Question

Jenny Vasquez, a 14-year-old Hispanic female, presents to the emergency department after having consumed a box of diphenhydramine (Benadryl) tablets. Her left wrist has also been cut horizontally; the amount of blood loss is unknown. Upon ED arrival, Jenny is alert and angrily addressing emergency medical personnel and the ED staff. Two security guards are present in the examination room. When the ED physician asks if he can assess Jenny’s wrist laceration, she attempts to slap him and threatens to “knock out” anyone who touches her. The ED physician orders application of physical restraints to Jenny’s wrists and ankles for protection of herself and others. Jenny’s vital signs include temperature 96.2°F tympanic; pulse 118 bpm; and BP 152/96 mmHg. Respirations cannot be assessed due to Jenny’s verbalization, but she does not appear to be in any acute respiratory distress. The ED physician quickly assesses Jenny’s left wrist wound; there is no active bleeding and the wound is superficial with no deep tissue damage. A dressing is applied to the wound. Gastric lavage is performed immediately to remove the drugs from Jenny’s stomach. Afterward, her wrist laceration is cleaned and sutured, and a sterile dressing is applied to the site. Jenny is beginning to calm down and she pleads for removal of the physical restraints. The ED physician makes a verbal contract with Jenny; she agrees that she will not attempt to harm herself or others if the restraints are removed. After removal of the restraints, Jenny cries quietly. The security guards remain in the examination room. Upon reassessment of Jenny, she speaks quietly and makes eye contact with the nurse. She explains that the teenagers at her school have been bullying her for the past year. Jenny is unsure about her sexual orientation, but was caught kissing another girl at the winter formal last year. Ever since then, she has been ostracized and teased constantly at school. The day of the suicide attempt she arrived at her locker to find that someone had spray painted the words “queer,” “freak,” and “spic” in red paint. Seeing no other way to stop the abuse, Jenny tried to kill herself.

Question 1 Based on the information provided about Jenny’s situation, do you believe she is at especially high risk for attempting suicide again? Please explain your answer. Question 2 Do you believe that Jenny was actually trying to kill herself, or was this incident more of a “cry for help”? Justify your answer with evidence from the case study. Question 3 Identify three nursing diagnoses that are appropriate for inclusion in Jenny’s plan of

Answer 1

1.Jenny is especially at high risk for attempting suicide because of being bullied,harrased, abused or ostracized by other school collegues. This was because of the difficulty in understanding her sexual orientation. The repeated activities by the other school childrens has made her depressed ,loose confidence ,a sense of unexplainable fear, inability to get proper help to sort the issue ,etc., had put her under mental pressure and attempt suicide.

2.Jenny was not actually trying to kill herself because a person who wants to commit suicide generally cut their arm deeper to bleed.The incident like extreme anger outburst , threatening others shows that she is need of help or is in a state of cry for help.

3.The three nursing diagnosis are

• Ineffective coping mechanism related to feeling guilt,temper tantrum as evidenced by poor cooperation , inability to understand and accept others help
• Risk for injury (self/others) a related to severe thought disorder as evidenced by anger
• Risk for self directed violence related to losd of hope as evidenced by suicidal behaviour