ENGLISH II

NCP AND ROLEPLAY

RICKY DWI CAHYO | TINGKAT 1 UNGGULAN

5/14/2013

NURSING CARE PLAN

CASE STUDY

Mr. Bitner is an 86-year-old alert, black, widowed male who was admitted to a nursing home 2 months ago. He is ambulatory and perform most of his self-care. dmitting medical diagnoses included diabetes mellitus and hypertension. He adds to the list !a touch of arthritis." His daughter complains to the charge nurse that her dad seems to be spending more and more time during the day napping and that he says he doesn#t sleep well at night., Assessment findings comprehensi$e sleep assessment of Mr. Bitner following his daughter#s e%pression of concern re$ealed the following data& Sleep-wakefulness pattern 'lient goes to bed between 8 am and ( pm and gets out of bed between ) am and 8 am because staffs are getting his roommate out of bed at this time. He states he ne$er falls asleep before midnight because he always watched the late news at home. He usually wakes twice during the night to $oid and often cannot fall back asleep. *uring the day he is fre+uently obser$ed do,ing in his chair. -f not discouraged, he returns to his room midmorning and afternoon for a .-hour nap. Effect of sleep pattern on everyday living !-#m always tired. - don#t seem to ha$e much energy anymore." 'lient has not sociali,ed yet with other residents and without strong encouragement does not participate in group acti$ities. /rom his point of $iew, life holds little for him to be awake for. !worked for the railroad for almost 01 years and . ne$er o$erslept one." Sleep aids

He *enies e$er using medication to fall asleep. 2tates he often rela%ed at home in the e$ening with the couple of beers. 3ikes a dim light on during the night so he can find the bathroom easily and likes his bedroom door a4ar. 2leeps with two blankets and is often still cold. Sleep disturbances and contributing factors. !5$er since my wife died -#m 4ust not getting enough sleep and since i came here its worse. - don#t know why i don#t fall asleep when i go to bed or why i wake up so much. -t sure makes the nights long. !He has no regular periods of e%ercise and drink black coffee with e$ery meal and one or two diet colas in the e$ening.

ASSESSMENT

2ub4ecti$e *ata client#s daughter complains to the nurse that her dad seems to be spending more and more time during the day napping and that he says he doesn#t sleep well at night 'lient said that since his wife died, he 4ust not getting enough sleep and since he came to the nursing home it#s getting worse. 6he client states that he ne$er falls asleep before midnight because he always watched the late news at home. the client 2tates that he often rela%ed at home in the e$ening with the couple of beers 6he client denies that he e$er using medication to fall asleep.

7b4ecti$e *ata 6he client usually wakes twice during the night to $oid and often cannot fall back asleep. *uring the day he is fre+uently obser$ed do,ing in his chair.

'lient has not sociali,ed yet with other residents and without strong encouragement does not participate in group acti$ities.

6he 'lient 2leeps with two blankets and is often still cold. 6he client has no regular periods of e%ercise 6he client usually drinks black coffee with e$ery meal and one or two diet colas in the e$ening.

DATA ANA !S"S

8o. ..

*ata 2*& client#s daughter complains to the nurse that her dad seems to be spending more and more time during the day napping and that he says he doesn#t sleep well at night 'lient said that since his wife died, he 4ust not getting enough sleep and since he came to the nursing home it#s getting worse. 6he client states that he ne$er falls asleep before midnight because he always watched the late news at home. the client 2tates that he often rela%ed at home in the e$ening with the couple of beers 6he client denies that he e$er using medication to fall asleep. 7*& 6he client usually wakes twice during the night to $oid and often cannot fall back asleep. *uring the day he is fre+uently obser$ed do,ing in his chair. 'lient has not sociali,ed yet with other residents and without strong encouragement does not participate in group acti$ities. 6he 'lient 2leeps with two

9roblem *isruption of sleep patterns

5tiology 5n$ironmental changes, /acility routines.

N#$S"N% D"A%N&S"S
.. *isruption of sleep patterns related to en$ironmental changes, facility routines.

