Exercise and Mental Health Notes

Which is the best reason for the nurse to screen this client for intimate partner violence? All women of childbearing age should be screened for intimate partner violence. Screening for intimate partner violence is recommended by the U.S. Preventive Service Task Force for all women of childbearing age. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 254, 256. Kwong, M., Harding, D., Roberts, C., Reinisch, D., & Hagler, J. (2020). Lewis's Medicalth Surgical Nursing. (11 edition). St. Louis, Missouri. Elsevier. Pg. 36, 1249, 1619. All clients should be screened for intimate partner violence in a primary care setting. According to the U.S. Preventive Service Task Force, there is insufficient evidence to recommend screening all individuals for intimate partner violence. The nurse is worried that children might be abused, and asking their mom about intimate partner violence is a good way to start the conversation. Screening for intimate partner violence is done to identify individuals who are at risk for poor health outcomes due to the violence, not to identify potential child abuse. The nurse overheard that she came from a domestic violence shelter. All women of childbearing age should be screened for intimate partner violence, regardless of clinical presentation or socio-economic status. Question 2 of 29 Which is the best way for the nurse to screen for intimate partner violence? Ask client is she has any specific injuries related to violence. The violence may not have left an injury or any injuries may have healed. Ask many, specific questions about types of violence so that you can document her history of abuse in the chart in case of legal action. Asking many, specific questions is not an efficient way to screen for intimate partner violence. It also may be viewed as aggressive from the client’s perspective. Evidencebased screening tools generally ask a few, broad questions to increase likelihood of disclosure. Tell client that she can trust the nurse and then give her the opportunity to disclose abuse if she wants to. Effective screening requires the nurse to ask about intimate partner violence. This increases the likelihood that the woman will disclose violence. Use an evidence-based tool such as the Abuse Assessment Screen. Evidence-based tools like the Abuse Assessment Screen are the best way to screen for intimate partner violence because they have been tested for reliability and validity. They also limit interviewer bias. Hunter, M. (2017). Varcarolis' Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 525. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 254. Question 3 of 29 Which behavior should the nurse avoid because it could make client less likely to disclose violence to you? Waiting in silence for her to answer the questions. While a long period of silence may feel uncomfortable in a normal social setting, giving client the opportunity to gather their thoughts and process what they are going to say is an important way to increase the likelihood of disclosure. Telling her that the nurse is legally required to contact the authorities if she discloses violence against her children. While this may decrease the likelihood of disclosure, it is important to be honest about your responsibilities as a nurse to disclose abuse of children. Honesty will also build rapport for future contact with the client. Using probing language to press for a response. Using probing language or pressing for more information than the client is ready to disclose will decrease the likelihood of disclosure. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 47, 437. Interviewing her alone without her children or the advocate. Providing privacy increases the likelihood of disclosure. Question 4 of 29 What risk factors for depression and anxiety are evident in the client’s health history? Marital status and recent move to a shelter. While a recent change in life circumstances, such as a move to a shelter, may increase the likelihood of depression and anxiety, marital status is not a risk factor. Number and age of children. Number and age of children are not risk factors for depression and anxiety. Headaches and trouble sleeping. Headaches and trouble sleeping are symptoms of depression and anxiety but not risk factors. Female gender and history of physical abuse. Female gender and history of physical abuse are risk factors for depression and anxiety. Kwong, M., Harding, D., Roberts, C., Reinisch, D., & Hagler, J. (2020). Lewis's Medicalth Surgical Nursing. (11 edition). St. Louis, Missouri. Elsevier. Pg. 72, 80. Question 5 of 29 What is the nurse most concerned about for this client, knowing her history of depression and intimate partner violence? Body image issues and eating disorders. While a woman who is experiencing depression and intimate partner violence may have issues related to body image and eating disorders, her risk for suicide and self-harm requires the most immediate intervention. Possibility of suicide or self-harm. Because of the serious nature of suicide and self-harm, this would be the most concerning outcome of depression and history of intimate partner violence for the nurse. Kwong, M., Harding, D., Roberts, C., Reinisch, D., & Hagler, J. (2020). Lewis's Medicalth Surgical Nursing. (11 