Ellie, a 9-year-old girl, was adopted by a family at the age of 4 after several years of severe neglect by her birth family

The adoptive family has been reporting that Ellie is angry a lot, manipulative with her teachers, and does not seek positive attention. The nurse working with Ellie will need to: 1. Provide education on decreasing stimuli in the home environment that triggers the anger.
2. Realize Ellie may have attachment issues related to her previous history and will need to encourage the family to be active in her care.
3. Support the family in the decision-making process of continuing to let Ellie live in the home.
4. Discuss inpatient therapy to decrease Ellie's manipulative behavior patterns.


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1. Triggers for anger should be identified, but will not aid in dealing with the manipulative behaviors or negative attention-seeking habits.
2. Anger, manipulative behaviors, and negative attention seeking, along with the severe neglect experienced for the first four years of life, indicate the need for active family involvement.
3. When adopting a child with severe neglect, the child is at risk for these behaviors and should be discussed prior to adoption, which is a lifelong commitment.
4. Inpatient therapy will not decrease the manipulative behavior patterns. Ongoing support and therapy will be needed to be successful.

Nursing

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