What Should the Nurse Do?
Estelle, a seventy-year-old female, presents at the community health clinic reporting symptoms of increased anxiety and persistent sadness. Her medical history includes a diagnosis of generalized anxiety disorder managed with outpatient therapy. Estelle describes heightened anxiety related to the uncertainties and challenges brought on by the COVID-19 pandemic. She reports difficulty sleeping, changes in appetite, and feelings of isolation due to social distancing measures. Estelle acknowledges the impact of the pandemic on her mental health and expresses concern about the future. Vital signs are a blood pressure of 140/85 mmHg, a heart rate of 110 bpm, a respiratory rate of 16 breaths per minute, and a temperature of 98.7°F (37°C).
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As a nursing student, how would you analyze the potential interplay between Estelle’s preexisting generalized anxiety disorder and the additional stressors introduced by the pandemic?
2
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How would you generate solutions to address both the immediate concerns related to pandemic-related stress and the ongoing management of Estelle’s generalized anxiety disorder?
Irina, a twenty-five-year-old female, presents at the emergency department with signs of physical trauma, malnutrition, and anxiety. Her medical history is unknown, and vital signs are a blood pressure of 150/85 mmHg, heart rate of 115 bpm, respiratory rate of 16 breaths per minute, and temperature of 99°F (37.2°C). Irina is accompanied by a male companion who is overly controlling, and she avoids eye contact during the assessment. Irina exhibits signs of physical abuse, such as bruising and lacerations. She appears fearful and hesitant to speak independently. The companion provides limited information about her condition, attributing the injuries to accidental falls. Irina avoids disclosing personal information and appears emotionally distressed.
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What specific cues in Irina’s presentation might indicate the possibility of human trafficking, and how do her physical injuries and behavior contribute to this suspicion?
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What specific actions would you take to connect Irina with resources for victims of human trafficking, and how would you navigate the presence of her companion during this process?
JJ is thirty-two years old and presents at the local urgent care clinic reporting symptoms of severe anxiety, recurring nightmares, and hypervigilance. JJ’s medical history indicates a traumatic experience during military service. Vital signs are within normal range, but JJ appears tense, avoids discussing details of the trauma, and demonstrates signs of emotional distress. JJ describes experiencing flashbacks and intrusive thoughts related to a combat-related incident during deployment. JJ also struggles with disrupted sleep patterns, social withdrawal, and challenges in maintaining relationships.
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As a nursing student, how would you analyze JJ’s avoidance of discussing details of the trauma and the impact of symptoms on daily functioning and relationships?
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How would you generate solutions to address JJ’s symptoms, considering therapeutic interventions, psychoeducation, and connection with appropriate resources?
Jordan, a twenty-two-year-old nonbinary individual, arrives at their primary care physician’s office reporting symptoms of persistent sadness, anxiety, and social withdrawal. Jordan has a medical history of previous depressive episodes and is currently not on any psychiatric medications. During the assessment, Jordan expresses concerns related to difficulties in disclosing their sexual orientation and gender identity to family and friends. Jordan describes feelings of isolation and discrimination related to their LGBTQIA+ identity, contributing to a sense of loneliness and heightened anxiety. Their vital signs are a blood pressure of 110/70 mmHg, heart rate of 115 bpm, respiratory rate of 16 breaths per minute, and temperature of 98.8°F (37°C).
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As a nurse, what hypotheses would you prioritize in understanding the interplay between societal attitudes, Jordan’s LGBTQIA+ identity, and their current mental health symptoms?
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How would you generate solutions to address Jordan’s mental health concerns, considering the importance of providing a safe and affirming environment and connecting them with LGBTQIA+ community resources?
Tanya, a forty-five-year-old female, is brought to the community health clinic by outreach workers. She is unhoused and has been living on the streets for several months. Tanya reports symptoms of severe anxiety, insomnia, and auditory hallucinations. Her medical history is unknown, and her vital signs are a blood pressure of 140/90 mmHg, heart rate of 115 bpm, respiratory rate of 16 breaths per minute, and temperature of 99°F (37.2°C). Tanya appears disheveled and is hesitant to share information about her mental health. Tanya describes constant fear, difficulty sleeping due to the noises of the street, and hearing voices that seem to exacerbate her anxiety. She has faced challenges accessing consistent shelter and food.
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What specific cues in Tanya’s presentation indicate the potential impact of homelessness on her mental well-being, and how do her reported symptoms align with common mental health challenges observed in unhoused individuals?
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How would a nurse generate immediate solutions to address Tanya’s basic needs, considering collaborative strategies with outreach workers and connecting her with mental health services?