edition). St. Louis, Missouri. Elsevier. Pg. 80. An increase in a chronic disease like hypertension. A client who has experienced intimate partner violence may have a higher propensity for chronic health conditions like hypertension. Potential for substance abuse. Intimate partner violence does increase a person’s chance for high risk behaviors like substance abuse. Question 6 of 29 Based on the history of violence, which physical health conditions would the nurse expect the healthcare provider to screen for? Type 2 diabetes due to risk for disordered eating. Intimate partner violence alone is not sufficient to warrant screening for type 2 diabetes. Liver failure due to risk for substance abuse. Intimate partner violence alone is not sufficient to warrant screening for liver failure. Dementia due to head trauma. Cognitive issues related to head trauma are common in women who have experienced intimate partner violence; however, a neurological screen would be appropriate instead of screening for dementia. Sexually transmitted disease due to forced sex. Clients with a history of sexual abuse should be screened for sexually transmitted diseases if they have not been screened since the assault. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 437. Question 7 of 29 Now that the nurse knows that a specific violent event has occurred, what is the nurse’s responsibility to report the incident? The nurse is not required to report the incident because it may put the client at greater risk. There is no law requiring nurses to report intimate partner violence. Involving the police without the client's consent may put the client in more danger of violence by her intimate partner. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 437. Kwong, M., Harding, D., Roberts, C., Reinisch, D., & Hagler, J. (2020). Lewis's Medicalth Surgical Nursing. (11 edition). St. Louis, Missouri. Elsevier. Pg. 223. The nurse is not required to report the incident because it is the healthcare provider’s responsibility. No member of the healthcare team, including the healthcare providerhealthcare provider, is required to report intimate partner violence against a healthy adult. The nurse is required to report the incident to Child Protective Services (CPS) because the children may be in danger. It would be appropriate to report the incident to Child Protective Services (CPS) if the children were involved in the violence incident (i.e., if a mother was holding a baby or if the child intervened in the incident). From the description of the incident, the nurse does not have any indication that the children was placed in danger. The nurse is required to report the incident to the police because reporting acts of violence against adults is required by law. There is no law requiring nurses to report intimate partner violence against a healthy adult. Question 8 of 29 How should the nurse document an assault such as the one the client just described in the record? Write down the nurse’s own assessment of injuries or symptoms related to the violence, but do not include any information that the nurse does not have evidence to support. It is appropriate for the nurse to write down all information gathered in the assessment, including word for word statements from the client, even if there is no physical evidence like bruising or fractures. Do not write anything if the client has no intention of going to the police about the incident. It is important to include all information regardless of the client’s current intention to go to the police because it may be useful in future care or the client may change their mind about seeking help from the police. Write down verbatim the statements that the client makes related to who assaulted her and when. The notes taken about the incident may be used as evidence or future care. It is best to write word for word what the clients says about the details of the incident, including the person who assaulted her and when it happened. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 437. Do not write anything as it is beyond the nurse’s scope of practice to collect evidence about violence. Collecting client data for an assessment and for use in a potential investigation about an assault is well within the nurse’s scope of practice. Question 9 of 29 What does the nurse know about client’s level of danger, based on the strangulation incident? Because the strangulation was non-fatal, it is likely that her husband is not capable of murdering her, so her future risk for being murdered is low. Whether the last attempt at strangulation was fatal or not, there is a greater likelihood that the abuser is likely to attempt a lethal form of violence again. Strangulation is an extremely rare form of intimate partner violence and no information is available on her future risk of murder. Strangulation is a relatively common form of intimate partner violence and is an indication of higher risk for murder. Strangulation is an indication that her risk of being murdered by her husband is high. Strangulation is an indication that the client's level of danger, including risk for murder, is high. