Case Study 127
March 26, 2015
1. What other information should you ask J.B. regarding his thoughts of suicide? The nurse would first assume an authoritative role to help the patient stay safe. Explain to the patient that his safety is your primary concern and will have to take precedence over other needs or wishes. Other questions that J.B. would need to answer are: Do you have a plan? Is so, what is it and is the plan specific? Do you have the means to carry out this plan? (access to a gun or items needed to accomplish plan) When and where were the last times you intended on carrying out this plan? Have you made death preparations?
Have you given away ay important items?
Have you attempted suicide in the past?
Any relatives recently commit suicide?
Any new medications added recently?
2. What characteristics of J.B put him at high risk for suicide? a. His wife recently passed away
b. Poor support system
c. Secluded: Not participating in his normal activities
d. Gender: Men account for 72% of suicides (Videbeck, 2001). e. Age: People over 65 are at higher risk of suicide (account for 25% of suicides but are only 10% of total population) (Videbeck, 2001). 3. Which psychiatric disorders can results in SI or gestures? a. Depression, Bipolar, substance abuse, PTSD, borderline personality disorder, and schizophrenia (Videbeck, 2001). 4. What questions would you ask J.B. to determine whether he is clinically depressed? a. I would use the Hamilton Rating Scale for Depression as a reference to guide my questions. i. Do you have any feelings of guilt?
ii. Do you have trouble falling asleep?
iii. Do you frequently wake up at night?
iv. Do you have feelings that life is not worth living?
v. Have you noticed slowness of thought and speech, impaired ability to concentrate, or decreased motor activity? vi. Have you noticed any increased anxiety or increased worry? vii. Have you experienced any agitation? Any new habits such as nail biting, hand wringing? viii. Any increased dry mouth, diarrhea, cramping, palpitations, headaches, or indigestion? ix. Any recent weight loss or change in appetite?
x. Have you been fatigued?
xi. Any feelings of helplessness, hopelessness, or worthlessness? 5. I would assess for other symptoms of depression to help determine the cause of symptoms. For instance, is the patient also having feelings of guilt or worthlessness? If no other symptoms are present then the patient could be dealing with the aging process. According to Dr. George Alexopoulos, depression is undiagnosed in the elderly population so special consideration would need to be taken with the elderly patient showing signs of depression. At this point, there is not a screening tool that is both specific and sensitive for detecting depression in the elderly or chronically ill (Deckx, Van Den Akker, & Daniels, 2015). 6. List the 5 most common signs of depression:
a. Depressed mood, Lack of Interest, Feeling of Worthlessness, Poor Concentration, Thought of Death 7. What immediate interventions would you carry out for J.B.? a. Providing a safe environment for J.B. is my first priority. This does involve frequently assessing his potential for suicide. b. Begin a therapeutic relationship by spending time with him. c. Establish adequate nutrition and hydration goals if he has experienced weight loss or constipation related to immobility or inadequate nutrition. d. Encourage J.B. to participate in activities available to him. 8. Identify two treatments that are available for depression: a. Medications: Antidepressants such as Effexor, Wellbutrin, Prozac, Zoloft, or Lexapro. b. Electroconvulsive Therapy (ECT)
9. Would J.B. be a candidate for ECT?
a. ECT is typically used with patients that do not respond to antidepressants or have intolerable side effects at therapeutic doses (more common in older adults). J.B. would also be a candidate if he is actively suicidal and there is a concern for his...
References: Alexopoulos, G. (2005, June). Depression in the Elderly. Science Direct , 365(9475), 1961-1970. Retrieved from http://www.sciencedirect.com.contentproxy.phoenix.edu/science/article/pii/S0140673605666652
Deckx, L., Van Den Akker, M., & Daniels, L. (2015, March ). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: results of a cohort study. BMC Family Practice , 16(30), . Retrieved from http://www.biomedcentral.com.contentproxy.phoenix.edu/1471-2296/16/30
Videbeck, S. L. (2001). Psychiatric Mental Health Nursing (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
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