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Difficulty: HardStress Management

A client on an inpatient psychiatric unit receives a phone call regarding the sudden death of a family member. The client drops the phone, begins pacing the hallway rapidly, hyperventilating, and shouting, "I can't breathe, I'm going to die!" Arrange the following nursing interventions in the correct order of priority. All options must be used.

  1. 1Escort the client to a quiet, private room away from the main unit milieu.
  2. 2Stand at a non-threatening distance and speak using short, simple, and firm sentences.
  3. 3Direct the client to mirror the nurse's slow, deep breathing pattern.
  4. 4Ask the client to name five objects they can see in the immediate environment.
  5. 5Offer the prescribed PRN dose of a short-acting benzodiazepine.

Answer

The correct sequence is: isolate from stimuli, establish communication parameters, address physiological symptoms, apply cognitive grounding, and finally use pharmacological intervention.
The correct sequence follows Maslow's hierarchy of needs and psychiatric emergency protocols: secure the environment (safety), establish safe communication, address acute physiological distress (breathing), address psychological distress (grounding), and utilize chemical restraints (medication) only as a last resort.

Step-by-Step Solution

1
Prioritize environmental safety and stimuli reduction.
The client is moved to a quiet, private room.
High-stimulus environments exacerbate severe anxiety and panic. Isolation protects the client and maintains the therapeutic milieu for others.
2
Establish the parameters of therapeutic communication.
The nurse stands at a safe distance and uses brief, directive statements.
Severe panic impairs cognitive processing. Complex sentences or perceived physical threats will escalate the crisis.
3
Intervene to manage acute physiological manifestations of panic.
The nurse coaches the client through controlled, deep breathing.
Hyperventilation must be arrested to prevent physical complications such as tetany or syncope, taking precedence over psychological processing.
4
Implement cognitive grounding strategies.
The client is asked to identify objects in the room (e.g., the 5-4-3-2-1 technique).
Grounding anchors the client in current reality, interrupting the cycle of catastrophic thoughts related to the stressor.
5
Evaluate the need for pharmacological support.
A PRN anxiolytic is offered if previous steps are insufficient.
Following the principle of least restrictive intervention, medications are utilized when behavioral and environmental de-escalation techniques do not resolve the severe distress.

Key Concept

Prioritization of Crisis Intervention and Panic Management
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Topics

Stress Management

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