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 437. Workman, C., Rebar, D., & Ignatavicius, M. L. (2018). Medical-Surgical Nursing. th (9 edition). St. Louis, Missouri. Elsevier. Pg. 124. The client has no increased risk of being murdered based on strangulation alone. The nurse needs to assess further to determine risk. While there are other factors that determine a woman’s absolute risk of being murdered by her partner, history of strangulation alone is sufficient to determine that she is at increased risk for being murdered. Question 10 of 29 What other factors may affect client’s risk for being murdered by her husband? She will have a lower risk of being murdered after recently leaving the abusive relationship. If a client has recently left an abusive relationship, she is at greater risk of being murdered by her ex-partner, especially if they lived together. She will have a higher risk of being murdered if she believes he is capable of killing her. Women who have experienced intimate partner violence are often accurate in their own risk assessment. Therefore, if a woman believes her intimate partner is capable of killing her, it is an important indication that she has a high risk of being murdered by the abuser. Hunter, M. (2017). Varcarolis' Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 527, 528. She will have a higher risk of being murdered if her husband has a job. If a woman’s abuser is employed, she is at lower risk for being murdered by the abuser. She will have a lower risk of being murdered if she has access to a gun in the home. Women are at greater risk of being murdered if there is a gun in the home. Question 11 of 29 Based on client’s experiences of physical and sexual abuse and her symptoms found during the assessment, the nurse realizes that the priority nursing problem relates to possible post-traumatic stress syndrome since the client has been subjected to multiple instances of abuse. The nurse is ready to begin a plan of care for the client. Which is the most important piece of information that the nurse needs at this point to address for post-traumatic stress syndrome? Previous history of abuse in childhood and adulthood. Cumulative trauma is an important factor in the severity and duration of post-traumatic stress syndrome. The more traumatic incidences that the client has had in their lifetime, the greater risk they have for more severe and lengthy problems after a traumatic event. th Keltner, Norman. (2019). Psychiatric Nursing (8 ed.). St. Louis, MO. Elsevier. p.230. Whether or not her children have been abused. The client’s response to violence against her children may be affected by post-traumatic stress syndrome, but her own cumulative trauma is more important in predicting the course of her recovery from trauma. The client’s income and education level. Income and education level may be a factor in the client’s risk for intimate partner violence and poor outcomes after the violence, but cumulative trauma has the most direct influence on the course of post-traumatic stress syndrome. Family psychiatric medical history. Genetic risk factors for mental health problems may impact the client’s post-traumatic stress syndrome; however, previous history of trauma, specifically abuse, is the most important information. Question 12 of 29 Which is not a symptom that the nurse would expect to see in a client with posttraumatic stress syndrome? Self-imposed social isolation. Avoiding situations or people that the client associates with the trauma is common for people with post-traumatic stress syndrome. Nightmares related to the event. Re-experiencing the traumatic event, such as through nightmares, is often reported by individuals with post-traumatic stress syndrome. Feeling things more deeply than usual. Post-traumatic stress syndrome is often accompanied by feelings of emotional numbness, not exaggerated feelings. rd Varcarolis, Elizabeth. (2017). Essentials of Psychiatric Mental Health Nursing (3 ed.). St. Louis, MO. Elsevier. p. 297,305. Being easily startled, such as by sudden noises. Increased arousal, as manifested by exaggerated startle response, is a common manifestation of post-traumatic stress syndrome. Question 13 of 29 What information is most important in determining a plan of care for post-traumatic stress syndrome for this client? Her willingness to go to counseling. Counseling may be an important part of recovery from post-traumatic stress syndrome. However, her informal resources (such as a church group or friend) and formal resources (such as an advocate at the shelter or a reduced cost clinic in her neighborhood) are more important in determining a plan of care. Her access to formal and informal social support. The client’s informal resources (such as a church group or friend) and formal resources (such as an advocate at the shelter or a reduced cost clinic in her neighborhood) are the most important factors in determining her plan of care. These resources will determine the emotional and tangible support that she has to cope with the trauma. