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This Concept Map, created with IHMC CmapTools, has information related to: Adolescent Depression, Key Problem Gastric ulcer Nursing Diagnosis: Ineffective health maintenance related to deficient knowledge regarding treatment and control of disease process Data: Undiagnosed peptic ulcer found on endoscopy Complaints of abdominal pain Chronic use of methamphetamines and alohol Ingestion of bleach just prior to admission Interventions: * Provide education regarding medication * Provide information about dietary changes to promote healing and prevent continued ulceration * Show patient images from upper endoscopy to help patient understand pathophysiology * Describe lifestyle changes and impact this diagnosis has on current diagnosis * Stress importance of avoiding ibuprofen Medications: Prevacid Outcomes: Short term - Patient will demonstrate understanding of necessary dietary changes by creating a weekly meal plan Intermediate term - Patient will continue to increase her exercise and health promotion activities after discharge Long term - Patient will have resolution of her gastric ulcer with proper health maintenance techniques (F.A. Davis Company, 2005) which can compound Key Problem Chronic pain Nursing Diagnosis: Chronic pain related to lesions secondary to increased gastric secretions and emotional stress Data: Chronic fatigue - sleeps ~10 hours daily Diagnosed adolescent depression Guarding with abdominal assessment Emotional instability with absence of mother, effective coping, and disfunctional family dynamics Interventions: *Establish an acceptable pain tolerance level * Treat acute pain with analgesics * Set up a behavior-oriented plan for pain management * Teach patient relaxation techniques (guided imagery, deep breathing) to help promote effective sleep * Refer patient to support group to help develop coping * Avoiding foods that increase pain or interfere with sleep techniques Medications: Tylenol Outcomes: Short term - Patient will identify characteristics of pain and proper management behaviors Intermediate term - Patient will implement a plan to manage activity and rest, exercise, medication, and resocialization behaviors Long term - Patient will have well-controlled pain within her acceptable pain tolerance level with appropriate self-managament (Functional Health Patterns, 2011), Health Care Need: Adolescent depression Key Assessments: 1. Social history 2. Head to toe assessment 3. Pain 4. Safety/Risk for suicide History: 15 year old Native American Female entered hospital with a history of adolescent depresssion and newly diagnosed gastric ulcers. Patient has otherwise unremarkable medical history. Rationale: 15.8 high-school age adolescents per 1,000 had seriously considered suicide during the previous 12-month period. Of these 15,293 children, 13,514 had attempted suicide one or more times and 12,959 of them had to consequently be treated by a medical professional for sustained injuries (Centers for Disease Control and Prevention, 2011). may cause Key Problem Social isolation Nursing Diagnosis: Risk for social isiolation related to fear of rejection or failure, absence of available signficant others or peers, and social stimga associated with diagnosis and seeking treatment Data: Diagnosed adolscent depression Sad, dull affect Seeking to be alone, assuming fetal position Stigma associated with depression in the Native American culture Interventions: * Develop a therapeutic nurse-patient relationship * Provide direct feedback about interactions * Devise therapeutic, structured activities for after discharge * Provide positive reincforcement * Spend time with patient, event just in silence Medications: N/A Outcomes: Short term - Patient will develop a trusting relationship with nurse or counselor while inpatient Intermediate term - Patient will voluntarily spend time participarting in group activites by time of discharge Long term - Patient will approach others in appropriate one-to-one relationships (F.A. Davis Company, 2005), Key Problem Suicide attempt Nursing Diagnosis: Risk of violence against self related to negative role modeling, dysfunctional family dynamics, low self-esteem, impulsivity, and depressed mood Data: Diagnosed adolscent depression Father is single parent that recently began dating Admits to "not feeling pretty" Mother not involved, left in search of drugs When caught coming in after curfew intoxicated, patient rashly brought a bottle of bleach to her mouth and threatened to kill herself Interventions: * Ensure safety * Provide one-to-one observation * Move patient close to nursing station * Help patient to make a safety contract * Observe for suicidal ideation