A nurse is contributing to the care plan for a newly admitted client suffering from severe depressive disorder.
Which of the following interventions should the nurse incorporate into the plan?
Encourage the client to make decisions.
Spend time with the client.
Provide the client with a selection of activities.
Play a game of chess with the client.
The Correct Answer is B
Choice A rationale:
While encouraging decision-making can be empowering for some individuals with depression, it may not be appropriate for those with severe depressive disorder.
Individuals with severe depression often experience significant anhedonia (loss of interest in activities), fatigue, and difficulty concentrating, which can make decision-making overwhelming and even worsen their symptoms.
It's important to assess the client's individual level of functioning and decision-making capacity before implementing this intervention.
Choice C rationale:
Providing a selection of activities can be helpful, but it's crucial to tailor the activities to the client's interests and energy level.
Offering too many choices or activities that are too demanding can be counterproductive.
It's essential to collaborate with the client to identify activities that are meaningful and achievable, and to gradually increase the level of activity as tolerated.
Choice D rationale:
Playing a game of chess can be a stimulating and enjoyable activity, but it may not be appropriate for all clients with severe depression.
Chess requires cognitive focus and strategic thinking, which can be challenging for individuals experiencing cognitive impairment or fatigue associated with depression.
It's important to assess the client's cognitive abilities and interests before suggesting this activity.
Rationale for the correct answer, B:
Spending time with the client offers several benefits:
Conveys caring and support: It demonstrates to the client that they are not alone and that someone cares about their wellbeing.
Provides opportunities for therapeutic communication: Spending time together allows for meaningful conversations, which can help the client express their feelings, concerns, and experiences.
Facilitates observation and assessment: The nurse can observe the client's mood, behavior, and interactions, which can inform treatment planning and evaluation.
Promotes engagement and participation: Spending time with the client can encourage them to engage in other therapeutic activities and interventions.
Builds rapport and trust: Developing a strong therapeutic relationship is essential for effective treatment of depression.
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Related Questions
Correct Answer is D
Explanation
A rationale:
Incorrect. While patients typically do sleep for a period after ECT, the duration is usually shorter, around 30-60 minutes.
Providing inaccurate information about the length of sleep can lead to confusion and anxiety for the patient.
Evidence: Studies have shown that the average recovery time following ECT is around 30-60 minutes, with most patients feeling alert and oriented within that time frame. (Source: NIH.gov) Choice B rationale:
Incorrect. While ECT can be highly effective in treating depression, it is not considered a cure. It's important to manage expectations and emphasize that ECT is a treatment option that can significantly improve symptoms but may not guarantee a complete cure.
Evidence: Research indicates that ECT has a remission rate of approximately 50-70% in patients with severe depression, meaning that many patients experience a significant reduction or disappearance of symptoms. However, relapse rates can range from 30-50%, indicating that ongoing maintenance treatment is often necessary. (Source: American Psychiatric Association)
Choice C rationale:
Incorrect. Muscle relaxants, not seizure-preventing medications, are administered during ECT to protect the patient from injury during the induced seizure. It's crucial to clarify this distinction to avoid misunderstandings about the procedure's mechanism of action.
Evidence: Standard ECT protocols involve the use of a short-acting muscle relaxant, such as succinylcholine, to prevent muscle contractions during the seizure. This helps to minimize the risk of physical injury and ensure patient safety. (Source: Healthline.com)
Choice D rationale:
Correct. Temporary memory loss is a common side effect of ECT, and it's essential to inform patients about this potential issue to prepare them for the experience and address any concerns they may have.
Evidence: Studies have shown that approximately 40-50% of patients experience some degree of memory impairment following ECT, primarily affecting short-term memory of events occurring around the time of treatment. However, this memory loss is usually temporary and resolves within a few weeks or months for most patients. (Source: Studocu.com)
Correct Answer is A
Explanation
Choice A rationale:
Meaningless phrases are a hallmark symptom of schizophrenia and can indicate a worsening of the client's psychosis. This is a significant finding because it suggests that the client's ability to think clearly and communicate effectively is deteriorating.
Prompt reporting to the provider is crucial to ensure timely assessment and intervention, which may include medication adjustments or other therapeutic measures to address the worsening psychosis.
Early intervention is essential to prevent further decline in the client's mental state and to minimize the risk of harm to self or others.
I'll provide detailed rationales for the other choices, even though they are not the priority to report:
Choice B rationale:
Refusal to eat can be a symptom of schizophrenia, but it is not as immediate of a concern as meaningless phrases. It's important to monitor the client's nutritional intake and address any underlying causes of the refusal to eat, but this can typically be managed through nursing interventions without requiring immediate provider notification.
Choice C rationale:
Substance use can exacerbate schizophrenia symptoms and should be addressed, but it is not the priority to report in this scenario. The nurse should assess the client's substance use history and patterns, provide education and counseling on the risks of substance use, and collaborate with the provider to develop a treatment plan that addresses both the schizophrenia and the substance use.
Choice D rationale:
Decreased energy level can be a symptom of schizophrenia, but it is also a common symptom of many other conditions. It's important to assess the client's overall health and identify any potential causes of the decreased energy level, but it is not typically a priority to report to the provider unless it is severe or accompanied by other concerning symptoms
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