00095 Insomnia

Domain 4: activity/rest
Class 1: sleep/rest
Diagnostic Code: 00095
Nanda label: insomnia
Diagnostic focus: insomnia
Approved 2006 • Revised 2017, 2020 • Evidence level 3.3

NANDA Nursing Diagnosis Definition

Nanda’s nursing diagnosis « insomnia ” is defined as: inability to initiate or maintain sleep that harms the operation

Definite characteristics

  • Alteration of affection
  • ATTACTION OF ATTENTION
  • alteration of the mood
  • Awakening early
  • Express dissatisfaction with the quality of life
  • Express dissatisfaction with sleep
  • Express lack of memory
  • Express the need for frequent naps during the day
  • Deterioration of health status
  • Increase of absenteeism
  • Increase in accidents
  • Insufficient physical resistance
  • Non-repairing sleep-vigilia

Related factors

  • Anxiety
  • Average daily physical activity is lower than recommended according to sex and age
  • Coffee consumption
  • Tiredness of the caregiver role (a)
  • Consumption of sugary drinks
  • Depressive symptoms
  • DISCONFORT
  • Dysfunctional beliefs about sleep
  • ATRACIONES OF THE ENVIRONMENT
  • Fear
  • Frequent naps during the day
  • Inadequate sleep hygiene
  • Incoguent lifestyle with normal circadian rhythms
  • Low psychological resilience
  • Obesity
  • Stressors
  • Inappropriate use of substances
  • Use of interactive electronic devices

Risk population

  • teenagers
  • People at economic disadvantage
  • People in grief
  • People who experience a change in the marital state
  • Workers in turn at night
  • Older adults
  • Women in the third quarter of pregnancy
  • Workers in rotary shifts
  • Women

Associated problems

  • Chronic disease
  • Hormonal changes
  • Pharmacological preparations

Suggestions of use

  • The insomnia label is used when sleep disturbance causes discomfort or interferes with the lifestyle that the patient wishes to have. Insomnia is a general diagnosis. Sometimes it can be efficiently specific, due to etiological factors, to direct a nursing intervention, as occurs in the case of insomnia related to frequent infant awakening during the night. Whenever possible, the specific type of insomnia (in the diagnosis is described by the problem) must be noted to better direct nursing care. The following are examples of adequate diagnoses:
  • Insomnia (early awakening) related to depression
  • Insomnia (difficulty reconciling) related to overestimulation before bedtime

Suggested alternative diagnostics

  • Activity, intolerance to
  • Fatigue
  • Sleep pattern,
  • disorder

  • Dream, deprivation of

NOC Results

  • Personal well -being: Degree of the positive perception of the state of one’s health
  • Fatigue level: gravity of generalized and prolonged fatigue, either reported or observed
  • Dream: natural periodic suspension of consciousness during which the body recovers

Evaluation objectives and criteria

  • The patient shows sleep, which is manifested by the following indicators (specify from 1 to 5: severely, substantially, moderately, slightly or not compromised):
    • Sleep hours (at least 5 hours in each 24 -hour period for adults)
    • Sleep pattern, quality and routine
    • Sensation of recovery after sleeping
    • Be awake at the right times
  • Other examples

    • Identify measures that improve rest or sleep
    • demonstrates physical and psychological well -being

    NIC Interventions

    • Energy management: regulate the use of energy to treat or prevent fatigue and optimize operation
    • Pain management: eliminate pain or reduce it to an acceptable level of well -being for the patient
    • Management of the environment: manipulation of the patient’s environment to obtain therapeutic benefit, sensory attraction and psychological well -being
    • mood management: provide safety, stability, recovery and maintenance to a patient who has a depressed or hypertimic spirit.
    • Improvement of coping: help the patient adapt to stressful factors, changes or perceived threats, which interfere with the satisfaction of the demands and the roles of life
    • Sleep improvement: facilitation of regular sleep-vigilia cycles
    • Anxiety reduction: minimize apprehension, fear, feeling or discomfort related to an anticipated danger of unknown origin