and means * Act as as role model Medications: Ativan, Prozac Outcomes: Short term - Patient will call for staff when having suicidal or harmful thoughts Intermediate term - Patient will verbalize adaptive coping strategies Long term - Patient will demonstrate these coping strategies and will no harm self or others (F.A. Davis Company, 2005) can be impacted by Key Problem Cultural factors Nursing Diagnosis: At risk for spiritual distress related to isolation from tribe, stigma associated with depression and treatment Data: * "...stigmatization of mental disorders leads stigmatized individuals to avoid treatment all together or discontinue treatment prematurely" (Kanter, Rusch, & Brondino, 2008, p. 663). * Particular stigma associated with depression and suicide in Native American culture Interventions: * Invite patient to detail culural remedies for depression * Enable patient to "smudge" if interested * Contact Native American cultural center * Provide information pertaining to culturally sensitive support groups available * Refer to outpatient psychiatric care available on the reservation Medications: N/A Outcomes: Short term - Patient will meet with case manager avialable through Native American cultural center Intermediate term - Patient will seek out outpatient treatment available on the reservation Long term - Patient will demonstrate culturally sensitive coping strategies for her depression. (Kanter, Rusch, & Brondino, 2008), Health Care Need: Adolescent depression Key Assessments: 1. Social history 2. Head to toe assessment 3. Pain 4. Safety/Risk for suicide History: 15 year old Native American Female entered hospital with a history of adolescent depresssion and newly diagnosed gastric ulcers. Patient has otherwise unremarkable medical history. Rationale: 15.8 high-school age adolescents per 1,000 had seriously considered suicide during the previous 12-month period. Of these 15,293 children, 13,514 had attempted suicide one or more times and 12,959 of them had to consequently be treated by a medical professional for sustained injuries (Centers for Disease Control and Prevention, 2011). predisposed by Key Problem Chronic pain Nursing Diagnosis: Chronic pain related to lesions secondary to increased gastric secretions and emotional stress Data: Chronic fatigue - sleeps ~10 hours daily Diagnosed adolescent depression Guarding with abdominal assessment Emotional instability with absence of mother, effective coping, and disfunctional family dynamics Interventions: *Establish an acceptable pain tolerance level * Treat acute pain with analgesics * Set up a behavior-oriented plan for pain management * Teach patient relaxation techniques (guided imagery, deep breathing) to help promote effective sleep * Refer patient to support group to help develop coping * Avoiding foods that increase pain or interfere with sleep techniques Medications: Tylenol Outcomes: Short term - Patient will identify characteristics of pain and proper management behaviors Intermediate term - Patient will implement a plan to manage activity and rest, exercise, medication, and resocialization behaviors Long term - Patient will have well-controlled pain within her acceptable pain tolerance level with appropriate self-managament (Functional Health Patterns, 2011), Key Problem Disrupted support system Nursing Diagnosis: Interrupted family processes related to modification in family social dynamic, family role shift, and interaction with community Data: Lack of biological maternal presence Father of patient started exclusively dating partner Few available adolescent support groups on Browning reservation Patient impulsively ingested bleach as a threat/ punishment in front of father Interventions: * Meet with family members to establish levels of authority and resonsibility within the family * Create a therapeutic environment * Involve patient in planning and decision-making * Refer to case managaer for home assessment * Teach all family members basic communication skills to enable issue discussion in positive ways. Medications: N/A Outcomes: Short term - Family will express understanding of rules, expectations, and defind family roles and responsibilites Intermediate term - Family will communicate clearly, honestly, and consistently Long term - Family will demonstrate improved methods for problem solving, resolving conflicts, and supporting patient (Functional Health Patterns, 2011) can be impacted by Key Problem Cultural factors Nursing Diagnosis: At risk for spiritual distress related to isolation from tribe, stigma associated with depression and treatment Data: * "...stigmatization of mental disorders leads stigmatized individuals to avoid treatment all together or discontinue