Nursing Diagnosis Generalized Anxiety Disorder | Sleep Pattern Disturbance

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.

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Nursing Care Plan Schizophrenia | Social Isolation

This care plan is designed for patients with schizophrenia with a nursing diagnosis of social isolation may be related to disturbed thought processes that result in mistrust of others/delusional thinking; and environmental deprivation, institutionalization (as a result of long-term hospitalization) possibly evidenced by difficulty in establishing relationships with others; social withdrawal/isolation of self, expressions of feelings of rejection, and dealing with problems using anger/hostility and violence.

Desired Outcomes: (1) Verbalize willingness to be involved with others; (2) Participate in activities/programs with others; and (3) Develop 1:1 trust-based relationship.

Nursing intervention with rationale:
1. Assess presence/degree of isolation by listening to client’s comments about loneliness.
Rationale: Mistrust can lead to difficulty in establishing relationships, and client may have withdrawn from close contacts with others.

2. Spend time with client. Make brief, short interactions that communicate interest, concern, and caring.
Rationale: Establishes a trusting relationship. Consistent, brief, honest contact with the nurse can help the client begin to reestablish trusting interactions with others.

3. Plan appropriate times for activities (by limiting withdrawal, varying daily routine only as tolerated).
Rationale: Consistency in 1:1 relationship and sameness of milieu are required initially to enable client to decrease withdrawn behavior. Motivation is stimulated by the humanistic sharing of a 1:1 experience.

4. Assist client to participate in diversional activities and limited/planned interaction situations with others in group meeting/unit party, etc.
Rationale: With toleration of 1:1 relationship and strengthened ego boundaries, client will be able to increase socialization and enter small-group situations. Brief encounters can help the client to become more comfortable around others and provide an opportunity to try out new social skills.

5. Identify support systems available to the client (e.g., family, friends, coworkers).
Rationale: Support is an important part of the client’s rehabilitation, providing a network to assist in social recovery.

6. Assess family relationships, communication patterns, knowledge of client condition.
Rationale: Problems within family (poor social/relationship skills, high expressed emotion) may interfere with client’s progress and indicate need for family therapy.

7. Note client’s sense of self-worth and belief about individual identity/role within milieu and setting.
Rationale: When client feels good about self and own value, family interactions with others are enhanced.

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