1. Sedative-Hypnotic Therapy

2. Nursing Process
• Assessment:
• CNS—identify level of alertness and orientation
• Vital sign—obtain BP, HR, RR
• Sleep pattern—usual pattern, disturbances, amt. of
hours, regular time to go to bed
• Anxiety level—need listening, stressors
• Environmental control—sleep interferences
• Nutritional needs—dietary history (caffeinated especially
• Alcohol intake—cause sedation, disrupts sleep, cause early-
morning awaking
• Exercise—degree of physical activity & what times of day
• Respiratory status--snoring

3. Nursing Diagnoses
• Disturbed sleep pattern
• Readiness for enhanced sleep
• Risk for injury (adverse effects)
• Deficient knowledge related to meds
• Insomnia
• Sleep deprivation

4. Nursing Process: Planning
• CNS function
– schedule assessments & monitoring vital signs at least Q8hr
• Sleep Pattern
– Usually ordered PRN
– Never leave at bedside
– Reassess cause of sleeplessness
• Anxiety level
– Be aware of paradoxical response
• Environmental control
– Safety needs—call light, bed in low position, side rails up, leave
nightlight on, less disturbances
• Nutrition
– Offer protein & diary product before sleep
• Exercise during the day

5. Nursing Process: Implementation
• Obtain vital sign periodically
• Give preoperative medication at specific time
• Monitoring effects (therapeutic & adverse
reactions)
• PRN assess and record effectiveness

6. Nursing Process: Implementation
• Patient Education & Health Promotion
• Bedtime – standard time to go to bed
• Nutrition – food plate, fluid intake, vitamin use, avoid heavy meal late in evening,
alcohol & caffeine consumption reduced or discontinued, introduce decaffeinated
or herbal products, dairy & protein products
• Personal comfort – position, back rub, empty bladder, calm fears
• Environmental control – quiet, darkened room, less distraction, no TV, adequate
ventilation, subdued lighting, correct temperature, control traffic, nightlight
• Activity & Exercise – include in daily activities
• Stress management –counseling, relaxation techniques, referrals for mastery of
biofeedback, meditation, express feelings, channeling toward positive realistic
goals
• Fostering health maintenance –discuss med, how it benefits, stress non-
pharmacologic interventions, compliance, provide significant other information,
adverse effects and serious adv. Effects
• Written Record –record of monitoring parameters, assess understanding, follow up
visit

7. Sedative Hypnotic
• Barbiturates
• Benzodiazepine
• Non-Barbiturates, Non-Benzodiazepine

8. Barbiturates
• Reversibly depress the activity of all excitable
tissue
• Used rarely limited to 2 weeks
• Amobarbital !
• Butabarbital
• Mephobarbital
• Pentaobarbital !
• Phenobarbital !
• Secobarbital

9. Benzodiazepines
• Serve as
– Anticonvulsants
– Antianxiety
– Muscle relaxants
– Sedative hypnotics
• Estazolam
• Flurazepam
• Lorazepam
• Midazolam
• Quazepam
• Temazepam
• Triazolam

10. Miscellaneous Sedative Hypnotics
• CNS depression
• Types:
– Histamine-1 blockers (antihistamines)
– Melatonin Receptors Stimulant
– Valerian
– Benzodiazepine Receptor Agonist
• Drugs:
– Chloral hydrate
– Dexmedetomidine
– Diphenhydramine
– Doxylamine
– Eszopiclone
– Melatonin
– Ramelteon
– Valerian
– Zalepion
– Ziopidem