A disheveled, severely depressed patient with psychomotor retardation has not showered for several days. The nurse should:
a. provide rewards when the patient showers and withhold them when he doesn't.
b. assist him into the shower, provide soap, and direct him to wash his face first.
c. motivate the patient by noting that his body odor is beginning to offend his peers.
d. discuss hygiene at the community meeting, without mentioning specific patients.
B
Impaired hygiene is common in severe depression. Depressed patients have difficulty organizing tasks involving multiple steps and may avoid them for that reason. They also suffer from anergia (reduced energy) and loss of awareness and interest related to hygiene. It is often necessary for nurses to take an active role in directing the patient into the shower and providing step-by-step instructions to guide the patient and keep him on task. Rewards do not work effectively on people who are anhedonic or feel undeserving (or deserving of punishment). Advising him that he offends his peers would be a disconfirming (nontherapeutic) statement in that it would cause embarrassment and shame, further impairing his self-esteem. Depressed patients are often cognitively disorganized, making it unlikely that they would respond as hoped to generic education about hygiene in a group setting.
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