Psychiatric Emergencies
When intervening with a suicidal client, the initial goal is to keep the client safe. These measures help to optimize safety.
What is remove access to the means to attempt suicide?
The nurse is caring for a client who states “I wish my family would come to visit.” The client is trying to meet this need based on Maslow’s hierarchy of needs.
What is love and belonging needs?
During a home visit, the nurse finds that an older adult client has amassed a large quantity of newspapers and magazines. When the nurse offers to remove some of the newspapers, the client becomes anxious. The nurse suspects this disorder.
What is hoarding?
While conducting a class on anxiety and stress reduction, the nurse describes the symptoms of anxiety (including panic), informing the class that the panic attack may mimic this physical symptom.
What is a heart attack?
A client has recently been diagnosed with pancreatic cancer and tells the nurse, "I have lived a wonderful life and gotten to do and see so many things. My children and spouse will be fine." The nurse identifies the client experiencing which stage of Kubler-Ross' stages of grieving.
What is acceptance?
A client states, "I'm worthless, and I don't deserve to live." This theme in the client's expressed thought may signal a maladaptive response of this disorder.
What is depression?
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are examples of this type of service.
What is self- help groups?
The nurse is assessing a client with a strong urge to arrange and rearrange the items on the table several times a day. These findings are associated with obsessive-compulsive disorder (OCD).
What is unable to tolerate deviations from routine.
This criterion is characterized by Generalized anxiety disorder (GAD).
What is excessive worry or anxiety lasting more than 6 months?
This term is used to describe grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially.
What is Disenfranchised grief?
This is the most important to assess and document in a client with depression.
What is suicide risk?
A parent is trying to teach a child good manners. Every time the child performs a desired behavior, the parent rewards the child with praise. The parent is using this type of reinforcement.
What is positive reinforcement?
This finding noted during the assessment indicates the effect of obsessive-compulsive disorder (OCD) in the client.
What is the client does not get adequate sleep?
A client has frequent panic attacks and often describes feeling disconnected from self during these attacks. The nurse documents this behavior will the nurse in the electronic health record.
What is Depersonalization?
A nurse is facilitating a support group for family members of people who have committed suicide. One client states,"My kids and I are just not the same. It was so selfish of my husband to do this." The nurse can accurately identifies this as which type of response to grief.
What is emotional?
A client comes to the health clinic stating that the client wants to commit suicide. The client has made a detailed plan and has access to a weapon. Currently, the client presents as disoriented. This client's degree of suicide risk the nurse describes is
What is high risk?
A nurse assessing a family evaluates how the family members deal with stressful events to determine their available.
What is coping skills?
The most common obsession experienced by a client diagnosed with obsessive-compulsive disorder.
What is fear of contamination?
A client with a panic disorder is participating in panic control treatment. The nurse documents the client is using this technique to control his panic reactions action.
What is engages in deep breathing?
After receiving word from the oncologist that the client's tumor is malignant, the client says to the nurse, “If you people had the faintest clue what you were doing, I wouldn't be like this.” The nurse recognizes that the client may be experiencing this stage of grief.
What is anger?
During an interview, the nurse has asked a client with depression about any hopes or plans for the future. In response, the client silently made a gesture of drawing the index finger from one side of the client's throat to the other. The nurse has informed the client that this must be communicated to the care team. This practice is the main rationale for the nurse's actions.
What is ensuring the client's safety?
A 22-year-old client states, "I just don't know who I am." The stage of development, according to Erikson, would this client is having difficulty completing this developmental stage.
What is Identity vs. identity diffusion?
A client explains to the healthcare provider that a cleaning ritual must be completed every day. If something disrupts this cleaning schedule, the client experiences the following effect.
What is extreme anxiety?
A client reports the client is beginning a new job and is feeling anxious about the client's performance. The nurse can explain this can improve functioning when this type of anxiety is used.
What is mild?
The most frequent and persistent bereavement-associated symptom.
What is Sleep disturbances?