A nurse is caring for a hospitalized pre-operative client experiencing insomnia in the hospital at 3:00 am (0300).
Which nursing intervention is the most appropriate for this client?

Diminished breath sounds in a client admitted with pneumonia. This is because diminished breath sounds indicate a worsening of the respiratory condition and a possible complication of pneumonia, such as atelectasis or pleural effusion.

The healthcare provider should be notified immediately to assess the client and order appropriate interventions.

Choice A is wrong because a report of joint pain by a client who recently started taking arthritis medication is not an urgent finding.

Joint pain is a common symptom of arthritis and may take some time to improve with medication.

The nurse should monitor the client’s pain level and administer analgesics as prescribed.

Choice B is wrong because report of decreased appetite and difficulty sleeping is not an immediate concern.

These are nonspecific symptoms that may be related to stress, anxiety, depression, or other factors.

The nurse should explore the possible causes of these symptoms and provide emotional support and education to the client.

Choice C is wrong because a weight loss of two pounds in a client admitted to congestive heart failure is not a critical finding.

Weight loss may indicate a reduction of fluid retention, which is a desired outcome for clients with heart failure.

The nurse should monitor the client’s weight daily and report any significant changes to the health care provider.

Normal ranges for weight, appetite, sleep, joint pain, and breath sounds vary depending on the individual’s age, gender, height, activity level, medical history, and other factors.

Offer a glass of warm milk. According to some studies, warm milk may have a relaxing effect on the body and help induce sleep. It also contains tryptophan, an amino acid that is converted to serotonin and melatonin, which are neurotransmitters that regulate sleep cycles.

Choice A is wrong because a warm shower may increase the body temperature and make it harder to fall asleep.

Choice C is wrong because notifying the healthcare provider is not necessary for a client with insomnia unless there are other signs of distress or complications.

Choice D is wrong because watching television may stimulate the brain and interfere with the production of melatonin, a hormone that promotes sleep.

Some other nursing interventions for insomnia are:

• Educate the patient on the proper food and fluid intake such as avoiding heavy meals, alcohol, caffeine, or smoking before bedtime.
• Evaluate the patient’s sleep hygiene such as having a regular bedtime and wake-up time, avoiding naps during the day, and limiting exposure to light at night.
• Provide a conducive environment for sleep such as reducing noise, adjusting temperature and lighting, and using comfortable bedding.
• Help the patient develop a sleeping plan such as engaging in relaxing activities before bed, avoiding checking the clock, and getting out of bed if unable to sleep after 20 minutes.
• Understand the proper use of sleep aids or other medications such as following the prescription, avoiding over-the-counter drugs without consulting the provider, and being aware of the side effects and interactions.