Question

Last night, your client attempted suicide. A friend, who normally has breakfast with your client every morning got concerned after the client did not show up at the local diner. The friend found the client passed out on a couch at his home rambling that he wanted to commit suicide. Your client was diagnosed with Major Depressive Disorder without psychotic features and a pattern of Global Assessment of Function (GAF) scores of 50, 40, 35. Two weeks ago, the client was started on Lexapro (Escitalopram Oxalate) 10 mg daily with fair compliance. The client arrived in the ER 10 hours ago with a blood alcohol content of 0.13, received IV fluids. Rapid urine assay was positive for benzodiazepines. Repeat BAC (1 hour ago) = 0.03. The client was medically cleared for a psychiatric evaluation, and admission to the Mental Health Unit.

Explore Insight into what​​​​​Assess Drug Action

Occurred Prior/During to Suicide Attempt​​and Concerns with Side Effects​

MEDICATION

Escitalopram oxalate 10mg daily

MOOD/BEHAVIOR

Suicide Attempt

GLOBAL ASSESSMENT OF FUNCTIONING

THERAPEUTIC COMMUNICATION Focus on Present

Answer the following questions prior to your simulation experience.

What questions are important to ask a patient that relate to the severity of a threat of suicide, or a suicide attempt?

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What does a pattern of findings provide the nurse in assessment of a patient’s functioning, using the Global Assessment of Functioning (GAF)?

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What steps would a nurse take to create and maintain a safe environment when self-harm may occur?

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Identify anticipated effect, side-effects from medications, and misuse of alcohol.

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Answer 1

Questions that pertain to severity of threat

• frequency of thoughts on death and dying- has the patient been thinking of suicide for the past few days/weeks
• Ask for immediate events preceding the attempt
• Assess patients planning of suicide- whether there was a thought out plan
• history of previous attampts
• Ask the patient about feelings of hopelessness
• Assess sleep and appetite
• Thoughts and feelings before the attempt
• Method of attempt- more lethal attampts indicate a more severe threat

CReating a safe environment:

• Remove dangerous objects that are accessible to the patient at apersonal level (belt, shoelace, sharp items)
• Identify and remove dangerous objects available at a unit level- ligatures etc.
• Ensure presence of a care-giver at all times after determining the level of supervision needed

Global assessment of functioning score assesses the social, ocuupational and psychological functioning of the patient. The score is from 1-100. This patients score is in a decreasing pattern. It can be influenced by drugs such as benzodiazepines and alcohol.

Escitalopram is used to treat major depressive disorders. Risk of suicide attempt is an anticipated side effect. Patients may also complain of nausea, sleeping trouble, sexual dysfuction etc

Alcohol is a CNS depressent and can worsen psychiatric issues.