treatment prematurely" (Kanter, Rusch, & Brondino, 2008, p. 663). * Particular stigma associated with depression and suicide in Native American culture Interventions: * Invite patient to detail culural remedies for depression * Enable patient to "smudge" if interested * Contact Native American cultural center * Provide information pertaining to culturally sensitive support groups available * Refer to outpatient psychiatric care available on the reservation Medications: N/A Outcomes: Short term - Patient will meet with case manager avialable through Native American cultural center Intermediate term - Patient will seek out outpatient treatment available on the reservation Long term - Patient will demonstrate culturally sensitive coping strategies for her depression. (Kanter, Rusch, & Brondino, 2008), Key Problem Ineffective coping Nursing Diagnosis: Ineffective coping related to situation crises of maturation, multiple life changes, vulnerability of the patient Data: Destructive self-behavior, history of "cutting" Poor verbal communication, withdrawn Lack of appetite - eats ុ% of meals Chronic fatigue - sleeps ~10hrs daily Use of illicit drugs (methamphetamines) and alcohol Admits to "not feeling pretty" Interventions: * Remove methods of inappropriate coping (ie internet, television, cell phone, access to visitors) * Reward improved coping methods with return of disired communications/entertainment * Offer access to support groups * Take the time to listen and not judge * Act as as role model Medications: Prozac Outcomes: Short term - Patient will recognize potential results of poor coping methods Intermediate term - Patient will verbalize appropriate coping mechanisms and when to use them Long term - Patient will implement these coping strategies and will no harm self or others (Functional Health Patterns, 2011) can be impacted by Key Problem Cultural factors Nursing Diagnosis: At risk for spiritual distress related to isolation from tribe, stigma associated with depression and treatment Data: * "...stigmatization of mental disorders leads stigmatized individuals to avoid treatment all together or discontinue treatment prematurely" (Kanter, Rusch, & Brondino, 2008, p. 663). * Particular stigma associated with depression and suicide in Native American culture Interventions: * Invite patient to detail culural remedies for depression * Enable patient to "smudge" if interested * Contact Native American cultural center * Provide information pertaining to culturally sensitive support groups available * Refer to outpatient psychiatric care available on the reservation Medications: N/A Outcomes: Short term - Patient will meet with case manager avialable through Native American cultural center Intermediate term - Patient will seek out outpatient treatment available on the reservation Long term - Patient will demonstrate culturally sensitive coping strategies for her depression. (Kanter, Rusch, & Brondino, 2008), Health Care Need: Adolescent depression Key Assessments: 1. Social history 2. Head to toe assessment 3. Pain 4. Safety/Risk for suicide History: 15 year old Native American Female entered hospital with a history of adolescent depresssion and newly diagnosed gastric ulcers. Patient has otherwise unremarkable medical history. Rationale: 15.8 high-school age adolescents per 1,000 had seriously considered suicide during the previous 12-month period. Of these 15,293 children, 13,514 had attempted suicide one or more times and 12,959 of them had to consequently be treated by a medical professional for sustained injuries (Centers for Disease Control and Prevention, 2011). can be caused by Key Problem Ineffective coping Nursing Diagnosis: Ineffective coping related to situation crises of maturation, multiple life changes, vulnerability of the patient Data: Destructive self-behavior, history of "cutting" Poor verbal communication, withdrawn Lack of appetite - eats ុ% of meals Chronic fatigue - sleeps ~10hrs daily Use of illicit drugs (methamphetamines) and alcohol Admits to "not feeling pretty" Interventions: * Remove methods of inappropriate coping (ie internet, television, cell phone, access to visitors) * Reward improved coping methods with return of disired communications/entertainment * Offer access to support groups * Take the time to listen and not judge * Act as as role model Medications: Prozac Outcomes: Short term - Patient will recognize potential results of poor coping methods Intermediate term - Patient will verbalize appropriate coping mechanisms and when to use them Long term - Patient will implement these coping strategies and will no harm self or others (Functional Health Patterns, 2011), Key Problem Suicide attempt Nursing Diagnosis: Risk