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A 46-year-old client is experiencing symptoms of post-traumatic stress disorder after being involved in a traumatic accident. The client has symptoms of nightmares and flashbacks about the event

Q1. A nurse is caring for a client in crisis who has endured a physical assault. The nurse would expect to see which behavior associate with the integration phase of crisis? Select all that apply.

The client tries to make sense of what happened

The client tries to control every situation

The client becomes isolated from others

The client starts to resolve feelings of blame

The client gets angry when talking about the event


Q2. A 46-year-old client is experiencing symptoms of post-traumatic stress disorder after being involved in a traumatic accident. The client has symptoms of nightmares and flashbacks about the event. The nurse knows that these symptoms most likely develop because of which of the following?

The body secretes too much melatonin, which leads to an increase in nightmares  The client may have a hyperactive amygdala that leads to an increase in feelings of fear  The client’s pituitary gland works in overdrive and consistently causes flashbacks

The client is no longer able to regulate levels of serotonin “My name’s Eugene Shaw but everybody calls me Gene. I was born on May 21 in Cleveland, Ohio. I am 82-years old and live with my wife Nancy.

We have a son, Robert Shaw who is 57. He lives about 500 miles away with his wife and they come to visit us fairly often. He went to college and got some fancy job selling chemicals. We have no family living close by except for my cousin Arthur and his family. We see them sometimes but Nancy doesn’t seem to be too social these days so I don’t push her too much. I try to get out with my buddy Jim. We served together in the Korean War but Nancy yells that we drink too much when we are together and it gets my sugar high. Who cares at my age?I’m not going to be around forever. I like my beer and a little nip of whiskey at night to help me sleep. I am a Veteran. I proudly enlisted and served for 2 years in the Marines. I was a private in the Medina County Marine Corps League Detachment 569, Medina VFW Post 5137. A great group of guys and we lost quite a few. I didn’t know what I was getting myself into when I signed up. It was so cold that first winter. Korea was a land of weather extremes–all bad. It went from 30 below zero in the winter to over 100 degrees in the summer.

During the cold winter months, we wore long- johns, utility trousers, waterproof cold weather trousers, utility jacket, sweater, a parka and thermo boots. The enemy wore heavy quilted coats and pants and, for the most part, sneaker-like shoes. From what I understand, they weren’t very warm.

In between summer and winter was the monsoon season that turned the country into a flooded swamp. Aside from the war, the bad weather was a morale factor more than anything. The cold and heat were unbearable and during monsoon season, no one was ever dry. That’s where my troubles started with my feet. Wow wee, my darn feet were always wet, stinking wet in the summer and cold and frozen in the winter. Those boots didn’t protect at all; in fact I think that they made things worse because they leaked so much. Probably can’t blame anyone but the soggy wet soil. You ever hear of trench-foot? I had it and still got some of it. That’s what I got to take home with me from Korea but it’s better than the alternative. Yeah that is war or a least it was in my time. I bet they have made some progress in getting those troops better equipment than in my day.

I came home from the Marines and I had a hard time walking. I went to the VA and they told me – “Boy, it’s off with those toes,” and off they went. You didn’t ask questions in those times. They took three off my right foot and left the others. Sometime after one just got black and fell off. My poor Nancy she washed my feet and tried to keep them circulating but it was too late. I go to the doctor sporadically, never can remember those dates. I’ve had several visits the last year or so. I keep getting sores on my right lower leg that don’t go away. My heel had a big ulcer not too long ago and I needed a lot of antibiotics to get that one to go away. Now look, it’s back again and it looks so blue. My foot is always so cold.

I came here today because my leg is really bothering me for about a week. I was getting into my car and I hit my foot on the car door. Since then I started to have these pains and my heel is getting bad again. My right calf has some awful pains and burning down the sides. I couldn’t hardly sleep at all last night cause of the pain and it got worse during the day. Nancy has been nagging me to have my leg checked out all week. She really got worried today when she saw how bad the pain was and the color of my leg and foot.she insisted that come here to see what ,s up so here i am

questions 2

What evidence do you read that may be indicative of depression?

How can you assess Eugene’s baseline functional status?

What coping strategies does Eugene use?

Who are Eugene’s support system and how can they help him?

What evidence of anxiety do you hear as Eugene talks?

What are Eugene’s strengths and weaknesses?

question 3

Consider assessment tools that would be appropriate for continuing to evaluate Eugene?

Utilize these tools to better understand:

The behaviors associated with Major Depression

Evidence of any cognitive impairment that may be complicating Eugene’s recovery

The overlap of depressive, cognitive and anxiety behaviors and what they mean

How alcohol may be a factor in compromising outcomes

What is Eugene’s baseline level of functioning and has he deviated from that point?

How can you evaluate Mrs. Shaw’s ability to manage the caregiving role?

Question 3

In the third scenario of the simulation, Eugene is recovering from surgery: Answer these questions based on the scenario given

What is depression?

What are the causes for depression?

What are the symptoms of depression?

What are the pharmacological treatments for depression?

Will these treatments impact any other treatments the patient may be getting?

What are the non-pharmacological treatments for depression?

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