Adrian Knight An 18-year-old Depressed Person Treated As – Flashcards

Tell Ad that you will stay with him for a few more minutes and then return in another hour

Ad's food and fluid intake Ad's bladder and bowel elimination patterns Ad's activity level

Industry vs. Inferiority Correct Between the ages of 6 and 12 years old, Ad was learning how to use his knowledge and skills to master his environment through persistence and relationships with peers. This is the task of Industry vs. Inferiority. Ad currently is attempting to solidify his self-concept, including self-image, values, and beliefs. This is the task of Identity vs. Role Diffusion (ages 12-20).

Risk for Self-Harm related to previous suicide attempt and unresolved grief Correct Since admission, Ad has neither confirmed nor denied whether or not he is still suicidal. His safety is a priority concern. Risk for Self-Harm is the nursing diagnosis that takes highest priority at this time.

B, C, D, E, F, G, His single lifestyle Correct Being single places Ad in a slightly higher risk category for suicide than if he was married. The fact that Ad is male Correct Males are three times more likely to complete suicide than females. Ad's male gender increases his risk for suicide. The fact that Ad is unemployed Correct Employment increases opportunity for self-esteem, social contacts, and meaningful contributions to society. Unemployment typically contributes to diminished self-esteem which can lead to feelings of hopelessness. This can increase risk of suicide. His state of depression Correct Ad's depression and associated hopelessness increase his risk for suicide. The fact that Ad is 18 years old Correct As a late adolescent, Ad is at increased risk for suicide. Suicide is the third leading cause of death in adolescents and the age group of 18-24 years. His history of losses Correct Ad's history of losses makes him vulnerable to hopelessness, and subsequently at risk for suicide.

C, D, E, F emoving belts, glass objects, coat hangers, razors, and other sharp items from Ad's environment Correct For a depressed person on suicide precautions, removing obvious articles that could be used in a suicide attempt is critical. These items are stimuli for suicidal thoughts and attempts. Staff members should also be alert to the availability of shoe strings, craft and cleaning supplies, light bulbs, and metal cans, all of which could be used to commit suicide. checking to be sure that Ad swallows his medication Correct For a depressed person on suicide precautions, checking whether or not the person is swallowing his medications is imperative. Depressed persons may "cheek" their medications, hoard them, and then attempt suicide by overdose. monitoring meal trays for missing utensils Correct To help maintain self-respect and self-esteem, depressed persons usually receive meal trays with metal silverware and the standard plastic plates and glasses. Silverware could potentially be used in a suicide attempt. For this reason, it is imperative that meal trays be checked for missing items. searching gifts and other items brought by visitors Correct Gifts and other items brought by visitors can potentially be dangerous to a suicidal person. Any items brought by visitors should be carefully scrutinized and assessed for the threat they might pose.

A, B, D "It's a burden to feel responsible for people leaving you." Correct Ad's mood and behaviors of the past several days indicate that he may feel burdened. His words, "I didn't do anything to stop them" suggest he feels responsible for his losses. This response would reflect Ad's feelings back to him and give him an opportunity to confirm or deny your perception. This would be a therapeutic approach. "You deserve to be punished?" Correct Therapeutic communication is generally enhanced when the nurse restates a client's thoughts or feelings. Restating Ad's words in a questioning tone of voice would encourage him to elaborate on his belief that he should be punished. This would be a therapeutic response. "You're feeling all alone and as if you have nothing?" Correct This response paraphrases Ad's statements of, "Everybody's gone. I'm all by myself, without a job, worthless." Paraphrasing would allow Ad to reflect on his feelings and thoughts in a new way. This would be therapeutic.

B,C, DE Preparation for ECT treatments require that the patient be NPO Written consent is required for treatments The patient is asleep during ECT treatments Memory impairment is common with ECT treatments

A,B, D, E, F Use of a bite block Administration of an IV muscle relaxant Pulse oximetry monitoring Blood pressure monitoring Electrocardiogram (ECG) monitoring

C "It sounds like you have made a firm decision and changed your mind." Correct This response is a good response. It acknowledges Ad's right to change his mind while reflecting what he has verbally and nonverbally said to you. After discussion with Ad, his family and treatment team accept his decision to not have treatments, at least for now.

8 AM and 12 noon Correct Insomnia, restlessness, and nightmares commonly occur with Prozac (fluoxetine). These occur less frequently when Prozac is administered during morning hours.

"The doctor has ordered thyroid and other tests to see if your feelings have a physical basis." Correct This response gives simple, specific, and accurate information. Ad is entitled to know as much as he is ready and willing to learn, without having to feel overwhelmed with too much information or patronized with too little.

withdrawal Correct Reacting to an isolated patient with similar behavior is called withdrawal. This a nontherapeutic response that needs to be changed.

By the time of discharge, Ad will begin to grieve in a direct and open manner Correct Ad needs assistance in learning how to express his feelings and thoughts honestly and directly. It would be realistic to expect that Ad could grieve in a direct and open manner by discharge. Ad will need to identify his losses and share feelings about his brother's death. Acute symptoms of grieving are common for 4-8 weeks. Active symptoms of grieving may be present from 3-6 months. The complete work of mourning takes 1-2 years.

Assist Ad in preparing a structured activity schedule so that he knows what is expected Correct Assisting Ad in preparing a structured activity schedule would allow him to anticipate activities and plan for his day. Meals, medication times, therapy sessions, time to sit in the milieu, visiting hours, and rest periods are some of the items to be included on Ad's activity schedule.

countertransference Correct When a client's descriptions or feelings remind you of events or feelings in your own life, the process is referred to as countertransference. Feelings of countertransference need to be recognized and personally acknowledged, and possibly discussed with a colleague. It is important that personal feelings not interfere with judgments about a client.

Kind but firm Correct A kind but firm approach uses words, voice tone, body stance, and gestures to communicate expectations. It would be the best approach to use to get Ad to follow his expected routine.

Reflect to Ad that he seems to be enjoying the music and suggest that he join the music group Correct Reflecting to Ad that he seems to be enjoying the music and suggesting that he join the music group would allow him opportunity for validation of his feelings as well as provide opportunity for interpersonal interaction.

A C E a promise to contact you or another staff member if he is tempted to act on destructive impulses surrendering of items such as sharps or pills participation of family and friends in the contract

Say to him, "You'll be leaving in a few days. How are you feeling about ending our relationship?" Correct Initiating the topic of ending your relationship would give Ad permission to talk about his thoughts and feelings in a time frame that would encourage closure. Important areas to explore with Ad would include what he has learned from the work you've done together, how he feels about it, and what regrets he may have. It would also be important for him to determine if there is anything he wants to tell you in the time that is left.

It's hard; but, I'm going to work on sharing my feelings a little bit at a time with my new therapist." Correct This statement sounds positive and realistic. In it, Ad acknowledges that although progress may be slow, he is committed.