Create A Nursing Care Plan That Provide Direction For Individualized Care of The Patient

The case study that we have chose is entitled Incomplete Abortion.
According to
WHO, Incomplete abortion is defined by clinical presence of open cervical os and bleeding,
whereby all products of conception have not been expelled from the uterus. Common
symptoms include vaginal bleeding and abdominal pain. Incomplete abortion should also be
suspected if, upon visual examination, the expulsed tissue is not consistent with the
estimated duration of pregnancy. The subject of the case study IS Mrs. E.A, a 41 years old
woman who is 11 weeks pregnant and was diagnosed to have incomplete abortion. There
are variable factors that the patient is suffering and one of these is sleep deprivation related
to changes of environment where hospitalized patient has insufficient amount of quality
sleep.
A sufficient amount of high quality sleep is assumed to be essential for optimum

physical and psychological functioning and also there is an emerging understanding of the
restorative role of sleep in health and disease. In fact, lack of sleep has been listed as a
potential source of harm to a person’s health and wellbeing (Pilkington, 2013). The stress
and physical effects of acute illness combined with the hospital environment make it difficult
for hospitalized patients to receive sufficient amounts of quality sleep. The noise, lights,
medications, pain, anxiety, and frequent patient care activities hampers with patients’ ability
to fall asleep and stay asleep. For these reasons, sleep deprivation is common in
hospitalized patients. Patients sleep lighter and for a decreased amount of time while in the
hospital. Less than 50 percent of sleep occurs during the normal nighttime hours (Bernhofer,
Daly, Burant, & Hornick, 2013). Thus, sleep deprivation is a common problem in hospitalized
patients. Since nursing staff has a major amount of direct interaction and establishing
rapport with patients, they are in the perfect position to assess for and prevent sleep
deprivation. Interventions are often tailored to counteract the conditions that cause sleep
disruptions. Nurses are aware of and interested in sleep-promoting interventions. Since
nursing staff has a major amount of direct interaction and establishing rapport with patients,
they are in the perfect position to assess for and prevent sleep deprivation. It is the duty of
the assigned nurse to provide comfort and address the patient’s concern regarding the
dilemma that he or she is currently facing or experiencing. Furthermore, the nurse must
establish a nursing care plan that is tailored to lessen the conditions that cause his/her sleep
disruptions. With the archive nursing care plan that was formulated, they were able to create
a nursing care plan that provide direction for individualized care of the patient and was able
to customize an intervention for the sleep deprived patient.
The student nurses were able to write exactly the patient’s concern regarding her
sleeping patterns. However, in the objective cues, it would have been better if they further
included the physical factors that they have observed such as presence of eye bags, pale
lips, or if the patient is obese in order to identify the related or risk factors and defining
characteristics that can be used to formulate a nursing diagnosis. On the outcome
identification column, objectives shown are Specific, Measurable, Attainable, Realistic, and
Time-bounded nevertheless I have added some outcomes in order to improve what they
wrote and for the audience to understand clearly what the student’s nurses wants to attain.
In the intervention column, I have deleted and added some nursing interventions that one
may inclined with the client’s values, culture, beliefs, and with other therapies. Furthermore,
the interventions are safe, and appropriate for client’s age, health, condition, and is
achievable with resources and time available. One the interventions stated by the author that
I have further enhanced is introducing relaxing activities such as warm bath, calm music,
reading a book, and relaxation exercises before bedtime. Music has been found to influence
human beings on many levels (Juslin 2001) and the impact of music listening on sleep has
been attributed to different mechanisms. Several authors argue that improvement of sleep is
obtained because slow soothing music enhances relaxation (Deshmukh 2009; Hernández‐
Ruiz 2005; Jespersen 2012; Lai 2005). This suggestion is substantiated by trials showing
reduced levels of cortisol as an effect of music listening (Koelsch 2011; Nilsson 2009), and
changes in autonomous measures such as heart‐rate and blood pressure (Korhan 2011; Su
2013; Trappe 2010). These trials show that music can affect various physiological measures
that reflect autonomic nervous system responses, and as such, slow soothing music may
lead to a decrease in sympathetic arousal and thus improve sleep (Su 2013). From a
psychological perspective, trials have shown that listening to music can reduce anxiety and
stress responses (Dileo 2007; Zhang 2012), which can lead to greater relaxation and
improvement of sleep. Another possible mechanism for the effect of music on sleep is the
distracting power of music. Hernández‐Ruiz 2005 suggests that music can function as a
focal point of attention that distracts from stressful thoughts and thereby improves sleep.
Since the archived nursing care plan doesn't have a dependent intervention, I have included
the administering of medications as ordered 5 mg to 15 mg taken of Diazepam once a day at
bedtime to enhance the quality of sleep of the patient. The most common treatment of
insomnia is the use of pharmacotherapeutic interventions, including over‐the‐counter and
prescribed medications (NIH 2005). Patients who are on T. Diazepam(5-10mg) or T.
Alprazolam (0.5-2mg) were assessed for sleep pattern at baseline, at 15 days and at the
end of one month. Quality of sleep was evaluated using pittsburgh sleep quality index scale
which includes subjective sleep quality, sleep latency, sleep duration, habitual sleep
efficiency, sleep disturbances, use of sleeping medication, daytime dysfunction. The results
of our study reveal that there was a significant difference in sleep pattern and quality of
sleep at first follow-up and was consistent till the last follow-up (at the end of one month).
So, the final score of the sleep pattern parameters is because of the resultant activity of
direct drug action and improvement in the underlying disease. It is concluded that Diazepam
and Alprazolam causes significant improvement in sleep pattern and in sleep quality which
was assessed by PSQI during the one month study period and the final score of the
parameters are because of the resultant activity of direct drug action and improvement in the
underlying disease. I have also added a collaborative intervention, in which patient may seek
help from a sleeping psychologist, it is okay to refer a patient to another healthcare
professional, especially if client is experiencing difficulty that is beyond our knowledge base.
The student nurses weren’t able to write down a rationale of the interventions written so I
have provided a rationale to support the interventions. Rationales are present to assist
nursing students in associating the pathophysiological and psychological principles with the
selected nursing intervention. Regardless of the enhancement I have made, overall I
commend the NCP the student nurses made for they had achieved Orlando’s Deliberative
Nursing Process Theory which focuses on the interaction between the nurse and patient,
perception validation, and the use of the nursing process to produce positive outcomes or
patient improvement (Faust C., 2002)
REFERENCES:
https://nurseslabs.com/nursing-care-plans/
http://www.iosrjournals.org/iosr-jdms/papers/Vol16-issue4/Version-8/W160408136142.pdf
http://www.counsellingpracticematters.com/5-occasions-when-you-might-refer-clients-to-another-
counsellor/
Moreover, Sleep deprivation has adverse effects on both the physical and psychological
health of the patient. Adverse effects include, but are not limited to, decreased immune
function, reduced inspiratory muscle strength, prolonged length of stay, delirium, and
increased levels of fatigue, anxiety, and stress.
Since nursing staff has a major amount of direct interaction and establishing rapport with
patients, they are in the perfect position to assess for and prevent sleep deprivation.
Interventions are often tailored to counteract the conditions that cause sleep disruptions.
Nurses are aware of and interested in sleep-promoting interventions.
I agree with The archived nursing care plan that was formulated however
As a nurse, we are vital in providing the proper nursing intervention

Create A Nursing Care Plan That Provide Direction For Individualized Care of The Patient

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The case study that we have chose is entitled Incomplete Abortion.

A sufficient amount of high quality sleep is assumed to be essential for optimum

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