Essay On Joan's Excessive Daytime Sleepiness

Mrs. Wilson is seen in her room at Glenbridge Nursing Home on 02/28/2018. She had an episode last night of chest pain. She is so ebullient and distracted that it is hard to get a straight history, it came on when she was asleep but she may been sitting up. She was seen by a nurse, a sat was taken. I am not sure if there were other orders taken, but there is none on the chart. She says that she spent most of this morning in the bed and still feels tired, but she does not think she broke out in a sweat. She was more short of breath. She is calling it is a "stroke." I had tried to begin tapering her diazepam by discontinuing the morning dose and apparently all daytime clorazepate was discontinued by error and she gets it only at night.

A review of her medical records indicates that she has not had any significant health events, such as falls or hospitalization since her last visit. She suffers from chronic stable hypothyroid, chronic DM which is mange with medication and chronic neuropathy.

The sleep assessment conducted on the patient had an interesting dynamic in how we think we sleep opposed to how our partner says we sleep. The patient wakes up every morning at 6 a.m. and takes a nap right after lunchtime approximately at 1 p.m. The daily naps, according to the patient, last about forty-five minutes to an hour. When asked about restlessness when waking up the patient with a stern voice and pointed finger says, "When I'm up I'm up and ready to go." The patient also explained that they have no trouble staying asleep; however going to sleep can be challenging depending on if anything troubling is on her mind.

Apart from these two main diagnosis’, Mrs. Reed appears relatively healthy. Unless she can incorporate more sleep and lower her stress levels, further cognitive deficits will most likely appear. Caffeine should be excluded from her diet, as caffeine may increase her anxiety. Furthermore, Mrs. Reed should focus on developing better sleep hygiene. She should work on a nightmare protocol with her psychologist to decrease nightmares, avoid eating or exercising within several hours of bedtime, and leave all electronic devices outside of the bedroom. It may also be beneficial to incorporate some light stretching, yoga, or meditation before bed. By decreasing her sleep deficit, Mrs. Reed’s cognitive function will likely increase, especially in regards to concentration and memory. It may also be beneficial to prioritize her work daily, in order to ensure completion of the most necessary tasks. Furthermore, it is imperative to monitor her cardiac functioning as she has a high family history of cardiovascular disease, and stress only exacerbates this condition more. A cardiologist, a psychologist, and a psychiatrist should be met with on a regular basis to monitor her condition and watch for any further decline. Given her relatively high levels of anxiety, Mrs. Reed may benefit from daily meditation and continuous exercise. This evaluation can serve as a baseline for her neuropsychological functioning, but further monitoring is recommended.

She was treated for neuropathy in Primary Care and received an extensive work up for syncope in Cardiology, but it wasn’t until she was referred to Neurology that she finally got a correct diagnosis: Autonomic Dysfunction. Of course, there are varying degrees of Autonomic Dysfunction that range from reversible to severe, but unfortunately she was diagnosed with the most severe form known as Multiple System Atrophy (MSA). “MSA is a sporadic, progressive, adult-onset disorder characterized by autonomic dysfunction, parkinsonism and ataxia (a failure of muscular coordination) in any combination” (Autonomic Disorder

The uncomfortable symptoms she has endured lately--muscle pain, negative thoughts, irrational fear and insomnia. Absolutely unbearable. As if ten thousand pounds of weights is now glued to her chest, holding her down when she wants to rise. Aging ten years since her arrest.

Exercise: Exercise is a specific form of physical activity which has various beneficial effect. Nurses can educate Sally about light exercises with the recommendation of Doctor and physiotherapist . It plays a crucial role in daily recovery by provide the opportunity to detach mentally from all other work. Nurses have frequent contact with Sally so it is easy for them to communicate with her about potential outcome of exercise. Sleep and exercise should relate with each other and restore lost resources which could be very beneficial for Sally's mental

She has disc herniation at L5/S1 that may also be a contributor and mimicker of her symptoms.

She is 74 years old, has a height of five foot six inches, and I was unable to acquire her weight. She was experiencing pain with her hammer toes at five on the pain scale. Her appetite was well. L.F. does not experience difficulty with urination or defecation, but sometimes needs assistance with going to the bathroom. She was having shortness of breath while laying down, however does not require oxygen interventions. I did have to repeat myself while performing her head to toe assessment. L.F. does not have any hearing devices. She wears corrective glasses. Her vital signs were as follows, blood pressure was 120/90 on her left arm while sitting, radial pulse rate was 84, pulse ox was 92, respirations were 20, and her temporal temperature was 97.6 ˚ F. L.F.’s radial pulses were equal in both arms. She was able to grasp my fingers equally and strongly with both hands. Her capillary refill lasted one to two seconds. Her breath sounds were normal and clear without productive or nonproductive coughing. L.F.’s apical pulse was 75 with a normal rate and rhythm, and her aortic, pulmonic, erb’s point, tricuspid, and mitral pulses had a normal rate and rhythm. Her abdomen had a round shape and bowel sounds were present and active with a low pitch in all four quadrants. L.F.’s abdomen was soft and she denied pain. She explained that she had normal passage of bowel movements without complications. She

It would be appreciated if you could arrange an appointment with Sam, 24-year-old PhD student who reports sleep onset insomnia, sleep fragmentation and poor quality sleep. Sam has undergone a couple of sleep studies that have not identified any specific disorder aside from a raised arousal index that that led to another sleep study and commencing him in Lyrica and melatonin. Sam has found these medications somewhat beneficial, but continues to report some sleep disruption and daytime fatigue. Your assessment would be appreciated.

long-term difficulties with sleep. As you are aware, for the last ten years she has been under to excellent care of Andrew Kyoong, but was keen for a second opinion.

Susan is a 30 year old wife, mother of two young children, and LPN of 10 years. She has also worked more than normal the last few months, due to the rising inpatient census. It is likely Susan is tired.

Her EKG showed no acute ST and T wave abnormalities. It did have evidence of a prior inferior wall

A review of the medical records indicates that she recently saw her PCP for new onset hallucination and is schedule to have a CT of the brain, along with a follow up with a neurologist. She continues to suffer from chronic COPD and chronic CHF for which she is oxygen dependent; chronic poorly controlled atrial fib and chronic CAD.

What do the effects of sleep deprivation have on people? When a person does not get enough sleep, he or she is depriving his or her body of something that it needs. A delightful sleep is one of the most satisfying human experiences with a role to play in supporting a good mood and cognitive acuity as well as in promoting physiologic balance and resilience (Chittora, Jain and Suhalka). People think because they get an insufficient number of hours of sleep, they will not have an emotional impact by it. Sleep is a required need for peoples’ day to day life to be able to perform and stay healthy emotionally and physically. The effects of sleep deprivation are an issue because it affects mood, performance, and health.