casestudy3

=Scenario Activity Questions

Review the scenarios and answer the below questions utilizing the attached material and resources.

Name some of the suicidal risk factors for the individuals:

Are either patient actively exhibiting any suicidal behaviors?  If so, explain.

What assessment items are you able to answer based on the information you have already been provided?  

What are some assessment questions you may want to ask this individual to obtain more information?

What level of risk would you consider these individuals to be?  Should suicide precautions be put in place for either patient?  If so, what precautions would you implement?

Table 27-2

Levels of Suicidal Behaviors

Suicidal ideation	Expressed thoughts or fantasies with no definite intent—may express ideas directly or symbolically
Suicidal threats	Verbal or written expressions of intent without actual actions
Suicidal gestures	Actions that result in little or no injury, but communicate the message of suicidal intent
Parasuicidal behaviors	Unsuccessful attempts with a low likelihood of success
Suicidal attempts	Serious self-directed actions with the intent to end one’s life
Completed suicide	The successful ending of one’s life

Box 27-3

Assessment the Potential for Suicide

“What has been the most difficult moment for you in the recent past?”

“Have things been so bad that you have thought about escaping? If so, how?”

“Are there times when death seems like an attractive option to you?”

“Have you thought of harming or killing yourself?”

“If you were to harm yourself, how would you do it?”

“Do you have access to the items you would need to carry out your plan? (This includes a gun, medications, a rope, an enclosed garage.)”

“Have you thought about or attempted to harm yourself in the past?”

“What has kept you from harming yourself thus far?”

“What might keep you from harming yourself in the future?”

“Do you think you can control your behavior and refrain from acting on your thoughts or impulses?” This is the  most important question to ask.

Table 27-3

Suicide Assessment

ASSESSMENT	DESCRIPTION
Suicide ideation (thoughts)	Client talks about wanting to be dead, imagines AIDS or other serious illness, seems gloomy, brooding.
History of suicide attempts  *	Client has tried to end own life before; there may be family history of suicide.
Present suicide plan	The more detailed a suicide plan, the more likely it will be carried out.
Availability of items to carry out plan	What guns, rifles, knives, or other weapons are available? How difficult is it to obtain such items?
Substance use or abuse	Suicide rates are higher in people who abuse alcohol or other chemical substances.
Level of despair	Ask about the future; when despair is high, hope is low.
Ability to control own behavior	Inpatient hospitalization is indicated for individuals who are unable to control their suicidal impulses.

*

Box 27-4

Problem Statements/Nursing Diagnoses Related to Suicide

Physical realm

Risk-taking  Behaviors

Disturbed  Body image

Noncompliance

Pain

Risk of  Self-mutilation

Rape-trauma syndrome

Risk of self-directed  Violence

Psychosocial realm

Anxiety

Ineffective  Coping

Ineffective  Denial

Complicated  Grieving

Hopelessness

Powerlessness

Chronic low  Self-esteem

Impaired  Social interactions

Spiritual distress

Box 27-5

Suicide Precautions

Protect client from harming himself or herself.

Determine whether client has specific suicide plan.

Determine history of suicide attempts.

Make a no-suicide contract.

Remove dangerous items from the environment.

Place client in least restrictive environment that allows for necessary level of observation.

Place client in room with protective window coverings, as appropriate.

Observe closely during suicidal crisis.

Escort client during off-ward activities, as appropriate.

Demonstrate concern about client’s welfare.

Refrain from criticizing.

Facilitate discussion of factors or events that precipitated the suicidal thoughts.

Facilitate support of client by family and friends.

Instruct client and significant others in signs, symptoms, and basic physiology of depression.

Instruct family that suicidal risk increases for severely depressed clients as they begin to feel better.

Instruct family on possible warning signs or pleas for help client may use.

Refer client to psychiatrist, as needed.

Reference

Morrison-Valfre, M. (2017). Foundations of Mental Health Care (6th ed.). 

St. Louis, MO. Elsevier