NCP: Disturbed Sleep Pattern r/t hospital setting environment Cues Subjective: Mom, I cant sleep as verbalized by the

client to his mother.

d. environmental modifications fit to optimize stimuli for sleeping. Interventions 1. Identify presence of factors that can contribute to lack of sleep; metabolic diseases and prescribed/OTC drug use. This helps identify causative or contributing factors.

Objective: - restlessness noted - irritable - decreased participation, interaction during interview and assessment after initial establishment of rapport - yawns recurrently Sleep patterns are unique to each individual. - semi dark periorbital features - bed not well tuckedbags, excess family blankets and a number of toys found cluttered at patients bed - overhead light very glaring. Need SLEEP AND REST PATTERN Diagnosis Disturbed Sleep Pattern related to hospital setting environment. Sleep is required to provide energy for physical and mental activities. Sleep patterns can be affected by the environment especially in hospital care settings. There patients experience sleep disturbances secondary to the noisy, bright environment, frequent monitoring and treatments, sharing of room with another, use of medications, night shift rotations that change ones circadian rhythms, acute illness and emotional problems as fear or anxiety. Disruption in the individuals usual diurnal pattern of sleep and wakefulness may be temporary. However, there disruptions may result in both subjective distress and impairment in functional abilities. Objectives That within our 7 hours span of care our client will gain relaxation and rest as evidenced by: a. physiologic/ behavioral improvements like decreased yawning, appropriate effect and facial expressions; b. return of calmness, normal mood and behavior stability; c. sleeping of at least 3 hours undisturbed; and Often, the patients perception of the problem may differ from objective evaluation. 6. Provide a comfortable and relaxing environment by fixing the bed and stretching and tucking well the linens. Also remove clutter from the patients bed. A bed with well fixed and well tucked bed linen is a conducive environment that promotes relaxation and sleep. 7. Assist patient to his comfortable resting position if not contraindicated. Positioning the client to his comfort enhances rest and relaxation since each individual has a varied positions while sleeping. It also promotes circulation. 8. Provide sleeping aid if not contraindicated in the form of a pillow under the feet of the client upon request. Some people require first sleeping aids before they could gain relaxation and sleep such as extra pillows to be placed in a particular body part, type and shape of pillow, stuffed toys, mosquito nets, etc. 9. Provide a quiet and peaceful environment. Reduce noise and avoid making loud noises. 4. Assess patients perception of cause of sleep difficulty and possible relief measures to facilitate treatment. For short term problems, patients may have insights into the etiological factors of the problem. 5. Document nursing or caregiver wakeful behaviors. Record number (e.g. noise, pain, discomfort, psychological (e.g. fear, anxiety) sleep. observations of sleeping and of sleep hours. Note physical urinary frequency) and/or circumstances that interrupt 2. Observe parent-child interactions/provisions of emotional support. Note mothers sleep-wake pattern. Lack of knowledge of child cues/problem relationships may create tension interfering with sleep. Structured sleep routines based on adult schedules may not meet the childs needs. 3. Assess past patterns of sleep in normal environment: amount, bedtime rituals, deep, length, positions, aid and interfering agent.

 A quiet and peaceful environment indicates relaxation and rest while noise interferes with it as it stimulates the brain to be reactive to stimuli present in the environment. 10. Darken the room and reduce light stimulation. Dark environment enhances relaxation and sleep as it activates serotonin; a neurotransmitter that instructs the brain the need for rest and sleep. 11. Encourage client to wear comfortable clothing. Clothes that are comfortable and appropriate to temperature and weather are conducive for sleep and relaxation while clothes that are distracting inhibits one person to rest and sleep. 12. Adjust the room temperature in accordance to the clients comfort. Room temperature is also an important factor to consider in promoting relaxation and sleep.. Individuals preferences that induce sleep also vary from one person to another. Cold room temperature most likely promote calmness and relaxation while a hot room environment stimulates a person to be awake and restless. 13. Close the door of the room always. Closing the door provides privacy and prevents distraction. Privacy is needed to by an individual to induce relaxation and rest. Evaluation Within our 7 hours span of care, the client was able to gain relaxation and rest as evidenced by: a. physiologic/ behavioral improvements like decreased in incidence of yawning, and facial expressions of appropriate effect during his waking hours; b. return of calmness, normal mood and behavior stability during the evening when his mother asked him to hydrate and eat fruits; did not easily get upset on circumstances his mother did not returned immediately his favor, and when his father reprimanded him for being stubborn. c. slept or started sleeping from 8:30 pm in the evening after his mother asked him to sleep and continued to sleep undisturbed with no in-between waking up until the end of our shift at 11 pm. Last time we checked up on him before we leave, he was still sleeping soundly; and d. environmental modifications fit to optimize stimuli for sleeping such as darkening of the room, reducing noise, stretching and tucking well the bed linens, and removing clutter from the bed.