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Boarding refers to the practice of holding patients, including those with mental health disorders, in the emergency department (ED) for extended periods due to the unavailability of appropriate psychiatric or mental health treatment facilities. This situation often occurs when there is a lack of inpatient psychiatric beds or insufficient community-based mental health resources.

When the nurse notifies the manager about clients with mental health disorders still present in the ED for over 48 hours, they are likely raising concerns about the practice of boarding. The nurse is highlighting the issue of keeping individuals with mental health disorders in an inappropriate setting for an extended duration, which can have negative implications for both the clients and the ED.

The other options are not directly related to the phenomenon of clients with mental health disorders staying in the ED for an extended period:

1. Temporary detaining orders for clients: Temporary detaining orders refer to legal provisions that allow for the involuntary detention of individuals who are at risk to themselves or others due to mental health concerns. While this may be relevant in certain situations, it does not address the broader issue of clients staying in the ED beyond 48 hours.

2. The revolving door for clients: The revolving door phenomenon refers to individuals repeatedly seeking care in the ED due to ongoing or recurrent health issues. While this may be a concern in the context of mental health, it does not specifically address the issue of clients with mental health disorders staying in the ED for over 48 hours.

3. The cost of holding clients in the ED for over 48 hours: While the cost of providing care and resources to clients staying in the ED for an extended period is a valid consideration, it does not encompass the broader issue of the appropriateness of this practice for clients with mental health disorders.

During a panic attack, the client may experience intense fear and anxiety, accompanied by physical symptoms such as rapid heart rate, shortness of breath, and trembling. The most critical action the nurse should take is to stay with the client and provide support. By remaining present, the nurse can help the client feel safe and reassured, while also monitoring their condition for any signs of worsening distress or the need for further intervention. Maintaining a safe environment is also crucial to prevent any harm to the client or others. Once the immediate crisis is managed and the client starts to calm down, the nurse can then proceed with other interventions, such as education on coping strategies or engaging in activities to redirect their focus. However, in this situation, the priority is to provide immediate support and ensure the client's safety.

The following are incorrect because:

Educate the client in ways to prevent a future panic attack: While education on preventing future panic attacks is important, it is not the priority action during an ongoing panic attack. The client is currently in distress and needs immediate support and assistance in managing the panic attack. Education can be provided at a later time when the client is calmer and more receptive to learning.

Take the client for a walk around the unit: Taking the client for a walk may be a beneficial intervention to help reduce anxiety and promote relaxation in some situations. However, during an active panic attack, the client may be experiencing significant distress and physical symptoms that can make movement difficult or exacerbate their symptoms. It is essential to prioritize the client's immediate needs and provide a supportive environment before considering other activities or interventions.

Redirect the client to an activity or task: Redirecting the client to an activity or task may be helpful in some situations to distract them from their anxiety. However, during a panic attack, the client may find it challenging to engage in activities or focus on tasks due to their heightened state of anxiety. Redirecting their attention without addressing their immediate distress may not be as effective or appropriate as providing support and maintaining a safe environment.