    Nursing Activities

    Valuations

    • (NIC) Improvement of sleep:
      • Determine the effects of patient medications on the sleep pattern
      • Monitor the patient’s sleep pattern and observe the physical circumstances (sleep apnea, respiratory tract obstruction, pain or discomfort and urinary frequency) or psychological (fear or anxiety) that interrupt sleep

    Patient and family education

    • Explain that alcohol could help the person to sleep, but also decreases sleep quality because it causes frequent nightmares and awakenings; advise that alcohol is avoided from 4 to 6 hours before bedtime
    • Discourage the useless use of sleeping pills; Explain that they interfere with sleep quality, which cause drowsiness during the day, and lose their effectiveness after a few weeks; advise the patient to consult your doctor
    • (NIC) Improvement of sleep:
      • Explain the importance of adequate dream during pregnancy, disease, psychological stress, etc.
      • Indicate the patient to avoid ingesting food and beverages at bedtime, since they can interfere with sleep
      • Instruct the patient and their relatives relatives about the factors that alter the sleep pattern (physiological, psychological factors, lifestyle, frequent changes of work schedule, rapid time zone changes, excessively prolonged work schedules, etc.)

    Collaboration activities

    • Talk to the doctor about the need to review the medication regime if it interferes with the sleep pattern
    • Channel to a sleep clinic, if necessary
    • (NIC) Improvement of sleep: encourage the use of sleeping medications that do not contain Mor
    • sleep suppressors

    Others

    • Avoid noise and the use of direct lights during night sleep; provide a quiet and silent environment, and reduce interruptions
    • Find a compatible roommate for the patient, if possible
    • Help the patient identify possible underlying causes of insomnia, such as fear, unsolved problems and conflicts
    • Inform the patient that irritability and alterations in mood are common consequences of sleep deprivation
    • Help the patient take a warm bath at night
    • (NIC) Improvement of sleep:
      • Facilitate the maintenance of a routine at bedtime, signs prior to sleep and family objects (for example, for children, a favorite blanket or toy, wicked them, a pacifier or tell them a story; for adults, a Read book), as required
      • Help the patient limit the dream during the day by providing activities that keep him awake, as required
      • Start or apply measures to achieve comfort such as massage, position changes and affectionate physical contact
      • Allow naps during the day, if indicated, to complete sleep needs
      • Group care activities to reduce the occasions that awaken to the patient; Allow sleep cycles of at least 90 minutes

    At home

    • All previous interventions can be adapted for use at home
    • Interview the couple to evaluate sleep behaviors and detect possible causes of insomnia (for example, ask if the hoarse patient)
    • Ask the patient to have a diary of his dream
    • Teach relaxation techniques

    Babies and Children

    • Maintain the usual routine of the child when bedtime. Provide family objects such as the favorite blanket or toy, wad it or give it the sucks; Read a story, sing him, etc.
    • Help the child feel comfortable and sure at night: use a night light, assure him that there will be someone close
    • Help the child in the transition to go to bed to involve him in quieter and quieter activities a little before bedtime (for example, curl it, read a story)

    Older people

    • Given the changes that occur in sleep quality by age, older people need more time in bed to obtain a recovery effect. However, real sleep time usually decreases with age.
    • Keep in mind that older adults make it difficult to reconcile sleep and to wake up more easily than young adults
    • Suggest the patient to reduce fluid intake at night to reduce the possibility of waking up for the need to urinate
    • Advise the patient to take diuretics early in the morning, if possible
    • Assess the presence of depression or anxiety, common among the elderly
    • Help the patient choose physical and social activities during the day, which are suitable for their functional skills (for example, walk)
    • Advise the patient to reduce the naps during the day, and if necessary, to take them as early as possible and with a limited duration
    • Instruct patients about normal changes that occur in sleep during aging
    • Use a night light for security
    • For patients suffering from dementia, helping families get a bed similar to that of hospitals, with railings that can be placed at a low height
    • Consider the placement of a comfortable next to the bed for night use, even if it is not required during the day