Ackley: Nursing Diagnosis Handbook, 12th Edition Revised Reprint with
2025-2026 NANDA-I® Updates
Lecture Notes
Problem-Based Learning/Critical Thinking
Case Study—Restless Leg Syndrome
Case Scenario
Abdul Malek is a 21-year-old college student. He attends the local state university and is a junior
studying graphic design. Three weeks into his fall semester, Abdul’s professors notice that he is
falling asleep in class and often looks restless. Abdul taps his foot and squirms around in his seat.
Abdul, who is usually an excellent student, has failed his first test in his Graphic Design II course.
His professor asks him to see his advisor because the fear is that Abdul has become chemically
impaired. His advisor sends Abdul to the student health services and his case is reviewed by the
nurse.
Nursing Assessment
Abdul is a well-developed 22-year-old male with a BMI of 20. His vital signs are blood pressure
104/78; temperature 98.4°F; heart rate—64 beats per minute; respiratory rate—16 breaths per
minute. A nutritional history confirms a well-balanced diet with the exclusion of pork products.
Abdul had been working out every day at the University gym but reports that he is currently ―too
tired‖ to do so. Abdul denies drug or alcohol use and this is confirmed by serum analysis. Abdul
complains about sleeping poorly and feeling as if, ―I am moving all night.‖ He states that he often
wakes up his dorm mate and feels bad about that. The nurse reclines Abdul on the examination
table and checks his deep tendon reflexes (DTRs) which are all 2+. The nurse asks Abdul to relax
and dims the lights while she consults with the primary care practitioner. While the nurse is out of
the examination room Abdul dozes, and when the nurse returns, the nurse observes Abdul’s right
leg jerking several times before she arouses him.
A. ASSESS
1. Identify significant symptoms by underlining them in the assessment.
2. List those symptoms that indicate the client has a health problem (those you have underlined).
• falling asleep in class
• often looks restless
• taps his foot
• squirms around in his seat
• failed his first test
• ―too tired‖
Copyright © 2022, Elsevier Inc. All rights reserved.
,Case Study Answers 2
• complains about sleeping poorly
• ―I am moving all night‖
• often wakes up
• dozes
• right leg jerking several times
3. Group the symptoms that are similar.
• falling asleep in class
• often looks restless
• taps his foot
• squirms around in his seat
• failed his first test
• complains about sleeping poorly
• dozes
• ―too tired‖
• ―I am moving all night‖
• often wakes up
• right leg jerking several times
• DIAGNOSE
4. Select possible nursing diagnoses for this client.
Do this by looking at the list of nursing diagnoses in, the book, Ackley/Ladwig Nursing Diagnosis
Handbook: An Evidence-Based Guide to Planning Care or by accessing the care plan constructor
at the EVOLVE SITE and viewing nursing diagnoses listed there.
Possible nursing diagnoses:
Sleep deprivation
Disturbed sleep pattern
Fatigue
Ineffective coping
Stress overload
2. Validate the possible nursing diagnoses.
Compare the signs and symptoms (defining characteristics) that you have identified from your
client assessment with the defining characteristics for the nursing diagnosis that you have selected.
Also read the definition and determine if this diagnosis fits this client.
Validated nursing diagnoses include:
Copyright © 2022, Elsevier Inc. All rights reserved.
,Case Study Answers 3
(You can copy and paste the information from the EVOLVE SITE in the areas below.)
Sleep deprivation
3. Write/select a nursing diagnostic statement for one of the nursing diagnoses by combining the
nursing diagnosis label with the related to (r/t) factors.
a. The label is the title of the nursing diagnosis as defined by NANDA-I.
b. A related to (r/t) statement describes factors that may be contributing to or causing the problem
that resulted in the nursing diagnosis.
NANDA-I label: Sleep deprivation
Definition
Prolonged periods of time without sustained natural, periodic suspension of relative consciousness
that provides rest.
Defining characteristics
Altered attention, anxiety, apathy, combativeness, confusion, decrease in functional ability,
drowsiness, expresses distress, fatigue, fleeting nystagmus, hallucinations, heightened sensitivity
to pain, irritable mood, lethargy, prolonged reaction time, psychomotor agitation, transient
paranoia, tremors.
Related factors (r/t): Age-related sleep stage shifts, average daily physical activity is less than
recommended for gender and age, environmental disturbances, environmental overstimulation,
non-restorative sleep-wake cycle, sleep terror, sleep walking, sustained circadian asynchrony,
sustained inadequate sleep hygiene.
The complete nursing diagnostic statement is:
Sleep deprivation r/t conditions with periodic limb movement
Copyright © 2022, Elsevier Inc. All rights reserved.
, Case Study Answers 4
C. PLAN
1. Select appropriate NOC outcome from Ackley/Ladwig text or from the EVOLVE Care Plan
constructor.
NOC outcome: sleep
Fill out the grid with NOC indicators and the appropriate Likert scale.
Select the appropriate point on the Likert scale to measure the client’s current status.
INDICATOR 1= 2= 3= 4 = Mildly 5 = Not
Severely Substantiall Moderately compromise compromise
compromis y compromise d d
ed compromise d
d
Hours of 1* 2 3 4 5
sleep
Sleep pattern 1* 2 3 4 5
Sleep quality 1* 2 3 4 5
Sleep 1* 2 3 4 5
efficiency
Feels 1* 2 3 4 5
rejuvenated
after sleep
Sleeps 1* 2 3 4 5
through the
night
consistently
2. Or write outcomes to help resolve the symptoms (defining characteristics). Refer to Section III
of the Ackley/Ladwig text for the nursing diagnosis care plan or the EVOLVE Care Plan
constructor.
