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The clinical nurse specialist is conducting an initial assessment of a client

The clinical nurse specialist is conducting an initial assessment of a client recently admitted to
the acute care setting. When asked about their frequent habit of looking over their shoulder,
the client became very anxious and evasive. The nurse says, “I can see that this interview is
making you uncomfortable. Would you prefer to continue our discussion at a later time?”
a. Discuss why the statement made by the nurse was appropriate at this time.
b. Consider key physiologic conditions that should also be assessed, and indicate why these
issues may have an impact on the client’s mental health function.

Sample Answer

The nurse’s statement, “I can see that this interview is making you uncomfortable. Would you prefer to continue our discussion at a later time?”, was highly appropriate for several reasons:

Recognizes client distress: It acknowledges the client’s non-verbal cues (looking over their shoulder, anxiety) and validates their discomfort. This builds trust and fosters safety in the interaction.
Respects client autonomy: The nurse offers the client agency over the interview, respecting their right to pause or reschedule. This empowers the client and reduces potential coercion.

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Reduces anxiety: Expressing understanding and offering an alternative can help lower the client’s anxiety, creating a more conducive environment for future conversation.
Maintains ethical practice: The nurse demonstrates respect for ethical principles like patient autonomy and informed consent by ensuring the client is comfortable and willing to participate.
Promotes therapeutic relationship: Building trust and showing consideration helps establish a strong therapeutic relationship between the nurse and client, ultimately benefiting the assessment and intervention process.

By offering to reschedule, the nurse prioritizes the client’s well-being and creates a safe space for them to open up when they are ready. This demonstrates sensitivity and professionalism, promoting successful communication and a more thorough assessment.

b. Key Physiologic Conditions impacting Mental Health:

Several key physiologic conditions can impact mental health function and should be considered in the client’s assessment:

Neurological conditions: Brain tumors, infections, head injuries, and neurodegenerative diseases can affect brain function and lead to depression, anxiety, cognitive decline, and other mental health issues.
Thyroid disorders: Hyperthyroidism and hypothyroidism can cause emotional dysregulation, anxiety, fatigue, and mood swings.
Sleep disorders: Chronic insomnia, sleep apnea, and other sleep disturbances can disrupt mood, energy levels, and cognitive function, impacting mental well-being.
Chronic pain: Persistent pain can contribute to depression, anxiety, and decreased quality of life, creating a complex interplay between physical and mental health.
Nutritional deficiencies: Vitamin B12 and folate deficiencies can lead to depression, cognitive impairment, and mood disturbances.
Substance abuse: Drug and alcohol use can significantly impact mental health, causing addiction, mood disorders, and cognitive problems.
Medical conditions: Some medical conditions like diabetes, cardiovascular disease, and cancer can have secondary effects on mental health, increasing the risk of depression and anxiety.
Medications: Certain medications for medical conditions can have side effects affecting mood, cognition, and sleep, impacting mental health.

Assessing for these physiological conditions can help identify potential contributing factors to the client’s emotional distress and inform a comprehensive treatment plan addressing both physical and mental health needs.

Remember: This is not an exhaustive list, and a thorough assessment should consider the client’s unique medical history, current medications, and other relevant factors.

By proactively assessing for these underlying physiological conditions, the nurse can gain a deeper understanding of the client’s situation and offer holistic care that addresses both the mental and physical aspects of their well-being.

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The clinical nurse specialist is conducting an initial assessment of a client

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b. Key Physiologic Conditions impacting Mental Health:

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