Question

1. Case Scenarios 4 & 5

Case Scenarios 4 & 5

A.Ms. Song, a 57-year-old accountant, comes to see you in the clinic with complaints of significant sleep problems that are impacting her quality of life. During your interview, you collect the following information:

● Work has been very stressful, especially during tax time when she has many deadlines

● Has trouble getting to sleep (average 45 minutes; some nights up to 2 hours) ● Wakes up two to three times a night to go to the bathroom or when her cat wakes her

● Drinks four to five cups of coffee a day but decaffeinated after 6 PM

● Usually has two glasses of wine at night to relax her

● Has trouble concentrating during the day and feels less productive

● Yawns frequently and at times has nodded off during boring meetings

● Has never used sleeping pills but now is willing if they will help her get a good night’s sleep.

1. What factors might be influencing Ms. Song’s sleep quality?

2. Script questions that could help her analyze factors that might be impacting her sleep.

3. Identify nonpharmacologic interventions that could improve her sleep.

4. Discuss the advantages and disadvantages of pharmacologic use of hypnotics to treat Ms. Song.

B.Patrick Matthews, an active and popular college baseball star, was treated in your emergency department after being hit in the face with a baseball. He talked a great deal to the staff about his concerns, and the staff all commented on how likable he was. Patrick’s eyes needed to be patched, and he received instructions to stay in an environment with minimal activity. His father has brought Patrick back to the hospital today. Patrick has refused to engage in conversation and has cut off contact with his friends. On the second night after the injury, Patrick showed signs of hallucinations that a roommate was talking to him and delusions that he was being poisoned through his meals. You have been assigned to give nursing care to Patrick the next morning.

1. Determine what additional information you might need.

2. Identify any specific concerns that you have about communicating with Patrick.

3. Examine the possible sources for disturbances in sensory perception that you believe are critical for Patrick.

4. Prioritize the areas you need to address in determining your nursing care.

Answer 1

1.factors which may be affecting her sleep quality are

Work Has been stressful especially during tax time which she have many deadlines

Wakes up two to three time at night time to go to the bathroom or when her cat wakes her

Drinks four to five Cup of coffee per day.

2.whether you are having difficulty in initiation of sleep ?

How much hour you get continuous sleep?

Whether you are having snoring?

Are you dependent on caffeine?

Sleep disruption started since how many months or years?

Are you doing any meditation or yoga?

Are you experencing any head ache?

3.non pharmacological intervention

Reduce intake of caffeine products

Practise meditation and yoga as a routine.

Try to reduce office stress and maintain happiness

Reduce use of wine in night time as it may induce diuresis and interupt sleep.

Avoid indoor pets or pets can be avoided from personal space.

Avoid excessive intake of water at night

She can have Luke warm milk with turmeric.

Avoid use of electronic gadgets at night.

4.advantage - she will have a sound sleep. .

Will be relaxed and there will be freshness after waking up

Lowers heart rate and blood pressure

Disadvantages - dependence on hypnotic agents

Impaired memory