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Zorluk: OrtaBehavioral Interventions

A young adult client arrives at an outpatient primary care clinic. While in the reception area, the client begins pacing rapidly, hyperventilating, and clutching their chest. Suddenly, the client attempts to push through the staff-only doors, shouting, "I need help right now, I am suffocating!" What is the priority nursing action?

  1. Speak in a calm, firm voice and guide the client to a nearby quiet examination room.Cevap
  2. B
    Place a hand on the client's shoulder to physically redirect them away from the staff doors.
  3. C
    Ask the nursing assistant to stay with the client and measure their blood pressure and heart rate.
  4. D
    Inform the client, "You need to calm down first, and then a doctor will examine you."

Cevap

The priority action is to speak in a calm, firm voice and guide the client to a nearby quiet examination room to reduce environmental stimuli and establish safety.
The client is exhibiting symptoms of severe anxiety or panic. The priority behavioral intervention is to provide a safe, reduced-stimulation environment while using clear, calm, and direct communication. Moving the client to a quiet room removes them from the chaotic reception area, and a firm but calm voice helps them feel secure, representing the most appropriate least-restrictive intervention.

Adım Adım Çözüm

1
Assess the client's current behavioral state and the surrounding environment.
The client is exhibiting signs of severe anxiety or a panic attack within a high-traffic, stimulating reception area.
Identifying the level of escalation and environmental triggers is necessary to select an appropriate de-escalation strategy.
2
Determine the most effective, least restrictive de-escalation intervention.
Moving the client to a quieter space while maintaining a calm, authoritative presence is chosen.
Reducing environmental stimuli and using simple, clear communication help the client regain a sense of control without the use of physical restrictions.
3
Evaluate other potential actions against safety, delegation, and therapeutic communication standards.
Physical contact, non-therapeutic demands, and delegating an unstable client to assistive personnel are ruled out.
These alternative actions violate nursing standards and risk further escalating the behavioral crisis.

Anahtar Kavram

De-escalation and Milieu Management for Severe Anxiety
Tahmini Süre:1m 0s
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Konular

Behavioral Interventions

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