Sleep Pattern Disturbance

Published on Saturday March 10th , 2007

Sleep Pattern Disturbance

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
(_) Impaired oxygen transport (_) Impaired elimination (_) Impaired metabolism (_) Immobility (_) Medication (_) Hospitalization	(_) Lack of exercise (_) Anxiety response (_) Life-style disruptions (_) Other:_____________________________ ____________________________________ ____________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Difficulty falling or remaining asleep
Minor: (May be present)	(_) Fatigue on awakening or during the day (_) Dozing during the day (_) Agitation (_) Mood alterations

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient will:

(_) Demonstrate an optimal balance of rest and activity A.E.B. ___ hours of uninterrupted sleep at night.

(_) Remain awake during the day.

(_) Other:

(_) Explore with patient potential contributing factors.

(_) Maintain bedtime routine per patient preference.

Likes to go to bed @ ___ pm.
Prefers quiet
Darkness
Night light
Music

(_) Takes sleeping pill as ordered by a physician @ ____ pm.

(_) Provide comfort measures to induce sleep:

Back rub
Herbal tea-warm milk
Pillows for support
Bedtime snack when appropriate.
Pain medication if needed.
Other:

(_) Limit nighttime fluids to:________

(_) Void before retiring.

(_) Coordinate treatment/meds to limit interruptions during sleep period.

(_) Limit the amount and length of daytime sleeping:____________

(_) Increase daytime activity:______
________________________
________________________
________________________

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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