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 78. Her income and education level. While income and education level may serve as a barrier for care, it should not be the most important determinant for your plan of care. Whether or not she has health insurance. While lack of health insurance may serve as a barrier for care, it should not be the most important determinant for a plan of care. Question 14 of 29 How might living in a domestic violence shelter act as an obstacle for recovery from post-traumatic stress syndrome? All of these scenarios may serve as an obstacle for recovery. A client with post-traumatic stress syndrome has increased arousal that may include irritability and exaggerated startle response. The client may be more sensitive to stressors such as living with strangers or following house rules in a shelter situation. A client will also likely have developed coping mechanisms that may not be available to them at the shelter, such as talking to a friend or going to the corner store for a coffee. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 44. Being away from familiar people, places, and routines may make coping more difficult. A client will also likely have developed coping mechanisms that may not be available to her at the shelter, such as talking to a friend or going to the corner store for a coffee. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 44. Living with a large number of strangers may cause overstimulation. A client with post-traumatic stress syndrome has increased arousal that may include irritability and exaggerated startle response. The client may be more sensitive to stressors such as living with strangers. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 44. Following house rules in the shelter may feel similar to the controlling nature of the abusive relationship. A client with post-traumatic stress syndrome has increased arousal that may include irritability and exaggerated startle response. The client may be more sensitive to stressors such as the feeling of being controlled again by house rules. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 44. Question 15 of 29 The nurse has completed the assessment and has infromation to create a plan of care for client. Before stepping outside the room, the nurse explains to client that the healthcare provider will perform an examination but that the nurse will return afterward to speak with client again. The nurse exits the room and meets with the healthcare provider. What is the best way for the nurse to communicate client’s history of violence with the healthcare provider? After asking permission from client to inform the healthcare provider of the abuse, give a thorough report of the assessment findings. The history of abuse may affect the diagnosis and treatment of the client. It is important that the healthcare provider has all pertinent information. The client, however, should be in control of whether the information that she tells the nurse is shared as much as possible without risking the safety of the client or others. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 437. Allow the healthcare provider to do an independent assessment in order to find possible inconsistencies in the story. It is not the job of the healthcare provider, or the nurse, to determine the truth about the incident or incidents of violence. For the purpose of a health visit, it is important to believe the client and act according to the information given. Keep the information about the abuse private to increase rapport with the client. Just as with any part of a health history, it is important for the healthcare provider to have all relevant information that has been collected about the client’s history of violence to inform care. Place a note on the chart letting the healthcare provider know that abuse has occurred. Important information that could affect the care of a client should be communicated verbally. Question 16 of 29 While the healthcare provider is in the room, the nurse goes to the desk to write down a plan of care. While working, the nurse notices client’s two children in the waiting area. The 6-year-old is sitting quietly next to the advocate. The child is rocking slightly in the chair and seems preoccupied. The 4-year-old is playing with another young child who is accompanied by a parent. The nurse hears the advocate tell the 4-year-old several times, “No hitting! We don’t hit!” As the nurse develops a plan of care for client the nurse also begins to think about client’s children and how they might be included in the plan of care. Which of the following is true about the affects of intimate partner violence on children? Intimate partner violence can cause emotional problems in the child even if the child has not seen or heard the violence happening. If there is intimate partner violence in the home, children can have serious and lasting physical and mental health problems as a result. Hunter, M. (2017). Varcarolis' Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 525, 526. