nursing priority advice needed

[nannanbear]

Please help me determine nursing priority!!!

Kate Williams is a 36 year old lady admitted to the emergency department following a motor vehicle accident. In the accident she sustained multiple lacerations and a fractured right femur which required surgical repair. She also had extensive suturing to her lacerations.

Kate was transferred after surgery to an orthopaedic ward and since admission has presented with low mood, poor appetite and early morning wakening. She is tearful a lot of the time and has revealed to the nurse that she recently lost her job because she was having difficulty concentrating. Her relationship has broken down and she is experiencing financial difficulties. She tells the nurse that: "my family would be better off without me" and "I am a failure and there is nothing in my life that gives me a sense of enjoyment".

She reports a three month history of low mood, worsening anxiety that is particularly bad early in the morning. "I wake at three in the morning and I can't get back to sleep. My thoughts torment me." She reports having a decreased level of energy and tells the nurse "I feel so hopeless that it is no longer worth living". She reports increased alcohol use (up to 2 bottles of wine per day) but denies illicit drug use. She is a smoker (up to 30 cigarettes a day). She has no physical problems apart from those resulting from the motor vehicle accident.

Kate's medical file indicates two admissions to the emergency department with an overdose over the past 2 years. The family history is positive for depression in her paternal grandfather and great grandfather and her uncle committed suicide about 10 years ago.

[NRSKarenRN, BSN, RN]

Moved to our Nursing Student Assistance forum. Check out the FAQ section at the top for advice on care planning especially read

Student Resources: Nursing Diagnoses

Tell us what you think is a priority so we can guide you.

[Episteme]

You are obligated to fill in the SADPERSONS inventory in the EMR and report it to the physician and document that you did it. (At least in our facility.)

Is your question whether her very clear clinical depression takes precedence over her broken bones and lacerations? (IOW: Is this one of those times when Maslow's "Higher Order Needs" supercedes physiological needs?)

It depends. I would do a lot of assessing... it's an important question.

(As an aside: Wonder what her BAL was after the car crash? Just sayin')

The depression is a very chronic problem. Her injuries could go south really fast (fat embolus from the broken long-bone? DVT due to immobility? Osteomyelitis?) My inclination would be to put the depression as a second priority... but an absolutely imperative one.

[nurseprnRN, BSN, RN]

What do you think? You have told us nothing except give us your homework assignment. Although my friend Episteme has helpfully given you some pointers, we aren't going to do your homework for you without knowing what you know already, and why you think so. Tell us and we can take it from there.