ACKLEY: NURSING DIAGNOSIS i i
HANDBOOK, 12TH EDITION REVISED
i i i i
REPRINT WITH 2024-2025 NANDA-I®
i i i i
UPDATES
i
Lecture iNotes
Problem-Based iLearning/Critical iThinking
i Case iStudy—Restless iLeg iSyndrome
Case iScenario
Abdul iMalek iis ia i21-year-old icollege istudent. iHe iattends ithe ilocal istate iuniversity iand iis ia
ijunior istudying igraphic idesign. iThree iweeks iinto i his ifall isemester, iAbdul’s iprofessors inotice
ithat ihe iis ifalling iasleep iin iclass iand ioften ilooks irestless. iAbdul itaps ihis ifoot iand isquirms
iaround iin ihis iseat. iAbdul, iwho iis iusually ian iexcellent istudent, ihas ifailed ihis ifirst itest iin ihis
iGraphic iDesign iII icourse. iHis iprofessor iasks ihim ito isee ihis iadvisor ibecause ithe ifear iis ithat
iAbdul ihas ibecome ichemically iimpaired. iHis iadvisor isends iAbdul ito ithe i student ihealth
iservices iand ihis icase iis ireviewed iby ithe inurse.
Nursing iAssessment
Abdul iis ia iwell-developed i22-year-old imale iwith ia iBMI iof i20. iHis ivital isigns iare iblood
ipressure i104/78; itemperature i98.4°F; iheart irate—64 ibeats iper iminute; irespiratory irate—16
ibreaths iper iminute. iA inutritional ihistory iconfirms ia iwell-balanced idiet iwith ithe iexclusion iof
ipork iproducts. iAbdul ihad ibeen iworking iout ievery iday iat ithe iUniversity igym ibut ireports ithat ihe iis
icurrently i―too itired‖ ito ido iso. iAbdul idenies idrug ior ialcohol iuse iand ithis iis iconfirmed iby
iserum ianalysis. iAbdul icomplains iabout isleeping ipoorly iand ifeeling ias iif, i―I iam imoving iall
inight.‖ iHe istates ithat ihe ioften iwakes iup ihis idorm i mate iand ifeels ibad iabout ithat. iThe inurse
ireclines iAbdul ion ithe iexamination itable iand ichecks ihis ideep itendon ireflexes i(DTRs) iwhich iare
iall i2+. iThe inurse iasks iAbdul ito irelax iand idims ithe ilights iwhile ishe iconsults iwith ithe iprimary
icare ipractitioner. iWhile ithe inurse iis iout iof ithe iexamination iroom iAbdul idozes, iand iwhen ithe
inurse ireturns, ithe inurse iobserves iAbdul’s iright ileg ijerking iseveral itimes ibefore i she iarouses
ihim.
A. ASSESS
1. Identify isignificant isymptoms iby iunderlining ithem iin ithe iassessment.
2. List ithose isymptoms ithat iindicate ithe iclient ihas ia ihealth iproblem i(those iyou ihave iunderlined).
• falling iasleep iin iclass
• often ilooks irestless
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
,• taps ihis ifoot
• squirms iaround iin ihis iseat
• failed ihis ifirst itest
• ―too itired‖
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
,Case iStudy iAnswers 2
• complains iabout isleeping ipoorly
• ―I iam imoving iall inight‖
• often iwakes iup
• dozes
• right ileg ijerking iseveral itimes
3. Group ithe isymptoms ithat iare isimilar.
• falling iasleep iin iclass
• often ilooks irestless
• taps ihis ifoot
• squirms iaround iin ihis iseat
• failed ihis ifirst itest
• complains iabout isleeping ipoorly
• dozes
• ―too itired‖
• ―I iam imoving iall inight‖
• often iwakes iup
• right ileg ijerking iseveral itimes
• DIAGNOSE
4. Select ipossible inursing idiagnoses ifor ithis iclient.
Do ithis iby ilooking iat ithe ilist iof inursing idiagnoses iin, ithe ibook, iAckley/Ladwig iNursing iDiagnosis
iHandbook: iAn iEvidence-Based iGuide ito iPlanning iCare ior iby iaccessing ithe icare iplan
iconstructor iat ithe iEVOLVE iSITE iand iviewing inursing idiagnoses ilisted ithere.
