief shortly
before bedtime

the
neurotransmitter
serotonin, which
helps induce and
maintain sleep.
Research has
shown back
massage to
effectively
promote sleep

High percentage
of sleep
disturbances are
affected by
illnesses

To avoid
disturbances
during sleep, and
to maximize
sleeping process

and position
client
comfortably for
sleep

Keep
environment
quiet (e.g.,
avoid use of
intercoms,
lower volume
on radio and
television,
keep beepers
on non-audio
mode,
anticipate
alarms on IV
pumps, talk
quietly on unit)

Explain the
necessity of
disturbances
for monitoring
VS and care
when
hospitalized

Clients have
reported that
uncomfortable
positions and pain
are common
factors of sleep
disturbance

Excessive noise
causes sleep
deprivation that
can result in ICU
psychosis. Health
volunteers
exposed to
recorded critical
care noise levels
experienced poor
sleep. It is
reported that
more than half of
the noises in ICUs
were caused by
human behavior
such as talking
and TV watching

To promote
understanding of
the importance of

care being done

to the patient