Copyright © 2022, Elsevier Inc. All rights reserved.
2025-2026 NANDA-I® Updates
Lecture Notes
Problem-Based Learning/Critical Thinking
Case Study—Restless Leg Syndrome
Case Scenario
Abdul Malek is a 21-year-old college student. He attends the local state university and is a junior
studying graphic design. Three weeks into his fall semester, Abdul’s professors notice that he is
falling asleep in class and often looks restless. Abdul taps his foot and squirms around in his seat.
Abdul, who is usually an excellent student, has failed his first test in his Graphic Design II course.
His professor asks him to see his advisor because the fear is that Abdul has become chemically
impaired. His advisor sends Abdul to the student health services and his case is reviewed by the
nurse.
Nursing Assessment
Abdul is a well-developed 22-year-old male with a BMI of 20. His vital signs are blood pressure
104/78; temperature 98.4°F; heart rate—64 beats per minute; respiratory rate—16 breaths per
minute. A nutritional history confirms a well-balanced diet with the exclusion of pork products.
Abdul had been working out every day at the University gym but reports that he is currently ―too
tired‖ to do so. Abdul denies drug or alcohol use and this is confirmed by serum analysis. Abdul
complains about sleeping poorly and feeling as if, ―I am moving all night.‖ He states that he often
wakes up his dorm mate and feels bad about that. The nurse reclines Abdul on the examination
table and checks his deep tendon reflexes (DTRs) which are all 2+. The nurse asks Abdul to relax
and dims the lights while she consults with the primary care practitioner. While the nurse is out of
the examination room Abdul dozes, and when the nurse returns, the nurse observes Abdul’s right
leg jerking several times before she arouses him.
A. ASSESS
1. Identify significant symptoms by underlining them in the assessment.
2. List those symptoms that indicate the client has a health problem (those you have underlined).
• falling asleep in class
• often looks restless
• taps his foot
• squirms around in his seat
• failed his first test
• ―too tired‖
Copyright © 2022, Elsevier Inc. All rights reserved.
,Case Study Answers 2
• complains about sleeping poorly
• ―I am moving all night‖
• often wakes up
• dozes
• right leg jerking several times
3. Group the symptoms that are similar.
• falling asleep in class
• often looks restless
• taps his foot
• squirms around in his seat
• failed his first test
• complains about sleeping poorly
• dozes
• ―too tired‖
• ―I am moving all night‖
• often wakes up
• right leg jerking several times
• DIAGNOSE
4. Select possible nursing diagnoses for this client.
Do this by looking at the list of nursing diagnoses in, the book, Ackley/Ladwig Nursing Diagnosis
Handbook: An Evidence-Based Guide to Planning Care or by accessing the care plan constructor
at the EVOLVE SITE and viewing nursing diagnoses listed there.
Possible nursing diagnoses:
Sleep deprivation
Disturbed sleep pattern
Fatigue
Ineffective coping
Stress overload
2. Validate the possible nursing diagnoses.
Compare the signs and symptoms (defining characteristics) that you have identified from your
client assessment with the defining characteristics for the nursing diagnosis that you have selected.
Also read the definition and determine if this diagnosis fits this client.
Validated nursing diagnoses include:
Copyright © 2022, Elsevier Inc. All rights reserved.
,Case Study Answers 3
(You can copy and paste the information from the EVOLVE SITE in the areas below.)
Sleep deprivation
3. Write/select a nursing diagnostic statement for one of the nursing diagnoses by combining the
nursing diagnosis label with the related to (r/t) factors.
a. The label is the title of the nursing diagnosis as defined by NANDA-I.
b. A related to (r/t) statement describes factors that may be contributing to or causing the problem
that resulted in the nursing diagnosis.
NANDA-I label: Sleep deprivation
Definition
Prolonged periods of time without sustained natural, periodic suspension of relative consciousness
that provides rest.
Defining characteristics
Altered attention, anxiety, apathy, combativeness, confusion, decrease in functional ability,
drowsiness, expresses distress, fatigue, fleeting nystagmus, hallucinations, heightened sensitivity
to pain, irritable mood, lethargy, prolonged reaction time, psychomotor agitation, transient
paranoia, tremors.
Related factors (r/t): Age-related sleep stage shifts, average daily physical activity is less than
recommended for gender and age, environmental disturbances, environmental overstimulation,
non-restorative sleep-wake cycle, sleep terror, sleep walking, sustained circadian asynchrony,
sustained inadequate sleep hygiene.
The complete nursing diagnostic statement is:
Sleep deprivation r/t conditions with periodic limb movement
Copyright © 2022, Elsevier Inc. All rights reserved.
, Case Study Answers 4
C. PLAN
1. Select appropriate NOC outcome from Ackley/Ladwig text or from the EVOLVE Care Plan
constructor.
NOC outcome: sleep
Fill out the grid with NOC indicators and the appropriate Likert scale.
Select the appropriate point on the Likert scale to measure the client’s current status.
INDICATOR 1= 2= 3= 4 = Mildly 5 = Not
Severely Substantiall Moderately compromise compromise
compromis y compromise d d
ed compromise d
d
Hours of 1* 2 3 4 5
sleep
Sleep pattern 1* 2 3 4 5
Sleep quality 1* 2 3 4 5
Sleep 1* 2 3 4 5
efficiency
Feels 1* 2 3 4 5
rejuvenated
after sleep
Sleeps 1* 2 3 4 5
through the
night
consistently
2. Or write outcomes to help resolve the symptoms (defining characteristics). Refer to Section III
of the Ackley/Ladwig text for the nursing diagnosis care plan or the EVOLVE Care Plan
constructor.
Copyright © 2022, Elsevier Inc. All rights reserved.
