Appropriate Interventions related to Adolescents






Late adolescents like TS are physically mature and comfortable with physical growth and have increased
self-esteem (p. 961). Patients like TS should be encouraged to complete self-care and hygiene
independently. Adolescents struggling with depression may need encouragement and reminding to
complete ADLs. The nurse should help facilitate a sense of control during hospitalizations by helping to
establish routines for safe self-care.
Late adolescents are capable of thinking more long-term (p. 961) and therefore it is important that the
patient is encouraged to explore their feelings of hopelessness (p. 971). When encouraging the patient
the nurse should ensure that the patient is in a “safe space” with consideration to privacy and
environment. The nurse should actively listen to the patient withholding judgment, assumptions, or
personal beliefs (p. 970). The nurse should help the patient to connect their feelings with their behaviors
in events where hopelessness was overwhelming. It is important for the nurse to remember that they
are there for the patient in the role of a nurse and that their personal beliefs, expectations, or
experiences (especially as a parent) do not apply to the situation, regardless of what emotion or thought
the patient expresses.
When encouraging the patient to explore their feelings, the nurse should communicate with respect to
the sensitivity of the topic, starting at the least invasive questions and progressing as tolerated by the
patient (p. 970). Adolescents are still exploring their sexuality, gender identity, and sexual orientation (p.
961, 967) and may express their thoughts surrounding these. It is important to remember that, as a
nurse, there is a special responsibility to provide education about sexuality and act as a resource for a
topic that the patient may not feel comfortable discussing with another adult (p.975). While the nurse is
there to support the adolescent, the nurse should be up front with the adolescent about certain things
that the nurse is required to break confidentiality on as a mandated reporter (p. 970).
In situations where the nurse must ask more invasive questions or perform examinations that are
uncomfortable, such as genital or post trauma exams, the nurse should be professional, direct, and clear
about what is happening and what the patient can expect next (p. 977).
The nurse should assess and consider the adolescents nutrition and eating habits. Adolescents may
purposely alter their eating habits as part of an eating disorder or in relation to body dysmorphia (p.
982). Mental health issues may also impact the patient’s desire or ability to intake the appropriate
amount of foods and fluid. Adolescents that are diagnosed with obesity are at an increased risk for other
health conditions. Obesity can also lead to social-isolation, depression, decreased self-worth, or an
eating disorder (p.978). When a nutritional deficit is identified, the nurse should determine the patient’s
ability and willingness to change and educate about the risks and treatment options available to the
patient. The nurse should remember the possibility of a collaborative intervention with nutritional
specialists or dieticians.
During any encounter with an adolescent the nurse should be assessing the patient for signs of
depression or risk for suicide (p. 990). Any manifestation of suicidality should be taken seriously and the
patient’s suicidality should be determined, along with a safety plan and referral to collaborative
psychiatric care. The nurse should make sure that the adolescent knows their threats/comments are
taken seriously and that the nurse must inform that patient that their lethality concerns will be reported
to family and professionals that can provide appropriate care (p. 991).
Questions for Thomas
Prior to asking Thomas questions, I want to acknowledge the things that he has already disclosed (in his
monologue) and make sure that the environment is safe, comfortable, and private. I will use verbal and
nonverbal ques to show active listening and make sure that he know that what he is saying is important to me. I
will sit at the same level as him and make sure that I am visibly present and not actively documenting or taking
notes while he is talking. I can ask clarifying questions or write down key info after we have already talked about
it. I will use words that are understandable by him and ask clarifying questions if he uses terms that I am
unfamiliar with or uncertain of their meaning (p.970).








“I heard you voice some concerns about your physical health, is there a specific reason that you think
may have caused you to gain more weight recently?” This starts the conversation about diet and
nutrition and guides further questions like: “How many meals do you usually eat a day?” “What kind of
food do you typically choose to eat?”
“In the past what have you tried or are you currently trying anything to lose weight or eat healthier?”
This question can help identify what did or didn’t work and give hint to his understanding of nutritional
health.
“Have you considered small changes like swapping a regular soda for diet soda or sparkling water?”
This also indicates his willingness to implement change. I can then further educate about easy
nutritional changes he can make.
