CONCEPT MAP

JH 36 y.o.

Rest and Sleep

Height: 185.4 cm (6' 2") Weight: 85.7 kg (189 lb) Temperature: 37.0C (98.6F) Pulse rate: 80 BPM Respirations: 18/minute Blood pressure: 144/88 mm Hg Pale, drawn, with dark circles under eyes CBC within normal range, x-ray left arm: evidence of superficial soft tissue injury

Police officer high-crime precinct. Bullet wound to arm 1 week ago. Recently promoted to detective. C/O increasing difficulty falling asleep and sometimes staying asleep. Concern over danger of his occupation and desire to do well in new position. C/O waking up feeling tired and irritable.

Sleep pattern disturbance r/t anxiety (aeb difficulty falling and remaining asleep, fatigue, irritability, drawn facial appearance, dark circles under eyes)

Sleep aeb Describes one or two factors that cause insomnia Identifies two or three measures that induce sleep Verbalizes decreased irritability and a greater sense of well-being by day 21 Recognizes his coping patterns by day 7 Identifies effective new and old coping strategies by day 10

Anxiety Reduction Create an atmosphere that facilitates trust Seek to understand his perspective of a stressful situation Encourage verbalization of feelings, perceptions, and fears Help him identify situations that precipitate anxiety Determine his decision-making ability

Sleep Enhancement Determine the client's sleep and activity pattern Encourage to establish a bedtime routine to facilitate transition from wakefulness to sleep Encourage him to eliminate stressful situations before bedtime Instruct Mr. Harrison and significant others about factors (e.g., physiologic, psychologic, lifestyle, frequent work shift changes, excessively long work hours, and other environmental factors) that contribute to sleep pattern disturbances Discuss with Mr. Harrison and his family comfort measures, sleep-promoting techniques, and lifestyle changes that can contribute to optimal sleep Monitor bedtime food and beverage intake for items that facilitate or interfere with sleep

Outcome Met Acknowledges his insomnia is a somatic expression of his anxiety regarding job promotion and fear of failing States that talking with the police department counselor has been helpful Practicing relaxation techniques each night and sleeps an average of 7 hours a night Expresses a greater sense of well-being
Legend: Assessment Nursing Diagnosis Outcomes Nursing Interventions/Activities Evaluation/Reassessment