Ocaña, Nicole Chloe C.

BSN 3
Mr AB, a 21-year-old pharmacy student, whose class schedule starts at 8:00AM and ends at
6:00PM—from weekdays to Saturdays, and would work from 7:00PM to 10:00PM everyday to
help his parents pay for his tuition. Mr AB would complain that he would constantly feel
stressed, anxious, and tired because of his busy schedule, as well as the many requirements
that he keeps on failing to meet on time because of his busy schedule. One day, Mr AB went to
a nearby clinic for a check-up, because he had trouble sleeping, as he keeps waking up in the
middle of the night. The physician diagnosed him with insomnia, and was given a seven-day
prescription for diazepam 10mg tablets, one to be taken at night. It is now three days since the
pharmacist dispensed his prescription and Mr AB has returned to the pharmacist because he
claims he is still not able to sleep properly.
ACTUAL: According to the NANDA International, Inc. Nursing Diagnoses: Definitions and
Classification 2018–2020, 11th edition. “Insomnia” is an approved nursing diagnosis under
Domain 4, Class 1, Diagnosis Code 00095.
Nursing Diagnosis: Insomnia related to feelings of stress, anxiety, and weary brought about by
work and school responsibilities as evidenced by the patient verbalizing that he constantly feels
stressed, anxious, and tired due to his busy schedule.
Goal & Desired Outcome/s:

 The patient would be able to learn about the mechanism of action of diazepam, and its
corresponding length of time to take full effect.
 The patient would be able to learn and perform interventions that would aid him to sleep.

Nursing Intervention Rationale

Independent: Independent:

 Suggest an environment conducive to  A lot of people sleep better in cool,

rest or sleep.
 Prevent the patient from thinking about
next day’s activities or any distracting
thoughts at bedtime.
 Suggest patient to get out of bed
temporarily and perform a relaxing
activity if unable to sleep 30-45 minutes
in bed.
 Remind the patient to avoid taking a
large amount of fluids before bedtime.
Dependent:
 Explain the mechanism of action of
dark, quiet environment.
 Providing a designated time for
these concerns allows the patient
to “let go” of these problems at
bedtime.
 The bed is not supposed to be
used for watching TV, work, or
wakefulness. The brain should
associate the bed with sleeping.
 Remind the patient to avoid taking
a large amount of fluids before
bedtime.
 diazepam, which is to potentiate the Dependent:
inhibitory effect of γ-aminobutyric acid on
neuronal transmission thus reducing  In order for the patient to
feelings of stressed, and anxiety thus understand as to why the
promoting weariness. It can take 5-7 medication has not taken its full
days for diazepam to take full effect. effect.

Collaborative: Collaborative:

 Instruct the patient to follow a consistent  Consistent schedules facilitate

daily schedule for rest and sleep.
 Educate the patient on the proper food
and fluid intake such as avoiding heavy
meals, alcohol, caffeine, or smoking
before bedtime.
 Encourage patient to take milk.
regulation of the circadian rhythm
and decrease the energy needed
for adaptation to changes.
 Having full meals just before
bedtime may produce
gastrointestinal upset and hinder
sleep onset. Coffee, tea, chocolate,
and colas which contain caffeine
stimulate the nervous system. This
may interfere with the patient’s
ability to relax and fall asleep.
Alcohol produces drowsiness and
may facilitate the onset of sleep but
interferes with REM sleep.
 L-tryptophan is a component of milk
which promotes sleep.

Evaluation:

 The patient was able to verbalize understanding regarding the mechanism of action of
diazepam, and its corresponding length of time to take full effect.
 The patient was able to learn and perform the interventions that would aid him to sleep.

The patient is a 32-year-old male with no significant past medical history presents to the
emergency department with abdominal pain. He states the pain began a few days ago in the
right lower quadrant of the abdomen, and now feels as though it is spreading to the mid-
abdomen. He describes the pain as coming on suddenly and sharp in nature. The patient is
concerned for a possible hernia as he does heavy lifting at work. Review of systems is negative
including no anorexia, no nausea or vomiting, no testicular pain or swelling, no urinary or bowel
complaints, and no fevers or chills.
POTENTIAL:
Nursing Diagnosis: Risk for disturbed sleeping pattern related to sudden onset of sharp pain
felt from the mid-abdomen as evidenced by the patient describing the pain as coming on
suddenly and sharp in nature.
Goal & Desired Outcome/s:

 The patient would be able to verbalize relief from abdominal pain

 The patient would be able to verbalize that he no longer feels discomfort from the pain

Nursing Intervention Rationale

Independent: Independent:

 Provide a pillow on the affected area
 Provide massage
 Provide heat applications
Dependent:
 Provide pharmacologic pain
management as ordered.
Collaborative:
 Provide cognitive-behavioral
(CBT) for pain management.
 The light pressure from the pillow
could aid in reducing the pain, thus
alleviating discomfort.
 When appropriate, massaging the
affected area interrupts the pain
transmission, increases endorphin
levels, and decreases tissue
edema. Massage aids in relaxation
and decreases muscle tension by
increasing superficial circulation to
the area.
therapy  Heat improves blood flow to the
area and thus results in the
reduction of pain reflexes.

Dependent:

 For relief of pain. Pain

management using pharmacologic
methods involves using opioids
(narcotics), nonopioids (NSAIDs),
and coanalgesic drugs.
Collaborative:

 These methods are used to provide

comfort by altering psychological
responses to pain.
Evaluation:
1. The patient has verbalized relief from abdominal pain
2. The patient has verbalized that he no longer feels discomfort from the pain