Major Depressive Disorder Case Study
During initial assessment, the nurse should focus on which areas in development of CP for anxiety? SATA
Symptoms of anxiety; Increasing symptoms of anxiety; Suicidal ideation
What should the nurse say to elicit the most subjective information form the client?
“Tell me more about your anxiety” (This statement encourages the client to talk openly about her anxiety)
Joan focuses on harassment complaints at work against her boss. She feels she is held at “a higher set of standard” What level of anxiety is Joan experiencing?
Severe (only focus on a narrowed area of concern. Joan focuses on her employer and coworkers)
Mild and Moderate anxiety:
would see themselves as successfully carrying out their ADLS
state of panic has intense physical symptoms such as chest pain, diaphoresis and SOB without and identifiable cause
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During interview Joan identifies intense anxiety, irritability and feelings of depression with thoughts of suicide as reasons for seeking treatment. Which question is most important for the nurse to ask Joan?
Do you have a plan for harming yourself?
Joan c/o recent chest pains. How should the nurse respond to Joan’s comments?
Tell me more about your chest pain.
Which nursing diagnosis for the client’s anxiety should the nurse record?
Ineffective coping related to interpersonal conflicts. (the client’s difficulty with peers is the only anxiety-related diagnosis that the nurse can impact)
Joan thinks her boss is out to get her because she is 52 years old. Which behavior should the nurse illicit from the client?
Stating the sources for present anxiety.
“Everyone thinks I should do better because of my age” Which nursing diagnosis should the nurse add to Joan’s POC. SATA
Anxiety r/t maturational crisis; Powerlessness r/t work conflict. (Powerlessness is the result of her feelings of hopelessness); Situational low self esteem r/t work
Which question or statement by the nurse is most likely to encourage Joan to talk about the issues that are contributing to her anxiety?
What does being 52 years old mean to you?
Is RX bupropion (Wellbutrin) 300mg once daily and lorazepam (Ativan) 0.50mg BID. How should the nurse answer Joan’s question about when to take the Ativan?
Measure your anxiety on a scale, then decide when to use Ativan, but do not exceed BID
What information should the nurse discuss with Joan about bupropion (Wellbutrin)?
Anxiety level may increase
Before starting Wellbutrin what should the nurse ensure that Joan has not experienced? SATA
Anorexia or bulimia; seizures
Joan asks about the consumption of etoh while taking Wellbutrin. How should the nurse resond?
Do not consume etoh while taking the medication (This may increase risk of seizures)
Several days after taking Wellbutrin, Joan calls the clinic and c/o headaches. How should the nurse respond?
The headaches usually go away within a few days. (This response encourages the client to continue to take medications)
What is a priority question to ask once the client has been taking the Wellbutrin?
have you had any suicide thoughts since starting the medication.
After 4 weeks Joan calls the clinic emergency line. She is crying and reports that she “has nothing to live for” Which question should the nurse ask Joan first?
How do you plan to hurt yourself? (When assessing the nurse must first determine if the client has a means to harm themselves)
Joan tells the nurse she thinks about OD on her medications. How should the nurse respond?
Go to the hospital now because this is a serious situation.
Joan is admitted and meds changed to Lexapro at hs and Wellbutrin in the morning. Which statement by the client best suggest that the medication combination and therapy are working?
The things that happen at work don’t bother me so much. (Work was her initial complaint)
After 6 months Joan wants to d/c her meds. How should the nurse respond?
Most clients do better by taking the medication for a year.
It has been 1 year since initial presentation to the clinic. Joan uses “reaction formation as a defense mechanism when she discusses work. On which statement by the client is the nurse basing this assessment?
I just tell the boss that nothing she does will upset me. (This is reaction formation. a type of defense mechanism that occurs when clients turn their feelings or impulses into their opposites, such as Joan about her boss)
is a defense mechanism clients use to conceal their mistakes or shortcomings by overachieving or exaggeration.
a type of defense mechanism in which clients use their energy to deal with anger
a type of defense mechanism in which clients down play or reduce the importance of offensive behavior
The nurse knows that Joan is still easily upset by her boss’ behavior. How should the nurse respond to Joan?
How do you feel when your boss says something that upsets you? (The nurse in encouraging her to focus on her feelings)
Joan is discharged after 6 more months. What makes termination important to the nurse-client relationship?
Termination summarizes the goals and objectives attained. (This is an opportunity for the client to discuss ways to incorporate new coping strategies learned while in treatment)
Eight months after being d/c from the clinic, Joan calls the clinic and “wants to talk”. How should the nurse respond?
Instruct the patient to make an appointment for follow-up