Chapter 7

Case Study

1. What CUES do you recognize as relevant in planning and providing care for Kinsey?

Relevant cues: Statements of hopelessness and decreased energy, difficulty concentrating and social withdrawal, flat affect, minimal verbal responses, and poor eye contact, recent diagnosis of HIV, received around the anniversary of a traumatic loss, history of severe depression in adolescence, eating only one meal daily with recent weight loss (3 kg), superficial self-inflicted scratches on forearm, fear about inability to continue working as a nurse, picking up extra shifts despite emotional distress and fatigue, limited family and social support

2. What is Kinsey’s priority nursing problem?

Risk for self-harm related to depressive symptoms, history of trauma, recent HIV diagnosis, and expressed hopelessness

3. What are your first steps in caring for Kinsey?

• Ensure immediate safety and monitor for suicidal ideation or further self-harm

• Conduct a suicide risk assessment

• Contact the behavioral health team for evaluation

• Provide a quiet, private space for care and build trust through therapeutic communication

• Initiate basic physical and emotional comfort measures

• Educate Kinsey about the next steps in care to reduce uncertainty and fear

4. What additional CUES are relevant for planning Kinsey’s care based on the nurse assessment?

• Bradycardia (P 48) and mild hypothermia (T 35.8), potentially linked to poor nutrition or depressive slowing

• Reports of physical pain since falling, may exacerbate emotional symptoms

• Self-neglect (wearing pajamas, slouched posture, needing help to eat)

• Rash on chest—non-raised, not itchy or warm—could relate to stress, viral illness, or medication effects

• Emotional detachment, blunted affect, sad expression, and slowed movement

• No evidence of hallucinations or delusions, but strong depressive content in thought processes

• Limited personal support system and few coping mechanisms in place

5. What is your hypothesis for Kinsey after analyzing the nursing assessment data?

Kinsey is experiencing a major depressive episode triggered by the combination of personal trauma, a new chronic illness diagnosis (HIV), and occupational and social stress. The presence of self-injury, weight loss, emotional withdrawal, and past mental health history suggests she is at high risk for worsening depression or suicidal behavior and needs immediate mental health support.

6. Write a SMART goal for Kinsey’s care based on priority nursing problem(s).

Kinsey will identify one coping strategy and one trusted support person by the end of the ED visit to demonstrate willingness to engage in care and promote emotional safety.

Alternative goal (inpatient setting):
Kinsey will remain free from self-harm during her hospital stay and participate in a mental health consultation within 24 hours.

7. What priority nursing interventions are important to implement when caring for Kinsey?

• Place Kinsey in a safe, low-stimulation environment and monitor frequently for self-harm behaviors

• Initiate referral to psychiatric services for further evaluation and possible treatment

• Use therapeutic communication to provide reassurance and encourage Kinsey to express feelings

• Reinforce that HIV-positive nurses can continue to work with proper precautions and are protected by employment laws

• Encourage nutrition by offering small, nutrient-rich snacks and fluids

• Coordinate with a social worker to explore community or peer support resources

• Maintain consistent documentation of assessments, observations, and interventions for continuity of care

Answers to interactive elements are given within the interactive element.