Question

You are working the day shift on a medical inpatient unit. You are discussing discharge instructions with
J.B., an 86-year-old man who was admitted for mitral valve repair. His serum blood glucose had been
averaging 250 mg/dL or higher for the past several months. During this admission, his dosage of insulin
was adjusted and he was given additional education in managing his diet. While you are giving these
instructions, J.B. tells you his wife died 9 months ago. He becomes tearful when telling you about that loss
and the loneliness he has been feeling. He tells you he just doesn't feel good lately, feels sad much of the
time, and hasn't been involved in his normal activities. He has few friends left in the community because
most of them have passed away. He has a daughter in town, but she is busy with her work and grandchildren.
He tells you that he has been feeling so down the past few months that he has had thoughts about
suicide.
1. What other information should you ask J.B. regarding his thoughts of suicide?
2. What characteristics of J.B. put him at high risk for suicide?
3. Which psychiatric disorders can result in suicidal ideations or gestures? Name at least three.
4. What questions would you ask J.B. to determine whether he is clinically depressed? Name at
least six.
5. Ill people often have trouble sleeping, experience a change in appetite, reduce their level of
activity, and have thoughts of death. How can you tell the difference between old age with
illness and depression?
6. List five of the most common signs of depression in the older adult.

Answer 1

1)ans)
✓Does he have a specific plan for suicide?
• Has he ever attempted suicide in the past?
• Does he have any weapons at home?
• Does he drink alcohol, and, if so, how much and how often? Does he use any drugs?
• Will he be alone once he goes home?
2)Ans)
• The highest suicide rate among males is in those aged 75 years or older.
• Depression often occurs with chronic illnesses, such as diabetes mellitus, cardiovascular disease,
stroke, and cancer.
• Loneliness or social isolation are risk factors, and he has had a recent loss.
3ans)
• Major depressive disorder
• Bipolar disorder, which is characterized by episodes of major depression accompanied by episodes
of mania
• Dysthymic disorder, which is a less severe but more chronic type of depression
• Schizophrenia
• History of alcohol or substance abuse
4)ans)
• Tell me about your sleep. Do you have difficulty falling asleep, staying asleep, or waking up early?
• How would you describe your appetite?
• Have you had any recent unintentional change in your weight?
• Tell me about your concentration. Are you able to read the newspaper or watch a TV show from
beginning to end?
• How is your energy level?
• How would you describe your mood or your spirits?
• Have you had any thoughts of death recently?
• Are there activities that you enjoy or give you pleasure?
• Have you lost interest in activities that you used to enjoy?
5) Ans)
Depression includes feelings of worthlessness, hopelessness, indecisiveness, and guilt. Ill people
might still express a sense of satisfaction as they think back over their lives, their connection with
family members, and their participation in a spiritual life. Ill people may still have the ability to
concentrate on positive things.
6)Ans)
• Persistent sad mood
• Loss of interest in activities that were once pleasurable
• Insomnia or hypersomnia
• A significant change in appetite with weight loss or weight gain
• Loss of energy
• Difficulty with concentration
• Feelings of worthlessness or guilt
• Thoughts of death or suicide
• Isolating oneself from others