“I’m so sorry to hear about your mom; I want you to know that just because she died of diabetes, you
are not guaranteed to and you can still make changes that reduce your risk of ever being diagnosed
with it. Can you think of any way that you can incorporate at least 20 minutes of physical exercise into
something you enjoy doing?” This again assess willingness to change and provides the opportunity to
educate about the importance of physical activity for his health. This has dual benefit because when he
is participating in physical activity for his physiological health there is a secondary benefit for his mental
health and depression.
“It sounds like a lot has changed in your life in the past year. How do you feel about everything that
has happened? How are you coping with you new school?” I expect that these questions will lead to
disclosure of his feelings of despair, hopelessness, or emotional distress. I know from his monologue
that he is coping with the change of school and bullying by avoiding it.
“Change can be hard and sometimes it’s easy to feel hopeless. Have you ever felt like life isn’t worth
living?” This and the following questions help to screen for suicidal ideation or intent (p. 991).
“Do you sometimes think about dying or wish that you were dead?” “Have you ever felt like hurting or
killing yourself?” “Have you thought about ways that you would kill yourself?” “Have you ever tried
anything to kill yourself in the past? What did you try? When?” “What plans have you made or
specific ways have you considered killing yourself in the past few days?” “Do you currently feel like
killing yourself?”
“What has stopped you from trying to kill yourself in the past?” If he has previous attempts were they
self-aborted or interrupted? This can help identify reasons for living.
The conversation would continue as led by the answers to his questions. I would make sure that he knew how
serious suicidality is and that I would let the doctor know and we would also make sure his sister is aware so
safety precautions can be taken. I would follow hospital policy regarding safety planning and contracting for
safety.
SBAR
Situation – Thomas Sykes is a 17 year old male referred to us by his guardian, his adult sister, for weight gain,
truancy, and social-isolation.
Background – Thomas has no known allergies and is up to date on immunizations. He has a past medical history
of chronic obesity without a history of surgery or medications. Thomas survives his mother who died 10 years
ago from complications of uncontrolled DM and obesity. His father’s medical history and status is unknown.
Thomas is a high school senior at a new school following relocation due to his adult sister’s employment.
Thomas lives with his sister and her 3-year-old son who he cares for intermittently when his sister has to work
evenings or nights. Thomas reports that he has no friends at his school and has been choosing to skip school up
to 3 times per week. Thomas identifies his only pastimes as playing video games alone or watching TV with his
nephew (sister’s 3 year old son). Thomas reports that he experiences bullying at his new school due to his
weight and specifically recalls a picture of him in only his underwear circulating amongst students.
Assessment – Upon interview Thomas presents with concern for his weight and fear of dying from DM
complications like his mother. Thomas appears to have a knowledge deficit in regards to healthy diet and
nutrition and obesity comorbidities such as DM.
Thomas complains of drastic recent weight gain which has resulted in most of his clothing not fitting properly.
He reports that he does not have access to means to get new, appropriately sized clothing.
Thomas appears withdrawn and with a flat affect. He expresses hopelessness and speaks of his future as being
“short-lived”. Upon my interview Thomas is positive for feelings of worthlessness and a desire to no longer live.
Thomas denies any previous suicide attempts or self-injurious behaviors but has considered methods of
completing suicide, including using his sister’s handgun which is locked in a safe that he knows the code to.
Thomas struggles to identify reasons to live other than the hurt it would cause his sister and her son. He denies a
current plan to attempt suicide but claims there is “nothing stopping me [him]” if the moment were to arise.
Thomas presents with ineffective individual coping, social isolation, chronic low self-esteem related to body
image, and high risk for self-harm and suicide.
Recommendation – Thomas was unable to complete safety planning. Due to the high-risk of self-harm with
access to methods I recommend that Thomas be referred directly to the Psychiatric Crisis Department at NCH
for further evaluation and treatment.
After Thomas is stabilized and safe I recommend a referral to a weight-loss clinic and dietitian for further
education and resources.
Thomas has indicated that there is some presence of financial struggle within the household and because of this
I recommend that our social services team be consulted to guide him and his sister to appropriate resources.
Thomas’s social situation and lack of parental support puts him at risk of becoming noncompliant with
medication that he may be prescribed by psychiatry. Social work should help him and his guardian to secure
resources and plan for his emancipation at age 18.
References
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2018). Maternal child nursing care. (6th). St.
Louis, MO: Elsevier.