Appearance Age: Caucasian, early 40s (no wrinkles, minimal sign of wrinkles and aging, she is married, with 2 young children) Body Build: hard to distinguish appears to have medium frame (she is wrapped in blanket) no sign of physical abnormalities. Eye Contact: and minimal eye contact during conversation with nurse (appears to be have less selfconfidence “feeling of Burdon on husband and kids”. As a result of therapeutic relationship towards the end, it reflects she maintained good eye contact when she is giving detailed response directed to therapeutic questions asked by nurse. Attire:wearing a dull grey sweatshirt (no pattern) Grooming/Hygiene: Hair not combed, no makeup on, clothing appears to be clean (no stains or discolouration) Nutritional/General health status: Swabbing and tearing eyes evident by `red and puffy eyes, she also said she is “tried”. No mention of nutritional status Pupils: appears to be normal Posture: Lying down, facing the nurse. Right hand supporting head .Open body language throughout the interview with the nurse ceclned when talking about intense stressors. An unusual posture noted, Speech Rate: overall low delayed speech (evident by her re-electing on what made her feel better when rating herself on a scale of 0 -10) Rhythm: speech is regular and syntactically correct, order of words and phrases were organized. Volume: she spoke softly Quantity: she was consistency responsive, throughout the interview. Characteristics: her speech is understandable, clear and coherent doesn’t appear to have lisp Motor Activity Level /rate of movement: Not active at the moment (laying in the bed, no hand gesture used) But she mention participating in group activity which requires movement out of the bed. Unusual movement: No repetitive movement, tics or tremors noted Coordination: In laying position she is supporting her head right hand, no shaking no tremor no accidentalty leaning forwards noted Interaction during Interview Attitude: she is cooperative and responsive throughout the interview. She was polite. Engaging with nurse in conversation, and that is evident by therapeutic relationship and trust being build. Her cooperation is seen through her willingness of opening up when interacting, and cooperating with nurse on doing her homework) Emotional State Mood: She feels hopeless, “I feel my family and friends are better off with me “ She feel Burdon “I feel I am Burdon to my kids and family” She rates herself on 2-3 on a scale of on scale of 0 to10 , 0 is when she attemped suide that shows she is improving a bit better “I feel washed out and too depressed Affect Quality: feeling despair Range: small rage of emotion (evident by the change in her emotion throughout the interview example she had tearing eye towards more balance mood (not crying, but still in a state of despair) Intensity: balanced intensity (not overly emotional) Stability /Duration: constant state of despair (however with decrease intensity due to the therapeutic relationship) Congruence: her flat facial expression, her slow speech and prolonged breathing in congruent with her reported mood being tried. Experiences Hallucination/ illusion none noted Depersonalization: Claire have Poor self-perception about herself evident by her hopelessness Thought Content No delusion noted Yes suicidal thoughts are present evident by her statement “they will be better off without me “, “why did my husband have to find me, why couldn’t he let me die in peace, why can’t it all be over”. Claire thoughts of suicidal are still present evident by her statement “why can’t it all be over” Thought Process Claire had consistent flow of ideas, however she took time to processing in answering the questions asked by the nurse Sensorium and cognition Level of conscious: she is alter evident by her responsive to the nurse Orientation: Claire is oriented to person as she know she is conversing with nurse , she is aware of her place as she say she is goes to group activity. Memory Recent memory recalls her relationship with husband and kids, AND IS ABLE TO RECALL HER MAJOR stressor Immediate memory: recalls memory of rating herself on 2-3 on the scale of 0when she is promptly to answer the other question. Level of concentration and calculation The level of concentration was present when the nurse ask Claire to rate herself, on 0 to 10 scale and she rated herself 2-3 Calculation is not formally tested Information and Intelligence Claire was able to communicate her feeling using proper grammar. She was able to recall information regards to past event (suicidal attempt) and process information when questioned by the nurse. We can pin point her level of education, however she is effectively communicating with the nurse throughout the interview shows that she is educated. Judgment Claire feels better associating with the group activity, because they are going thought same experience as her and they can relate, this suggests she is open to progressing because she is willing to adhere to nurses instruction on taking baby step, to improve in the mood. Insight Claire is awere of her suffuring from depression and it is impacting herself and people around her “ she is too tried of taking care” Priorities Rationales Claire Safety is are concern as a student nurse. Because of the patient suicidal ideation as evident by her statement “friends and family are better off without me”. Intervention: 1. Claire attempted suicide a week ago, which puts her at high risk for re-attempting suicide, this is why she requires intense supervisions. Determine the level suicide precautions needed, by suicide assessment risk, because this will give us more insight on how much she is re -contemplating. 2. Encourage Claire to talk about her feelings, disappointments,anger, and ways to handle frustration by creating a therapeutic relationship. This way Claire can learn alternative ways of dealing with her overwhelmingemotional and gain a sense of control over her life. 3. Develop a safety plan for Claire, because in case she feels tempted to self-harm, a nurse could provide with alternative manners of channeling her emotions such as writing her feelings in a journal, or creating art. Also remove any kind of source such as pill,jewellery, sharp objects that could allow her to self-harm. 4. Contact and educate family on suicidal behaviour and provide external resource which links to self-help group, this important because re-establish social ties and.If Claire feeling extremely anxious and has not slept in days, then anti-anxiety agent might me prescribed, So Claire get relief from anxiety and there is restoration of sleep loss can help the her think more clearly and might restore some sense of well being Self esteem In Claire‘s situation self –esteem is an issues, because it hinders her from acknowledging her strengths, and positive attributes which prevent her being able to progressing to a healthier state mind . as she stated “ I am so washed up , and depressed”, and I feel I am Burdon to my husband and kids”. Interventions 1) Work with the patient to identify cognitive distortion that encourages negative self -appraisal. for example overgeneralization and self blame. this is important in Claire situation, because cognitive distortions reinforce negative, inaccurate perception of the self and the world. for example Claire statement ( direct quote from video). " they are better off without me" assuming husband thinks without any evidence. 2) teach visualization techniques that help patient replace negative self images with more positive thoughts and images. this is important to promote healthier and more realistic self - image by helping Claire choose more positive actions and thoughts. Social isolation 3)work with Claire, on areas that she would like to improve using problem-solving skills and patient's need for assertiveness training. Evaluate need for more teaching in this area. this will help Claire with her feeling of low self esteem which interfere with usual problem solving abilities. Social interaction is essential in Claire situation , because she feels hopelessness it enables her to understand that others are also going through similar shared emotions like despair, hopelessness , guilt, frustrated And may have similar emotion and normalization her own feeling and seeing that how it relates to her own experiences. This will help Claire to develop sense of relief and support from seclusion as a result of interaction. Intervention pg. 167 1. Since Claire , is severely depressed as she states " I am washed up and depressed", involve her in one to one activity. this activity can maximize the potential for interactions while minimizing anxiety levels. 2. Assess what spiritual practices have offered comfort and meaning to Claire's life when not ill. this assessment will evaluate neglected areas in patent's life that, if reactivated, might add comfort and meaning during a painful depression. 3. Discuss what has given meaning and comfort to Claire in the past. this is important because when depressed there is often a struggle for meaning in life and reason to go on when feeling hopeless and despondent. 4.Encourage Claire to write in a journal every day, expressing daily thoughts and reflections . Journal writing can help the patient to identify significant personal issues and thoughts and feelings surrounding spiritual issues. Journal writing is an excellent way to explore deeper meaning of life.