N#$S"N% 'A$E ( AN
8o. .. *ata 2*& client#s daughter complains to the nurse that her dad seems to be spending more and more time during the day napping and that he says he doesn#t sleep well at night 'lient said that since his wife died, he 4ust not getting enough sleep and since he came to the nursing home it#s getting worse. 6he client states that he ne$er *o& :oals *isruption of sleep patterns resol$ed by 2%2< hours. 'riteria of ;esults 2*& ction 9lans .. ssess sleep habits and the changes that occur. 2. 9ro$ide a comfortable bed and some personal property. >. 'reate a new bedtime routine that included to the old patterns and new en$ironments. <. 5ncourage the client to do some light physical acti$ity during the day. 0. 6each rela%ation techni+ues 6. ;educe noise and light. ). -ncrease the comfort while sleeping, e.g., warm bath or massage, a glass of

- client says
there#s an increase in the pattern of sleep = rest

- client looks
rela%ed

- 'lients
look fresher

falls asleep before midnight because he always watched the late news at home. the client 2tates that he often rela%ed at home in the e$ening with the couple of beers 6he client denies that he e$er using medication to fall asleep. 7*& 6he client usually wakes twice during the night to $oid and often cannot fall back asleep. *uring the day he is fre+uently obser$ed do,ing in his chair. 'lient has not

warm milk when wants to sleep 8. 'ollaboration of sedati$es, hypnotics as indicated.

sociali,ed yet with other residents and without strong encouragement does not participate in group acti$ities. 6he 'lient 2leeps with two blankets and is often still cold. 6he client has no regular periods of e%ercise 6he client usually drinks black coffee with e$ery meal and one or two diet colas in the e$ening.

"M( EMENTAT"&N
*ay, *ate, 6ime. Monday, 2>-1<-21.2, 1).11 am *% *% no. . ction ssess sleep habits and the changes that occur. ;esult& -8urse knows the patient habit 2ign

while sleeping.

Monday, 2>-1<-21.2, 18.11 am

*% no. .

9ro$ide a comfortable bed and some personal property. ;esult& -9atient becomes more comfortable while sleeping and feels like at home. 'reate a new bedtime routine that included to the old patterns and new en$ironments ;esult& - patient#s sleep pattern controlled and patient can sleep and get enough sleep. 5ncourage the client to do some light physical acti$ity during the day. ;esult& - patient becomes more rela%ed and sleep more rela%ed. 6each rela%ation techni+ues. ;esult& patient becomes more rela%ed.

Monday, 2>-1<-21.2, 18.>1 am

*% no. .

Monday, 2>-1<-21.2, .1.11 am

*% no. .

Monday, 2>-1<-21.2, ...11 am Monday, 2>-1<-21.2, 16.11 pm Monday, 2>-1<-21.2, 1).11 pm

*% no .

*% no .

;educe noise and light. ;esult& patient sleep more comfortable and can sleep after $oid.

*% no .

:i$e patient massage, and a glass of warm milk when wants to sleep. ;esult& patient said that he feels sleepy and he can sleep like a baby.

Monday, 2>-1<-21.2.

*% no .

'ollaboration of sedati$es, hypnotics as indicated if needed.

E)A #AT"&N
*ay and *ate 6uesday, 2<-1<-21.2 *% *% no. . *e$elopment 2& - patient said that he can sleep $ery comfortable and rela%ed, more than at home. 7& - patient had a producti$e sleep, and no longer sleepy during the day. & - *isruption of sleep patterns related to en$ironmental changes, facility routines resol$ed. 9& 9lans stopped, keep monitoring the client conditions.

ROLE PLAY
ASSESSMENT
*N+ Nurse *(+ (atient

8& good morning Mr. Bitner, My name is ricky, and i will be your nurse for today until 2 pm. How about last night? *id you sleep well? 9& no, i can#t sleep. 8& why you can#t sleep, sir? -s there anything disturbing in your body, like pain, hot, or else? 9& 8o, it#s not like that. - 4ust can#t sleep. 8& okay then, better we had a little chat to sol$e the problem, maybe about .1 minutes, is it okay? 9& okay, nurse. 8& allright then, i want to ask you something first, did these things happened lately? 9& yes, actually. - cannot sleep since my wife died, i 4ust not getting enough sleep at night and since i came to here, it#s getting worse. 8& so, if you only ha$e a little sleep e$ery night, do you do nap at the day, sir? 9& yes i am. i always sleepy at the day and tends to ha$e a nap. 8& do you know how long you ha$e a nap at the day? 9& yesterday i ha$e 6 hours nap, and the day before i ha$e 0 hours nap. 6he time i need to nap is increasing e$eryday, nurse. 8& when you#re at home, is there any habitual action you do in the day and night?

