A nurse is caring for a client who is receiving inpatient treatment for an eating disorder. The client states, "I just can't sleep soundly here because it's too noisy." Which of the following actions should the nurse take?

Choice A reason:
When leading a crisis intervention group, especially for adolescents who have witnessed the traumatic event of a classmate's suicide, it is crucial to first identify the individuals' prior coping skills. This initial step is essential because it helps the nurse to understand the baseline coping mechanisms each adolescent has previously employed. Adolescents may have varying levels of resilience and different strategies for dealing with stress and trauma. By identifying these skills early on, the nurse can tailor the intervention to reinforce these existing skills while introducing new coping strategies. This personalized approach ensures that each adolescent's unique needs are addressed, which is particularly important in the aftermath of a suicide, where feelings of guilt, confusion, and grief can be overwhelming. Moreover, understanding their prior coping skills can help the nurse to predict potential challenges and provide targeted support to those who may be more vulnerable or at risk of negative outcomes.

Choice B reason:
Reviewing community resources is an important action but not the first one that should be taken. Community resources can provide additional support and services to the adolescents after the initial crisis intervention. These resources might include mental health services, support groups, or educational programs. However, before directing adolescents to these resources, it is essential to assess their current psychological state and coping abilities. This ensures that the resources recommended are appropriate and beneficial for each individual's specific situation.

Choice C reason:
Discussing the importance of confidentiality is a critical component of any therapeutic intervention, particularly in a group setting. It creates a safe space where adolescents feel secure to share their thoughts and feelings without fear of judgment or breach of privacy. However, this is not the first action to take. Establishing confidentiality is part of setting the ground rules for the group intervention, which typically occurs after initial assessments and once a rapport has been established.

Choice D reason:
Initiating referrals may be necessary for adolescents who require more specialized care or individual therapy. Referrals are an important part of the continuum of care and ensure that adolescents have access to the appropriate level of support. However, this action is typically taken after the initial crisis intervention session, where the nurse has had the opportunity to assess each adolescent's needs and determine who might benefit from additional services.

a. Methadone 40 mg PO daily: This is contraindicated. Methadone is primarily used for opioid withdrawal and maintenance, not for alcohol withdrawal.

b. Nutritional consult: This is anticipated. Nutritional therapy can help balance out the loss of nutrients due to heavy drinking.

c. Perform Alcohol Use Disorders Identification Test (AUDIT): This is contraindicated. AUDIT is a screening tool for assessing alcohol consumption and related problems, but it’s not typically used once a diagnosis of alcohol use disorder has been established and the patient is in withdrawal.

d. Complete blood count and basic metabolic profile: This is anticipated. These tests can help assess the patient’s overall health status and identify any potential complications related to alcohol withdrawal67.

e. Group therapy: This is anticipated. Group therapy can provide peer support and is often beneficial in the treatment of alcohol use disorder.

f. Schedule electroconvulsive therapy (ECT): This is contraindicated. ECT is typically used for severe depression and other psychiatric disorders, not for alcohol withdrawal.

g. Diazepam 10 mg PO three times a day: This is anticipated. Diazepam, a benzodiazepine, is commonly used in the management of alcohol withdrawal to reduce symptoms and prevent complications.

h. Propranolol 40 mg PO twice a day: This is contraindicated. Propranolol, a beta-blocker, is not typically used as a first-line treatment for alcohol withdrawal. It may be used to manage some symptoms such as tremors or high blood pressure, but it does not prevent seizures, a potential complication of alcohol withdrawal.