Nursing Case Study

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Nursing Case Study


Sleeping Disturbance

There are several concerns about the client that needs change. Sleep disturbance is a disorder whereby the patient finds it difficult to initiate and maintain sleep also referred to as insomnia (Cho, Savitz, Dantzer, Teague, Drevets, & Irwin, 2017. Sometimes the patient can fall asleep but cannot remain asleep for the desired time. Ascertaining whether a patient has insomnia or not requires the clinician to ask the client how many hours they sleep and their perception of the quality of sleep they have.

It is important to gather adequate information about the problem before starting treatment (Cox, & Olatunji, 2016). This is the reason for asking the question to establish if the patients sleep long enough. This is because sometimes a client may feel that they do not have enough sleeping hours, but in the real sense, they have slept for the recommended hours. In other instance, the client may be sleeping for recommended hours, but the quality of sleep is poor due to frequent waking. The patient indicated that he sleeps for a maximum of 30 minutes uninterrupted in every 4 hours. The patient involuntarily falls asleep during the day which impairs productivity. This is unhealthy hence the need for change.

Causes of the Sleeping Disturbance

According to this client, he is unable to seep because various weird things happen to him when sleeping. The client is mostly anxious, lonely and has a series of nightmares. The client also has persistent flashbacks of the parents’ murder. The client also indicated that he had had unsatisfying relationships. In the patient also has a behavior of collecting crime information which might be the possible cause of the sleeping disturbance because he gets reflections of what he had been doing throughout the day.

Deeper Problems.

One should deal with trauma through strategies such as by ensuring that he is busy throughout the day (Shalev, Liberzon, & Marmar, 2017). This is because the problem is made more intense by carrying out activities that catalyze his condition. The other problem with the client may be due to the use of drugs and alcoholic substances. The client may also be using drugs that impair alter normal sleeping patterns. There is a probability that the client killed his parents hence the reason for the persistent memory of their murder. It is also likely that h witnessed their murder an incidence which is traumatizing. Additionally, the client’s source of the problem may be due to a lack of justice for the parents hence the reason why he constantly collects criminal information. The underlying problem, however, may be that the client has post-traumatic stress disorder.

The important thing in the treatment of post-traumatic stress disorder is admitting that there is a problem (Shalev, Liberzon, & Marmar, 2017). The good thing with this particular client is that he recognizes that this is a serious health concern which needs to be addressed immediately. The client recognized that there are some of the behaviors that may be accelerating the condition. He admitted that he rarely interacts with people and he prefers to stay most of the time indoors. He admitted that failure to engage in social interactions has made his condition worse. The client showed an interest in working with clinicians to help him change the behavior.



Anger is one of the visible symptoms of post-traumatic stress disorder (Shalev, Liberzon, & Marmar, 2017). When asking the client about his condition and how long he slept per day I observed that he became angry to the extent that he could not respond to the question. I had to cool him down by convincing him that this exercise was aimed at improving his condition and not to demean him. He was however reluctant on providing in-depth analysis of relationship life. He, however, indicated that he had several failed relationships.

Concentration Challenges

Poor concentration and high levels of distracted behaviors are common symptoms among people who have had traumatic disorders (Shalev, Liberzon, & Marmar, 2017). A person who has gone through extremely stressful situations becomes easily distracted and can handle productively engage in a meaningful conversation. When interviewing the patient, it becomes evident that he could not pay attention for more than one minute. He was easily distracted and when he could hear something like a door bang he became restless.

Avoidance and Withdrawal

Post-traumatic stress disorder patients portray a behavior of avoiding conversations related to the events that may be the cause of trauma (Shalev, Liberzon, & Marmar, 2017). They struggle so much not to think or experience these feelings. The client avoided some of the questions and became very distressed. Additionally, he became distressed when someone strange entered the room. He became terrified and could not sit or talk until the person left the room.

Behaviors that are Specifically in Need of Change.

The journey towards post-traumatic stress depression starts by admitting that a problem exists and willingness to solving the concern (Shalev, Liberzon, & Marmar, 2017). One of the behaviors that need to be critically changed is withdrawal. To solve the issue, the client will have to interact with different healthcare practitioners. If he fears them, then it means that treatment will not be fruitful or may also be impossible. The client also needs to be open and discuss all the details so that the root cause of the problem can be established. Otherwise, the therapeutic sessions may not be practical because they will not consider the aspects that may be causing the condition.



Cho, H. J., Savitz, J., Dantzer, R., Teague, T. K., Drevets, W. C., & Irwin, M. R. (2017). Sleep disturbance and kynurenine metabolism in depression. Journal of psychosomatic research99, 1-7.

Cox, R. C., & Olatunji, B. O. (2016). A systematic review of sleep disturbance in anxiety and related disorders. Journal of anxiety disorders37, 104-129.

Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-traumatic stress disorder. New England Journal of Medicine376(25), 2459-2469.