of violence against self related to negative role modeling, dysfunctional family dynamics, low self-esteem, impulsivity, and depressed mood Data: Diagnosed adolscent depression Father is single parent that recently began dating Admits to "not feeling pretty" Mother not involved, left in search of drugs When caught coming in after curfew intoxicated, patient rashly brought a bottle of bleach to her mouth and threatened to kill herself Interventions: * Ensure safety * Provide one-to-one observation * Move patient close to nursing station * Help patient to make a safety contract * Observe for suicidal ideation and means * Act as as role model Medications: Ativan, Prozac Outcomes: Short term - Patient will call for staff when having suicidal or harmful thoughts Intermediate term - Patient will verbalize adaptive coping strategies Long term - Patient will demonstrate these coping strategies and will no harm self or others (F.A. Davis Company, 2005) can lead to Key Problem Gastric ulcer Nursing Diagnosis: Ineffective health maintenance related to deficient knowledge regarding treatment and control of disease process Data: Undiagnosed peptic ulcer found on endoscopy Complaints of abdominal pain Chronic use of methamphetamines and alohol Ingestion of bleach just prior to admission Interventions: * Provide education regarding medication * Provide information about dietary changes to promote healing and prevent continued ulceration * Show patient images from upper endoscopy to help patient understand pathophysiology * Describe lifestyle changes and impact this diagnosis has on current diagnosis * Stress importance of avoiding ibuprofen Medications: Prevacid Outcomes: Short term - Patient will demonstrate understanding of necessary dietary changes by creating a weekly meal plan Intermediate term - Patient will continue to increase her exercise and health promotion activities after discharge Long term - Patient will have resolution of her gastric ulcer with proper health maintenance techniques (F.A. Davis Company, 2005), Key Problem Social isolation Nursing Diagnosis: Risk for social isiolation related to fear of rejection or failure, absence of available signficant others or peers, and social stimga associated with diagnosis and seeking treatment Data: Diagnosed adolscent depression Sad, dull affect Seeking to be alone, assuming fetal position Stigma associated with depression in the Native American culture Interventions: * Develop a therapeutic nurse-patient relationship * Provide direct feedback about interactions * Devise therapeutic, structured activities for after discharge * Provide positive reincforcement * Spend time with patient, event just in silence Medications: N/A Outcomes: Short term - Patient will develop a trusting relationship with nurse or counselor while inpatient Intermediate term - Patient will voluntarily spend time participarting in group activites by time of discharge Long term - Patient will approach others in appropriate one-to-one relationships (F.A. Davis Company, 2005) can be impacted by Key Problem Cultural factors Nursing Diagnosis: At risk for spiritual distress related to isolation from tribe, stigma associated with depression and treatment Data: * "...stigmatization of mental disorders leads stigmatized individuals to avoid treatment all together or discontinue treatment prematurely" (Kanter, Rusch, & Brondino, 2008, p. 663). * Particular stigma associated with depression and suicide in Native American culture Interventions: * Invite patient to detail culural remedies for depression * Enable patient to "smudge" if interested * Contact Native American cultural center * Provide information pertaining to culturally sensitive support groups available * Refer to outpatient psychiatric care available on the reservation Medications: N/A Outcomes: Short term - Patient will meet with case manager avialable through Native American cultural center Intermediate term - Patient will seek out outpatient treatment available on the reservation Long term - Patient will demonstrate culturally sensitive coping strategies for her depression. (Kanter, Rusch, & Brondino, 2008), Health Care Need: Adolescent depression Key Assessments: 1. Social history 2. Head to toe assessment 3. Pain 4. Safety/Risk for suicide History: 15 year old Native American Female entered hospital with a history of adolescent depresssion and newly diagnosed gastric ulcers. Patient has otherwise unremarkable medical history. Rationale: 15.8 high-school age adolescents per 1,000 had seriously considered suicide during the previous 12-month period. Of these 15,293 children, 13,514 had attempted suicide one or more times and 12,959 of them had to consequently be treated by a