A factory abruptly closes. An office worker initially tries to take it in stride, begins the job search, and networks with peers. Five weeks later, he has not received a single call-back from a prospective employer

Question

He cannot sleep, is irritable, does not want to interact with his family or peers, paces, and spends several hours most days alone in a local bar. He has given up applying for jobs. Which three nursing diagnoses would be the highest priority at this time? Select all that apply. a. Risk for self-injury
b. Risk for compromised resilience
c. Ineffective denial
d. Ineffective coping
e. Chronic low self-esteem
f. Social isolation

Answer 1

A, D, F
The fact that the person is no longer making adaptive efforts to cope suggests hopelessness. Withdrawal, irritability, and impaired sleep suggest possible depression. The depression, hopelessness, alcohol abuse, and isolation are risk factors for suicide, so Risk for self-injury is the highest-priority diagnosis. The root cause of his current status is that his systems for coping have been overwhelmed, making Ineffective coping the second priority after safety. Risk for compromised resiliency is not a priority relative to other concerns, and the data do not support Ineffective denial or Chronic low self-esteem. Social isolation is clearly a concern because of his withdrawal and lack of access to supports, so it is also a top-three priority.