Possible inursing idiagnoses:
Sleep ideprivation
iDisturbed isleep ipattern
iFatigue
Ineffective icoping
iStress ioverload
2. Validate ithe ipossible inursing idiagnoses.
Compare ithe isigns iand isymptoms i(defining icharacteristics) ithat iyou ihave iidentified ifrom iyour
iclient iassessment iwith ithe idefining icharacteristics ifor ithe inursing idiagnosis ithat iyou ihave iselected.
iAlso iread ithe idefinition iand idetermine iif ithis idiagnosis ifits ithis iclient.
Validated inursing idiagnoses iinclude:
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
, Case iStudy iAnswers 3
(You ican icopy iand ipaste ithe iinformation ifrom ithe iEVOLVE iSITE iin ithe iareas ibelow.)
i Sleep ideprivation
3. Write/select ia inursing idiagnostic istatement ifor ione iof ithe inursing idiagnoses iby icombining
ithe inursing idiagnosis ilabel iwith ithe irelated ito i(r/t) ifactors.
a. The ilabel iis ithe ititle iof ithe inursing idiagnosis ias idefined iby iNANDA-I.
b. A irelated ito i(r/t) istatement idescribes ifactors ithat imay ibe icontributing ito ior icausing ithe iproblem
ithat iresulted iin ithe inursing idiagnosis.
NANDA-I ilabel: iSleep ideprivation
iDefinition
Prolonged iperiods iof itime iwithout isustained inatural, iperiodic isuspension iof irelative iconsciousness
that iprovides irest.
Defining icharacteristics
Altered iattention, ianxiety, iapathy, icombativeness, iconfusion, idecrease iin ifunctional iability,
idrowsiness, iexpresses idistress, ifatigue, ifleeting inystagmus, ihallucinations, iheightened isensitivity
ito ipain, iirritable imood, ilethargy, iprolonged ireaction itime, ipsychomotor iagitation, itransient
iparanoia, itremors.
Related ifactors i(r/t): iAge-related isleep istage ishifts, iaverage idaily iphysical iactivity iis iless ithan
irecommended ifor igender iand iage, ienvironmental idisturbances, ienvironmental
ioverstimulation, inon-restorative isleep-wake icycle, isleep iterror, isleep iwalking, isustained
icircadian iasynchrony, isustained iinadequate isleep i hygiene.
The icomplete inursing idiagnostic istatement iis:
Sleep ideprivation ir/t iconditions iwith iperiodic ilimb imovement
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
HANDBOOK, 12TH EDITION REVISED
i i i i
REPRINT WITH 2024-2025 NANDA-I®
i i i i
UPDATES
i
Lecture iNotes
Problem-Based iLearning/Critical iThinking
i Case iStudy—Restless iLeg iSyndrome
Case iScenario
Abdul iMalek iis ia i21-year-old icollege istudent. iHe iattends ithe ilocal istate iuniversity iand iis ia
ijunior istudying igraphic idesign. iThree iweeks iinto i his ifall isemester, iAbdul’s iprofessors inotice
ithat ihe iis ifalling iasleep iin iclass iand ioften ilooks irestless. iAbdul itaps ihis ifoot iand isquirms
iaround iin ihis iseat. iAbdul, iwho iis iusually ian iexcellent istudent, ihas ifailed ihis ifirst itest iin ihis
iGraphic iDesign iII icourse. iHis iprofessor iasks ihim ito isee ihis iadvisor ibecause ithe ifear iis ithat
iAbdul ihas ibecome ichemically iimpaired. iHis iadvisor isends iAbdul ito ithe i student ihealth
iservices iand ihis icase iis ireviewed iby ithe inurse.
Nursing iAssessment
Abdul iis ia iwell-developed i22-year-old imale iwith ia iBMI iof i20. iHis ivital isigns iare iblood
ipressure i104/78; itemperature i98.4°F; iheart irate—64 ibeats iper iminute; irespiratory irate—16
ibreaths iper iminute. iA inutritional ihistory iconfirms ia iwell-balanced idiet iwith ithe iexclusion iof
ipork iproducts. iAbdul ihad ibeen iworking iout ievery iday iat ithe iUniversity igym ibut ireports ithat ihe iis
icurrently i―too itired‖ ito ido iso. iAbdul idenies idrug ior ialcohol iuse iand ithis iis iconfirmed iby
iserum ianalysis. iAbdul icomplains iabout isleeping ipoorly iand ifeeling ias iif, i―I iam imoving iall
inight.‖ iHe istates ithat ihe ioften iwakes iup ihis idorm i mate iand ifeels ibad iabout ithat. iThe inurse
ireclines iAbdul ion ithe iexamination itable iand ichecks ihis ideep itendon ireflexes i(DTRs) iwhich iare
iall i2+. iThe inurse iasks iAbdul ito irelax iand idims ithe ilights iwhile ishe iconsults iwith ithe iprimary
icare ipractitioner. iWhile ithe inurse iis iout iof ithe iexamination iroom iAbdul idozes, iand iwhen ithe
inurse ireturns, ithe inurse iobserves iAbdul’s iright ileg ijerking iseveral itimes ibefore i she iarouses
ihim.
