This care plan is designed for patients with generalized anxiety disorder with a nursing diagnosis of sleep pattern disturbance may be related to psychological stress; and repetitive thoughts possibly evidenced by reports of difficulty in falling asleep/awakening earlier or later than desired; not feeling rested, and dark circles under eyes; frequent yawning.
Desired Outcomes: (1) Verbalize understanding of relationship of anxiety and sleep disturbance; (2) Identify appropriate interventions to promote sleep; and (3) Report improvement in sleep pattern, increased sense of wellbeing, and feeling well-rested.
Nursing intervention with rationale:
1. Determine type of sleep pattern disturbance present, including usual bedtime, rituals/routines, number of hours of sleep, time of arising, environmental needs, and how much of a problem it is to client.
Rationale: Identification of individual situation and degree of interference with functioning determines need for/appropriate interventions.
2. Provide quiet environment, comfort measures (e.g., back rub, wash hands/face, bath), and sleep aids, such as warm milk. Restrict use of caffeine and alcohol before bedtime.
Rationale: Promotes relaxation and cues for falling asleep. Stimulating effects of caffeine/alcohol interfere with ability to fall asleep.
3. Discuss use of relaxation techniques/thoughts, visualization.
Rationale: Promotes reduction of anxious feelings, resulting in improved sleep/rest.
4. Suggest ways to handle waking/not sleeping (e.g., do not lie in bed and think, but get up and remain inactive, or do something boring).
Rationale: Having a plan can reduce anxiety about not sleeping.
5. Involve client in exercise program, avoiding exercise within 2 hours of going to bed.
Rationale: Increases fatigue, promotes sleep but avoids excessive stimulation from activity before bedtime.
6. Avoid use of sedatives, when possible.
Rationale: Sedative drugs interfere with REM sleep and affect quality of rest. A rebound effect may lead to intense dreaming, nightmares, and more disturbed sleep.
7. Administer medications as indicated, e.g., zolpidem (Ambien).
Rationale: Although drug is recommended for short-term use only, it may be beneficial until other therapeutic interventions are successful.