Nursing diagnosis: Sleep Deprivation related to dementia, sundowner’s syndrome; aging-related sleep stage shifts; inadequate daytime activity
Possibly evidenced by
Changes in behavior and performance, irritability, agitation
Fatigue, daytime drowsiness
Desired Outcomes/Evaluation Criteria—Client Will
Establish adequate sleep pattern, with wandering reduced.
Report or appear rested.
Nursing intervention with rationale:
1. Provide for adequate rest. Restrict daytime sleep as appropriate; increase interaction time between client and family and staff during the day, then reduce mental activity late in the day.
Rationale: Although prolonged physical and mental activity results in fatigue, which can increase confusion, programmed activity without overstimulation promotes sleep.
2. Avoid use of continuous restraints.
Rationale: Restraints may potentiate sensory deprivation, agitation, and restrict rest. Note: The Health Care Financing Administration’s (HCFA) guidelines (1999) require that clients be free from chemical or mechanical restraint unless warranted by a medical diagnosis and that the least restrictive means of control be used.
3. Evaluate level of stress and orientation as day progresses.
Rationale: Increasing confusion, disorientation, and uncooperative behaviors may interfere with attaining restful sleep pattern.
4. Adhere to regular bedtime schedule and rituals. Tell client that it is time to sleep.
Rationale: Reinforces that it is bedtime and maintains stability of environment. Note: Later-than-normal bedtime may be indicated to allow client to dissipate excess energy and facilitate falling asleep.
5. Provide evening snack, warm milk, bath, or back rub or general massage with lotion.
Rationale: Promotes relaxation and drowsiness and helps to address skin-care needs.
6. Reduce fluid intake in the evening. Toilet before retiring.
Rationale: Decreases need to get up to go to the bathroom/incontinence during the night.
7. Provide soft music or “white noise.”
Rationale: Reduces sensory stimulation by blocking out other environmental sounds that could interfere with restful sleep.
8. Allow to sleep in shoes or clothing, if client demands.
Rationale: Provided no harm is done, altering the “normal” lessens the rebellion and allows rest.
9. Administer medications, as indicated for sleep, for example: Antidepressants, such as trazadone (Desyrel) or quetiapine (Seroquel)
Rationale: May be effective in treating pseudodementia or depression, thus improving ability to sleep.
10. Avoid use of diphenhydramine (Benadryl).
Rationale: Once used for sleep, this drug is now contraindicated because it interferes with the production of acetylcholine, which is already inhibited in the brains of clients with DAT.