A patient is recovering from a severe myocardial infarction.He tells his nurse,to whom he is very close,"I will be fine once I get home.All that 'watch your cholesterol,watch your calories,watch your stress' stuff is bull;if your time is up,your time is up." Which response would be most therapeutic?

Question

Quizplus · Accepted Answer

The patient is in denial and is rationalizing his desire to avoid the anxiety,loss,and grief associated with giving up the lifestyle he has enjoyed.Rationalizing that he has little control over what will happen and therefore need not worry so much about it could also be his way of coping with the fact that his life is in a precarious state at the moment.Focusing him on how his family might feel about his fatalistic comments is designed to get him to consider his life from another perspective that might be more important than continuing his unhealthy lifestyle or avoiding dealing with his mortality.The response is indirectly confrontational,which is acceptable given that they are in the working phase of the nurse-patient relationship;it is designed to lead him towards cognitive reframing of his beliefs about how to live after a severe myocardial infarction (MI).The "when you are home you can do as you wish" comment suggests anger about the patient's seeming disregard of his health and devaluing of life and is nontherapeutic.Dictating diet and exercise while the patient is hospitalized does not address his anxiety and other emotional responses to how the MI will affect his lifestyle.If the patient had a knowledge deficit related to recommended post-MI lifestyle changes,providing information about research on health practices and outcomes after MI might be of value,but he seems to have at least some awareness that the practices mentioned are recommended.

A Patient Is Recovering from a Severe Myocardial Infarction