Question

Ms. A. A. is a 24 y/o female admitted with complaints of palpitations and shortness of breath. Her most recently vital signs are 100/70, HR 120, RR 22, SpO2 @ 98% on room air. She states she has not been able to sleep for the last five days and appears restless and teary eyed. EKG shows sinus tachycardia and all labs return unremarkable. She denies any past medical history besides issues with sleeping and states she is taking zolpidem 5 mg once daily at bedtime. Despite taking this medication, she has not been able to sleep or stay asleep.

1. What do you think is the concern here?
2. How would you assess the severity of the issue?
3. Identify the various levels of this issue and explain what can occur at each level.

When you return to the room, you notice Ms. A. A. sitting in the corner of the room with her hands above her head while she rocks back and forth and repeats “I just want to sleep. I feel so tired but so restless. Why is this happening to me?”

4. What level do you think Ms. A. A. is currently in? What are your initial priority interventions at this time?

Ms. A. A. begins to cry again and asks if the doctor can prescribe something to help her with her feelings of impending doom and worry.

5. What pharmacological treatments are appropriate for this situation? List at least two medications. Include indication, class, mechanism of action, side effects, adverse effects, patient teaching, and nursing considerations.

Ms. A. A. begins to stabilize after administration of medication. Her vital signs show BP 105/78, HR 98, RR 20, Sp02 99% on room air. She begins to dose off and is able to fall asleep. The next morning, Ms. A. A. apologizes for her behavior. She states, “I’m sorry, that was very embarrassing of me to panic like that.”

6. What is an appropriate response to this statement? At this time, what other questions can you ask?

Ms. A. A. begins to reveal that she recently lost her father and worries she will lose her boyfriend too. She states they get into fights often because he tells her to stop worrying but she doesn’t know how to.

7. What would you suggest to Ms. A. A.?
8. List two nursing diagnoses applicable to Ms. A. A.
9. What are some interventions to decrease anxiety? List at least five and provide rationales as appropriate.
10. What are some interventions to promote sleep? List at least five and provide rationales as appropriate.

Answer 1

●The concern here is the patient is experiencing some mental disturbances like anxiety probably because of some life experiences.

●The severity of the issue is moderate because the patient is facing severe sleep disturbances, inability to take decisions, is in absolute need of help to make her sleep and relax,not being aware what she is doing ,increased heart rate,restless,tired

●The various levels of issue are

• Personal:inability to cope up with the loss and situation,fear of losing loved ones
• Physical:can affect the health directly because of stress resulting in decreased appetite, irritability, anger ,frustration, self harm, sleep deprivation etc.,
• Psychological :can trigger anger and frustration resul6in violence ,isolation ,etc.,
• Social:can interrupt the way how to balance and over co e the societal needs and responsibilities

●She is in moderate level.The intervention required here are

• Provide a safe environment and take safety precautions to prevent any unjury
• Divert the patient by engaging in conversation
• Encouraging the client to speak out the problems, so that solution can be provided
• Provide patient reassurance and help to cope with situations