A nursing home client with major depressive disorder reports difficulty going to sleep until late at night. The client gets up, paces the hallway, wrings the hands, and appears teary. What interventions should be included in the client's nursing care plan? Select all that apply.

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Quizplus · Accepted Answer

Sleep disturbances are part of the diagnostic criteria for major depressive disorder. Clients may experience insomnia (early in the night, in the middle of the night, or in the early morning hours) or hypersomnia. Long-term treatment with medication alone is not necessarily the best approach to treat insomnia. Nonpharmacological strategies for improving sleep hygiene include: Avoiding naps throughout the day Engaging in physical activity or exercise, preferably at least 5 hours before bedtime Receiving at least 20 minutes of natural sunlight each day, ideally in the morning, to improve sleep patterns Avoiding caffeinated beverages after noon Avoiding alcohol and/or smoking at bedtime Participating in a relaxing activity before bedtime (eg, warm bath, reading, listening to soft music) Decreasing environmental stimuli; making sure the bedroom is dark, cool, and quiet Avoiding heavy meals or large amounts of fluids at bedtime Drinking a cup of warm milk or eating a small amount of carbohydrates before bedtime, which promotes comfort and relaxation to aid sleepiness (Option B) Napping during the day interferes with normal sleep patterns. (Option C) Exercising right before going to bed increases brain metabolic activity and wakefulness. Educational objective: Nonpharmacological strategies for improving sleep hygiene include exercising during the day, engaging in a relaxing activity before bedtime, having a relaxing sleep environment, avoiding naps during the day, avoiding caffeine after noon, and receiving at least 20 minutes of sunlight each day.

A Nursing Home Client with Major Depressive Disorder Reports Difficulty