Calamba Shaira Ann V.
Tan 45 yrs old, M
BSN 3Y1-3S
Pathophysiology: Insomnia is often considered a disorder of
excessive activation of the arousal systems of the brain A 45-year old man presents with difficulty
down.
Hyperarousal in the physiologic, emotional, or cognitive networks is falling asleep and staying asleep. The problem
believed to prevent sleep regulatory processes from naturally
the started after the death of his sister 2 months Diagnosis Test:
occurring in patients with insomnia. periodic limb movements may
ago. He is unable to sleep until atleast an hour
be an important causative factor in insomnia. Though the leg
movement may project as simple symptom like artifact during after going to bed. He has no previous sleep
sleep, it may be the root cause of the underlying disorder. problems. A general practitioner he consulted
had prescribed low dose anti-depressant as
sedation but Mr. Tan was unable to tolerate
the drowsiness and dry mouth caused by
Dx: Insomia, Period limb movement disorder medication. He consumes 4 cups of coffee
Medication
during the day ad lately takes alcohol at night to
aid sleep. The patient wife has noted that his
legs jerk occasionally during sleep though Mr.
Medical history Tan is not aware of these movements.
Risk for complicated Grieving as evidenced by death of
significant other
Insomia related to intake of stimulants/alcohol:
Sleep deprivation related to periodic limb movement as
medication as evidenced by difficulty falling asleep
evidenced by repetitive kicking leg movement
Anti-depressant can cause difficulty of sleeping Allow the patient to recognize and express feelings
legs jerk and determine the connection between the feelings
and the event.
Suggest alternative methods to determine and cope
Educate the patient on the proper food and fluid intake such as with underlying feelings of anger, hurt, and rejection.
avoiding heavy meals, alcohol, caffeine, or smoking before Treatment does not cure the disorder but usually relieves symptoms
If indicated, mention stories of how others have dealt
bedtime. Treatment involves medication that either reduces the movements or helps
with the same experience.
Review medications being taken and their effect on sleep the person sleep through the movements. (as prescribed by the doctor)
-Benzodiazepines: These drugs suppress muscle contractions. They Discuss and educate patient the normal stages of grief
suggesting modification in regimen. and accept the reality of related feelings such as guilt,
are also sedatives and help you sleep through the movements.
Encourage daytime physical activities but instruct the patient to anger, and powerlessness.
-Dopaminergic agents: These drugs increased the levels of an
avoid strenuous activities before bedtime. Assist the patient in recognizing early signs of
important neurotransmitter (brain chemical) called dopamine, which is
Instruct the patient to follow a consistent daily schedule for rest depression and identify methods to mitigate these
important in regulating muscle movements.
and sleep. signs. If the symptoms persist or worsen, suggest
-Anticonvulsant agents: These medications reduce muscle
Remind the patient to avoid taking a large amount of fluids before other professional support.
contractions
bedtime.
-GABA agonists: These agents inhibit release of certain
Suggest an environment conducive to rest or sleep.
neurotransmitters that stimulate muscle contractions.
Refer to neurologist (a specialist in disorders of the nervous system) Patient will demonstrate improvement in handling with
Patient obtains optimal amounts of sleep as evidenced by the stages of grief at his or her own pace.
rested appearance, verbalization of feeling rested, and Patient will verbalize a sense of improvement toward
improvement in sleep pattern. The patient report improvement in sleep.
resolution of hope and grief in the subsequent time.