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 223, 709. Intimate partner violence alone does not directly affect children, but children in violent homes are often abused emotionally and/or physically abused. Intimate partner violence in the home can cause physical and mental health problems in children. Intimate partner violence can cause emotional problems in the child if the violence is fatal or near-fatal, such as the strangulation attempt on the client. While the level of violence may affect the severity of emotional problems, any level of intimate partner violence in the home can affect the mental health of children. Intimate partner violence usually only causes emotional problems if the child sees the violence happen. A child does not have to see or hear intimate partner violence to be affected by it. If there is violence in the home, the child can have serious and lasting physical and mental health problems. Question 17 of 29 What else can the nurse determine about these children’s risk for emotional and behavioral problems from the assessment of the family so far? The children would probably have better mental health outcomes if their mother returned to the abuser even if her mental health would suffer. Being in a home where intimate partner violence occurs increases risk for the children to have mental health problems. Therefore, returning to the home would increase the likelihood of further problems. Any mental health problems that the children have are not likely to affect their development if they are otherwise healthy. Mental health problems in children can affect their ability to reach developmental milestones. They are more likely to suffer from emotional problems because their mother has a history of depression. Children are at greater risk for emotional problems if a parent has mental health problems. Hunter, M. (2017). Varcarolis' Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 526. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 223, 709, 710. Because of the history of violence in the home, they will definitely develop mental and behavioral health problems. While intimate partner violence in the home increases risk for mental and behavioral health problems, it is not certain that all children will be affected. Question 18 of 29 How should the nurse assess the children for post-traumatic stress syndrome? It is not possible for these children to have post-traumatic stress syndrome because they are not old enough. Pre-school and school age children, such as the client’s children, are old enough to experience Post-trauma Syndrome if they have witnessed violence. The assessment should only include the feelings of safety and security as talking about the event may worsen the trauma. While asking questions about the event may be traumatic for a child with post-traumatic stress syndrome, it is important to assess the child in order to give proper care. The assessment should include their exposure to a traumatic event, their understanding of the event, and their feeling of safety after the event. It is important to assess for post-traumatic stress in a developmentally appropriate way, including gaining an understanding of their perception of the event and how it has affected their feelings of security after the event. Hunter, M. (2017). Varcarolis’ Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 525. The assessment for children is the same as assessment for adults. Age and developmental level impacts the manifestation of post-traumatic stress syndrome in children. For that reason, it is important to modify the assessment for a child. Question 19 of 29 Which is not an important reason for the nurse to consider the children’s mental health in the formulation of the plan of care for this particular client? The children have a better chance of recovery from trauma than their mother due to their young age, so it is best to focus on them. If the mother has poor mental health, it places her children at risk for mental health problems as well. Ignoring the mental health issues of the mother is not appropriate. Hunter, M. (2017). Varcarolis’ Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 531. The client’s parenting might be affected by her post-traumatic stress syndrome, so gathering information about the children may help in planning outcomes. Post-traumatic stress syndrome can also affect parenting skills, which means she may be less equipped to handle behavioral problems from the children. If the children are experiencing behavioral problems, it may further traumatize the client and exacerbate her mental health problems. A client who has experienced intimate partner violence and has post-traumatic stress syndrome may have children who are also affected by the violence. Behavioral and mental health problems in the children that may result from being in a violent home can exacerbate the mother’s trauma. The children have multiple risk factors for mental health problems. Understanding all risk factors that the children have for mental health problems is an important part of making a plan of care. Question 20 of 29 While working on the care plan and observing the children, the nurse begins to feel emotional and angry. The nurse thinks that it is not fair to the children to be subjected to violence in the home. At first the nurse is angry at client’s husband for the violence, and then becomes angry at the client for what has been a bad relationship decision. The nurse realizes that the community health center does not have a standard way of addressing potential negative feelings related to hearing about trauma from clients even though the staff members at the center frequently interact with women from the domestic violence shelter and many people who work or volunteer there. What should the nurse do as soon as negative emotions toward the client are realized? Ask the other nurse working that day to take over care of the client to avoid letting the client know the nurse is