medical professional for sustained injuries (Centers for Disease Control and Prevention, 2011). treatment influenced by Key Problem Cultural factors Nursing Diagnosis: At risk for spiritual distress related to isolation from tribe, stigma associated with depression and treatment Data: * "...stigmatization of mental disorders leads stigmatized individuals to avoid treatment all together or discontinue treatment prematurely" (Kanter, Rusch, & Brondino, 2008, p. 663). * Particular stigma associated with depression and suicide in Native American culture Interventions: * Invite patient to detail culural remedies for depression * Enable patient to "smudge" if interested * Contact Native American cultural center * Provide information pertaining to culturally sensitive support groups available * Refer to outpatient psychiatric care available on the reservation Medications: N/A Outcomes: Short term - Patient will meet with case manager avialable through Native American cultural center Intermediate term - Patient will seek out outpatient treatment available on the reservation Long term - Patient will demonstrate culturally sensitive coping strategies for her depression. (Kanter, Rusch, & Brondino, 2008), Health Care Need: Adolescent depression Key Assessments: 1. Social history 2. Head to toe assessment 3. Pain 4. Safety/Risk for suicide History: 15 year old Native American Female entered hospital with a history of adolescent depresssion and newly diagnosed gastric ulcers. Patient has otherwise unremarkable medical history. Rationale: 15.8 high-school age adolescents per 1,000 had seriously considered suicide during the previous 12-month period. Of these 15,293 children, 13,514 had attempted suicide one or more times and 12,959 of them had to consequently be treated by a medical professional for sustained injuries (Centers for Disease Control and Prevention, 2011). may cause Key Problem Suicide attempt Nursing Diagnosis: Risk of violence against self related to negative role modeling, dysfunctional family dynamics, low self-esteem, impulsivity, and depressed mood Data: Diagnosed adolscent depression Father is single parent that recently began dating Admits to "not feeling pretty" Mother not involved, left in search of drugs When caught coming in after curfew intoxicated, patient rashly brought a bottle of bleach to her mouth and threatened to kill herself Interventions: * Ensure safety * Provide one-to-one observation * Move patient close to nursing station * Help patient to make a safety contract * Observe for suicidal ideation and means * Act as as role model Medications: Ativan, Prozac Outcomes: Short term - Patient will call for staff when having suicidal or harmful thoughts Intermediate term - Patient will verbalize adaptive coping strategies Long term - Patient will demonstrate these coping strategies and will no harm self or others (F.A. Davis Company, 2005), Health Care Need: Adolescent depression Key Assessments: 1. Social history 2. Head to toe assessment 3. Pain 4. Safety/Risk for suicide History: 15 year old Native American Female entered hospital with a history of adolescent depresssion and newly diagnosed gastric ulcers. Patient has otherwise unremarkable medical history. Rationale: 15.8 high-school age adolescents per 1,000 had seriously considered suicide during the previous 12-month period. Of these 15,293 children, 13,514 had attempted suicide one or more times and 12,959 of them had to consequently be treated by a medical professional for sustained injuries (Centers for Disease Control and Prevention, 2011). predisposed by Key Problem Disrupted support system Nursing Diagnosis: Interrupted family processes related to modification in family social dynamic, family role shift, and interaction with community Data: Lack of biological maternal presence Father of patient started exclusively dating partner Few available adolescent support groups on Browning reservation Patient impulsively ingested bleach as a threat/ punishment in front of father Interventions: * Meet with family members to establish levels of authority and resonsibility within the family * Create a therapeutic environment * Involve patient in planning and decision-making * Refer to case managaer for home assessment * Teach all family members basic communication skills to enable issue discussion in positive ways. Medications: N/A Outcomes: Short term - Family will express understanding of rules, expectations, and defind family roles and responsibilites Intermediate term - Family will communicate clearly, honestly, and consistently Long term - Family will demonstrate improved methods for problem solving, resolving conflicts, and supporting patient (Functional Health Patterns, 2011)