A nurse is preparing to insert a nasogastric tube in a client. Which of the following actions should the nurse take?

Rationale:

• Dependent personality disorder: Characterized by excessive need to be taken care of and fear of separation. This does not fit the client’s symptoms of hopelessness, poor hygiene, flat affect, and suicidal thoughts, which are more consistent with major depression.
• Schizophrenia: Involves hallucinations, delusions, and disorganized behavior, none of which are reported in this client. The absence of psychosis and the presence of mood-based symptoms suggest a depressive disorder rather than a psychotic disorder.
• Major depressive disorder: Fits with the client's expression of hopelessness, withdrawal, poor hygiene, job loss, and suicidal ideation. These are classic symptoms of major depression and require careful monitoring and support.
• Dementia: Typically includes memory impairment, disorientation, and decline in cognitive function. The client is coherent, oriented, and presenting with mood rather than cognitive issues, ruling out dementia.
• Speak with the client using simple words: While clear communication is always beneficial, there is no indication the client has cognitive impairment requiring simplified language. The priority is emotional support and safety, not communication complexity.
• Remain in the room with the client: Ensures the client feels supported and safe, especially in the context of suicidal ideation. Continuous presence also allows for immediate intervention if the client's mental state worsens.
• Encourage client to eat slowly: Not relevant to the client’s presentation. There are no issues with appetite, swallowing, or physical illness necessitating this intervention. It does not address the mental health concerns at hand.
• Assist the client to identify stressors: Helps promote insight and develop coping mechanisms. Identifying stressors is essential in managing depressive symptoms and planning appropriate therapeutic strategies.
• Determine client’s level of disorientation: The client is not exhibiting signs of confusion or disorientation. This action would be more appropriate for cognitive disorders such as dementia or delirium.
• Panic attacks: The client reports anxiety but has not described acute panic symptoms like hyperventilation or chest tightness. Monitoring panic attacks is not a priority in this depressive context.
• Hallucinations: There is no evidence of perceptual disturbances. The client is not demonstrating psychosis, so monitoring for hallucinations is not indicated.
• Wandering at night: More relevant for clients with dementia or delirium. This client is coherent and not at risk of nocturnal wandering.
• Suicidal ideation: A key concern due to the client expressing that life is not worth living. This must be monitored continuously for client safety and to guide suicide prevention strategies.
• Sleep patterns: Depression commonly affects sleep, leading to insomnia or hypersomnia. Monitoring sleep helps gauge treatment response and overall progress in managing depressive symptoms.

Rationale:

A. Docusate: Docusate is a stool softener that does not interfere with coagulation or increase bleeding risk. It is often safely used in clients taking anticoagulants to prevent straining during bowel movements, which is especially important in post-operative or cardiovascular patients.

B. Cimetidine: While cimetidine may interact with some medications metabolized by the liver, it does not significantly affect bleeding risk when used with enoxaparin. However, it should still be used cautiously due to potential drug interactions and altered metabolism.

C. Calcium supplement: Calcium supplements do not interfere with the anticoagulant action of enoxaparin. They are commonly used for bone health and are generally safe, provided they are taken at recommended doses without excessive vitamin D.

D. Garlic: Garlic, especially in supplement form, can have antiplatelet effects and may increase the risk of bleeding when taken with anticoagulants like enoxaparin. Clients should be advised to avoid herbal products like garlic, ginkgo, or ginseng without provider approval.