Sleep

4. Abnormal findings — the necessity chain

Finding → severity → comparison → risk → intervention → notification (provider + representative) → orders → response → reassessment.

*Model abnormal 1*
Sleep-wake reversal signaling a change: a new day-night reversal with nighttime wakefulness and mild agitation and daytime somnolence, different from the resident’s pattern — often an early sign of delirium or an acute change. A delirium screen initiated (CAM) and a trigger screen (infection, medication, hypoxia, pain, constipation), the provider notified, orders received, non-pharmacologic sleep-hygiene and safety measures put in place, and an unnecessary hypnotic avoided. Will reassess the pattern and mental status; supports the Section update. Skilled recognition of the sleep-wake change as a possible acute sign required. (The delirium workup routes to the Cognitive reference.)

Model abnormal 1

Sleep-wake reversal signaling a change: a new day-night reversal with nighttime wakefulness and mild agitation and daytime somnolence, different from the resident’s pattern — often an early sign of delirium or an acute change. A delirium screen initiated (CAM) and a trigger screen (infection, medication, hypoxia, pain, constipation), the provider notified, orders received, non-pharmacologic sleep-hygiene and safety measures put in place, and an unnecessary hypnotic avoided. Will reassess the pattern and mental status; supports the Section update. Skilled recognition of the sleep-wake change as a possible acute sign required. (The delirium workup routes to the Cognitive reference.)

*Model abnormal 2*
CPAP/BiPAP intolerance with desaturation: the resident not tolerating the device (removing the mask) with observed apneas and SpO₂ dropping below the ordered range overnight — a respiratory-safety problem. The mask fit and settings troubleshot per protocol, oxygen adjusted per order, the provider notified, and the resident monitored; a follow-up on the device plan requested. Will reassess tolerance and overnight SpO₂; supports the Section O update. Skilled device troubleshooting and respiratory surveillance required. (Respiratory detail routes to the Respiratory reference.)

Model abnormal 2

CPAP/BiPAP intolerance with desaturation: the resident not tolerating the device (removing the mask) with observed apneas and SpO₂ dropping below the ordered range overnight — a respiratory-safety problem. The mask fit and settings troubleshot per protocol, oxygen adjusted per order, the provider notified, and the resident monitored; a follow-up on the device plan requested. Will reassess tolerance and overnight SpO₂; supports the Section O update. Skilled device troubleshooting and respiratory surveillance required. (Respiratory detail routes to the Respiratory reference.)

1. Purpose and clinical relevance

4. Abnormal findings — the necessity chain