9& well, i do. *uring the day, i often do,ing in my chair. for a nap.

nd if i get sleepy, i will go to my bed

nd about the night, - cannot sleep before midnight because i always watched the

late news at home. nd when i sleep, if i wake up to $oid, i cannot fall back asleep. 8& is there any effect because of your sleeping habit in e$eryday li$ing? 9& -#m always tired. - don#t seem to ha$e much energy anymore and because of my pre$ious 4ob which i need to wake e$ery night, it make it worse. i worked for the railroad for almost 01 years and ne$er o$erslept one. 8& so, because of your sleeping habit, you didn#t ha$e much energy to go through day, and also because of your 4ob, you ne$er sleep at night, is it? 9& 5%actly. 8& do you sociali,e with other people at home, like playing bingo at noon, chatting with neighbor? 9& no, i ha$en#t sociali,ed yet with other residents and without strong encouragement from my daughter, i does not participate in group acti$ities. 8& oh i see. 2ir, do you e$er use of medication before sleep? 9& no, i ne$er. 8& okay. -s this hospital condition aslo affected the way you sleep? 9& yes, i often sleep with a dim light, and the door open. nd i often sleep with two blanket. 8& anything else? /rom your e%ercise and food, maybe? 9& i has no regular periods of e%ercise and drink black coffee with e$ery meal and one or two diet colas in the e$ening. nd i often rela%ed at home in the e$ening with the couple of beers. 8& allright. - can conclude that you can#t sleep because of the habit and the room condition. -sn#t it? 9& it is, nurse.

8& if that so, we#ll try to change the condition in your room and change your sleep habit, do you agree? 9& yes nurse. 8& now i#ll out for setting up, and if you need my help, you can press the button on your left. 9& thank you, nurse ricky.

INTERVENTION
*N+ Nurse *(+ (atient

8& :ood afternoon, Mr. Bitner. 8ow i will do some assessment to help you ha$e a better sleep and no longer sleepy at the day. *o you agree? 9& if it help, okay. 8& hopefully sir. 8ow i will ask you some +uestion. is the condition in this room make you hard to sleep? 9& yes. - feel that this room is so.. so.. bright and boring. -t makes me hard to sleep. - usually sleep at after midnight. But the nurse always waking me at 8, i didn#t ha$e enough sleep, so i always sleepy at the day and after a nap, i e$en more unable to sleep at night.. 8& okay then, so you cannot sleep because of the condition in this room and also the time management of waking up and nap. -sn#t it? 9& maybe. 8& now i will make a shedule for you to sleep and nap, and make your condition while sleep like your habit at home.

9& thank you, nurse. 8& is this bed is comfort enough to make you sleep? 9& no nurse. -t#s $ery firm.. it only make me stiff, not rela%. 8& if that so, i will ask the head nurse to change the bed, okay? 9& yes nurse, please. 8& sir, because you spend most time in bed, your body become @la,y#. Aou need to do some light e%ercise like light walk, or 4ust swingin your hand and feet. 2o your body does not stiff and you can be more rela% and comfortable at night. - will also teach you the rela%ation techni+ue to help you become rela%. 9& okay nurse. 8& now i @ll teach you the rela%ation techni+ue. 9lease follow my instruction. Bteach the client rela%ation techi+ueC 8& that#s it. *o you understand? 9& yes nurse. 8& greatD nd the last thing, if you want to sleep, please call the nurse by pressing the nurse button, ask them to dim this room light or if you can do it alone, you don#t ha$e to. But ask them to bring you a glass of couple milk to make you comfortable, and can sleep faster. 7kay? 9& okay nurse. 8& well, i think we ha$e sol$ed the problem. -#ll come here tomorrow to check is the action is useful. -#ll go out now because there are other patient that i should help. :ood afternoon. 9& :ood afternoon nurse, and thank you.