A young adult with obesity comes to the free clinic for a 2-week post-antibiotic follow-up visit for a superficial abdominal skin abscess. The client has a history of major depressive disorder and was hospitalized twice in the past 6 months for attempted suicide. The client now reports feeling "emotionally upset, alone, and at the end of my rope," due to difficulty finding a job and inability to qualify for medical insurance. The client is currently prescribed fluoxetine but has not been able to follow up with the prescribing health care provider (HCP). What is the priority nursing diagnosis (ND) at this time?

Question

Quizplus · Accepted Answer

Suicide is the second leading cause of death in people age 15-24. The risk for suicide is increased in individuals with psychiatric disorders, such as depression, and in those who have attempted suicide within the past 2 years. Based on the client's history and statements, the HCP must perform a suicide assessment and take action (ie, psychiatry referral) to provide for the client's safety. This is imperative as the client is prescribed the antidepressant fluoxetine (Prozac) and has had no follow-up with the prescribing HCP. Risk for suicide related to depression is the priority ND. (Option A) Hopelessness is the belief that a situation or problem is intolerable, inescapable, or unending, and the individual is unable to find a solution. Hopelessness related to inability to find a job, social isolation, lack of medical insurance, and feeling at the "end of my rope" is an appropriate ND for this client, but it is not the priority ND at this time. (Option B) Ineffective coping is the inability to manage stressors and problems effectively. Depression can affect a client's cognitive ability (eg, poor concentration, lack of judgment) and ability to cope with feelings of despair. Ineffective coping related to inadequate support network, limited socioeconomic resources, and impaired cognitive ability is an appropriate ND for this client, but it is not the priority ND at this time. (Option C) Risk for infection related to inadequate primary defenses secondary to impaired skin integrity is an appropriate ND for this client, but it is not the priority ND at this time. Educational objective: Risk for suicide related to depression is a priority ND for a client with previous suicide attempts.

A Young Adult with Obesity Comes to the Free Clinic