A. ASSESS
1. Identify isignificant isymptoms iby iunderlining ithem iin ithe iassessment.
2. List ithose isymptoms ithat iindicate ithe iclient ihas ia ihealth iproblem i(those iyou ihave iunderlined).
• falling iasleep iin iclass
• often ilooks irestless
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
,• taps ihis ifoot
• squirms iaround iin ihis iseat
• failed ihis ifirst itest
• ―too itired‖
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
,Case iStudy iAnswers 2
• complains iabout isleeping ipoorly
• ―I iam imoving iall inight‖
• often iwakes iup
• dozes
• right ileg ijerking iseveral itimes
3. Group ithe isymptoms ithat iare isimilar.
• falling iasleep iin iclass
• often ilooks irestless
• taps ihis ifoot
• squirms iaround iin ihis iseat
• failed ihis ifirst itest
• complains iabout isleeping ipoorly
• dozes
• ―too itired‖
• ―I iam imoving iall inight‖
• often iwakes iup
• right ileg ijerking iseveral itimes
• DIAGNOSE
4. Select ipossible inursing idiagnoses ifor ithis iclient.
Do ithis iby ilooking iat ithe ilist iof inursing idiagnoses iin, ithe ibook, iAckley/Ladwig iNursing iDiagnosis
iHandbook: iAn iEvidence-Based iGuide ito iPlanning iCare ior iby iaccessing ithe icare iplan
iconstructor iat ithe iEVOLVE iSITE iand iviewing inursing idiagnoses ilisted ithere.
Possible inursing idiagnoses:
Sleep ideprivation
iDisturbed isleep ipattern
iFatigue
Ineffective icoping
iStress ioverload
2. Validate ithe ipossible inursing idiagnoses.
Compare ithe isigns iand isymptoms i(defining icharacteristics) ithat iyou ihave iidentified ifrom iyour
iclient iassessment iwith ithe idefining icharacteristics ifor ithe inursing idiagnosis ithat iyou ihave iselected.
iAlso iread ithe idefinition iand idetermine iif ithis idiagnosis ifits ithis iclient.
Validated inursing idiagnoses iinclude:
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
, Case iStudy iAnswers 3
(You ican icopy iand ipaste ithe iinformation ifrom ithe iEVOLVE iSITE iin ithe iareas ibelow.)
i Sleep ideprivation
3. Write/select ia inursing idiagnostic istatement ifor ione iof ithe inursing idiagnoses iby icombining
ithe inursing idiagnosis ilabel iwith ithe irelated ito i(r/t) ifactors.
a. The ilabel iis ithe ititle iof ithe inursing idiagnosis ias idefined iby iNANDA-I.
b. A irelated ito i(r/t) istatement idescribes ifactors ithat imay ibe icontributing ito ior icausing ithe iproblem
ithat iresulted iin ithe inursing idiagnosis.
NANDA-I ilabel: iSleep ideprivation
iDefinition
Prolonged iperiods iof itime iwithout isustained inatural, iperiodic isuspension iof irelative iconsciousness
that iprovides irest.
Defining icharacteristics
Altered iattention, ianxiety, iapathy, icombativeness, iconfusion, idecrease iin ifunctional iability,
idrowsiness, iexpresses idistress, ifatigue, ifleeting inystagmus, ihallucinations, iheightened isensitivity
ito ipain, iirritable imood, ilethargy, iprolonged ireaction itime, ipsychomotor iagitation, itransient
iparanoia, itremors.
Related ifactors i(r/t): iAge-related isleep istage ishifts, iaverage idaily iphysical iactivity iis iless ithan
irecommended ifor igender iand iage, ienvironmental idisturbances, ienvironmental
ioverstimulation, inon-restorative isleep-wake icycle, isleep iterror, isleep iwalking, isustained
icircadian iasynchrony, isustained iinadequate isleep i hygiene.
The icomplete inursing idiagnostic istatement iis:
Sleep ideprivation ir/t iconditions iwith iperiodic ilimb imovement
Copyright i© i2022, iElsevier iInc. iAll irights
ireserved.
