Question

Create a conceptual map using the case scenarios as guide. Conceptual map should include
pathophysiology, medical diagnosis, signs and symptoms, and risk factors, if any. Nursing
diagnosis, nursing interventions, medical management (medication and procedures), expected
outcomes.
A 45-year old man presents with difficulty falling asleep and staying asleep. The problem started
after the death of his sister 2 months ago. He is unable to sleep until at least an hour after going to bed.
He has no previous sleep 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
medication. He consumes 4 cups of coffee 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. Tan is not aware of
these movements.

Answer 1

Insomnia is a condition in which patient is unable to fall asleep and is classified under sleep disorders. The common signs and symptoms include difficulty in falling asleep, waking up in between sleep, early waking up and feeling tired on waking up. The patient may have associated periodic limb movement disorder, contraction of the legs during stage 1 and 2 of sleep about which the patient may be unaware of. Chronic insomnia is a condition in which the problem persisits for more than 3 months or longer.

Cause may be a stressful life event, environmental disturbances, life style, medications or comorbidities that causes discomfort like breathlessness or pain.

Pharmacological management is not indicated unless in case of chronic insomnia not managable with sleep hygiene practices alone.

CONCEPT MAP