angry. It is not appropriate for a nurse to only care for clients who do not affect their emotions. It will also interrupt the progress of building a working relationship with the client if she is transferred to a different nurse’s care mid-visit. Talk to a friend about the client situation to get the feelings out in the open so that the nurse can move past them. Talking about the client to others for issues not related to the client's care would be unethical and violate HIPAA regulations. Ignore the feelings and move forward with care as if the nurse never had them. Trying to ignore feelings is an ineffective and unhealthy coping mechanism. Perform a self-assessment to determine the source of the feelings so that the nurse can address them before returning to speak with the client. It is common to have negative feelings about clients or their behaviors, but the nurse must still do the assigned task to care for the client. It is most appropriate for the nurse to determine the source of their feelings so that they can work through them and provide the client appropriate care. Hunter, M. (2017). Varcarolis' Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 529. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 31, 144. Question 21 of 29 What activity should the nurse suggest to the nurse's supervisor to help the nurses and other staff at the community health center deal with the emotional issues of interacting with traumatized clients in the future? Provide a venue for talking about feelings related to interacting with traumatized clients while protecting the client’s privacy. Secondary trauma is common in nurses that interact with individuals who have experienced intimate partner violence. It is appropriate for a clinic to provide a venue where nurses who are at risk for secondary trauma can talk about feelings and learn strategies for self-care. Hunter, M. (2017). Varcarolis’ Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 529. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 31, 144. Encourage nurses who experience secondary trauma to seek counseling from their own healthcare provider. While counseling may be necessary if the nurse is unable to cope with secondary trauma, it is appropriate for the center to provide a venue to help nurses with their coping skills. Hire a psychologist to talk to traumatized clients because it is beyond the nurse’s scope of practice. Nurses are capable of using therapeutic communication to help clients recover from trauma. Have clients do a violence screen on the computer so the nurses do not have to hear about specific violent incidences. While this might limit risk for secondary trauma for the nurse, it decreases the nurse’s ability to use therapeutic communication to help the client recover. Question 22 of 29 The healthcare provider leaves the room after a consultation with the client. The nurse notes on the chart that the HCP diagnosis noted is Post-Traumatic Stress Disorder. The healthcare provider has prescribed paroxetine 20 mg per day by mouth and a referral to see a counselor. The nurse goes back into the room to talk about the plan of care and provide education on the prescription. First, the nurse wants to help client think of strategies to cope with the trauma and set some goals for the first few weeks after the visit. What would be an effective coping mechanism for dealing with post-traumatic stress for this client? Confront the abuser to show that she is not afraid of him. Confronting the abuser is not an effective coping skill and would likely increase trauma and place the client at greater risk. Identify and use a coping mechanism that she used and was effective when she was diagnosed with postpartum depression. Using coping mechanisms that have worked before is the safest and most effective way to address symptoms of post-traumatic stress. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 221, 706-707, 709, 710. Rely upon the medication to address the symptoms. While medication may help with symptoms, the client can use other coping mechanisms to manage post-traumatic stress. Avoid any mention of the subject of the abuser or abuse until she no longer has symptoms of post-traumatic stress. Helping the client to cope with memories in a healthy way is a more effective intervention than trying to have the client suppress memories. Question 23 of 29 What are some realistic short-term outcome goals that the nurse should set with client related to the HCP's diagnosis of Post Traumatic Stress Disorder? The client will effectively suppress memories of the event to avoid distress. Suppressing memories is not an effective coping mechanism. The client will return to pre-trauma level of functioning. It is not reasonable to expect the client to return to pre-trauma level of functioning in the short term. The client will complete daily tasks without needing assistance from social support. Using social support is an important part of recovery from trauma. The client will speak about the trauma and express feelings of rage, guilt, fear, anxiety, and hopelessness. Confronting feelings and memories is an important part of recovery from trauma. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 27, 218, 221, 708. Question 24 of 29 Client verbalized understanding of the nurse’s instructions regarding the medication. She tells the nurse that she has already started counseling with the psychologist at the shelter and that she prefers to continue to receive care at the shelter instead of using the referral that the healthcare provider gave her. In addition to the HCP diagnosis of Post-Traumatic Stress Disorder, the nurse thinks it is appropriate to add a family nursing problem to the care plan to address the interactions between the client and her children. The nurse selects the problem of family dynamic disruption related to situation transition. The nurse begins to speak with client about how she and her children are coping after leaving her husband and going to the shelter. She has been worried about the children’s behavior for a while, but the transition to the shelter has been very hard, especially for the 6-year-old. What are some ways to decrease the effects of the large changes on the children while they are in the shelter? Provide the children a structured schedule so that they do not have time to dwell on unpleasant thoughts. Placing too much structure on a child who has experienced trauma may create stress and exacerbate mental health problems. Allow the children to make all decisions about daily activities. The responsibility of making decisions should remain as close to normal as possible so as not to exacerbate the stressful feelings of change. Maintain normalcy by keeping to family rituals as much as possible. The goal for a family with disruption of family dynamics should be to return to as much normalcy as possible. Having expected ways of doing things, like praying before meals or reading a story before bed, will help to minimize stress for the children. nd Yoost, L., Crawford, B. (2020). Fundamentals of Nursing. (2 edition). St. Louis, Missouri. Elsevier. Pg. 709, 710. Be more permissive about behavior problems as punishment is more likely to exacerbate the children’s emotional problems. Appropriate limit setting and punishment should not exacerbate emotional problems in children. Maintaining normalcy, including normalcy of behavioral expectations, is important. Question 25 of 29 Two weeks after the initial visit, client returns with her two children. She tells the nurse that she is still living in the shelter and that many of the children there are sick with cold symptoms. Both of her children have congestion and a cough, but her oldest child has been wheezing. The healthcare provider prescribes albuterol 0.1 mg/kg. The child weighs 48 pounds. How many mg of albuterol should the nurse administer? 4.8 mg First convert pounds to kilograms (48 lbs = 22 kg). Then multiply by 0.1 (22 x 0.1=2.2). 2 mg First convert pounds to kilograms (48 lbs = 22 kg). Then multiply by 0.1 (22 x 0.1=2.2). 5 mg First convert pounds to kilograms (48 lbs = 22 kg). Then multiply by 0.1 (22 x 0.1=2.2). 2.2 mg First convert pounds to kilograms (48 lbs = 22 kg). Then multiply by 0.1 (22 x 0.1=2.2). th Morris, D. (2017). Calculate with Confidence. (7 edition). St. Louis, Missouri. Elsevier. Pg. 28, 253, 380. Question 26 of 29 As the nurse is giving the older child a breathing treatment, client confides to the nurse that her children’s behavioral problems have worsened in the shelter. She has been called twice to the shelter daycare because her 4-year-old is biting and hitting other children. Her 6-year-old child, on the other hand, seems cold and distant, which is very different from the child’s usual behavior. Both children cry at night saying they miss their house and their dad. The client tells the nurse that her difficulty sleeping is getting worse because of the constant noise and lights at the shelter. At the same time, she is getting Facebook messages from her husband telling her how sorry he is and that he went to the pastor at her church to get help for his anger problems. She confides in the nurse, saying that she is on the verge of going back to him. Between the difficulty in living in the shelter environment, the changes in her children’s behavior, and the pleading from her husband, she is beginning to believe that she made a mistake in leaving him in the first place. What is the best explanation for the husband’s change in behavior and attitudes from the previous violent event to the Facebook messages asking for forgiveness? Her husband has likely made a decision to permanently change his behavior based on the client’s actions. It may be true that the abuser intends to make a change in behavior; however, it is difficult for an abuser to stop the cycle of violence without a behavioral intervention. Her husband is probably being kind out of fear of the client calling the police or taking him to court. While it may be true that the abuser fears repercussions of the abuse, it is very normal behavior for abusers to be apologetic and attempt to win their partner back whether they are in fear of legal problems or not. This behavior is an expected part of the cycle of violence and is termed the honeymoon phase. The cycle of violence includes a tension-building phase, a serious battering phase, and a honeymoon phase. During the honeymoon phase, the abuser displays loving and apologetic behavior. Hunter, M. (2017). Varcarolis' Foundations of Psychiatric Mental Health Nursing, th (8 edition). St. Louis, Missouri. Elsevier. Pg. 524.