A nurse is caring for a toddler who has acute laryngotracheobonchitis after a repair of an intussusception. Which of the indicates that the treatment has been effective?

A. "I don't care about work anymore since I was not given a promotion":

This statement demonstrates the maladaptive use of regression. Regression involves reverting to an earlier stage of development in the face of unacceptable thoughts or impulses. In this case, the client's response to not receiving a promotion is to display a lack of interest in work, which can be seen as regressing to a less mature coping mechanism.

B. "I wrote a short story about a heroic woman when I was really mad at my boss."

This statement describes the defense mechanism of sublimation rather than regression. Sublimation involves channeling unacceptable impulses or emotions into more socially acceptable activities or behaviors. In this case, the client channels their anger into writing a short story, which is a constructive and creative outlet.

C. "I still cannot remember the scene of my husband's car accident":

This statement does not demonstrate regression. Instead, it suggests repression, which involves the unconscious blocking of unpleasant memories, thoughts, or feelings from conscious awareness. The client's inability to remember the scene of the accident may indicate repression as a defense mechanism.

D. "I mentally separate myself from distractions around me when I paint on canvas."

This statement describes the defense mechanism of dissociation rather than regression. Dissociation involves a disconnection between a person's thoughts, identity, consciousness, or memory. In this case, the client mentally separates themselves from distractions while painting, which is a form of dissociative coping.

C. Dialectical behavior therapy (DBT):

Rationale: This is the correct intervention. Dialectical behavior therapy (DBT) is a type of psychotherapy that is specifically designed to treat borderline personality disorder (BPD). It focuses on teaching clients skills to manage their emotions, improve relationships, and cope with distressing situations effectively. Including DBT in the discharge plan for a client with BPD can help them continue their therapeutic progress after leaving the hospital or clinical setting.

Incorrect:

A. Safety plan:

Rationale: While a safety plan may be appropriate for some clients with borderline personality disorder, it is not specific to DBT and may not address the broader range of issues that DBT aims to target. Safety plans typically focus on identifying triggers for self-harm or suicidal ideation and outlining steps for managing crises, whereas DBT encompasses a more comprehensive approach to managing emotions and behaviors.

B. Behavioral contract:

Rationale: Behavioral contracts are agreements between individuals and their treatment providers that outline specific behaviors, consequences, and rewards. While behavioral contracts may be used as part of a comprehensive treatment plan for clients with BPD, they do not specifically address the skills-based approach of DBT.

D. Bibliotherapy:

Rationale: Bibliotherapy involves the use of written materials, such as self-help books or educational resources, to support therapeutic goals. While reading materials may complement DBT and other therapeutic approaches, bibliotherapy alone is not considered a primary intervention for treating borderline personality disorder.