Question

Scenario You are working the day shift on a medical inpatient until. 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 250mg/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 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 his 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.
	Case Study Progress: You use the SAD PERSONS scale to assess J.B.’s potential for suicide and find that he is at a 4 on the 10-point scale. J.B. tells you that he has just had general thoughts of suicide, but has not really thought about how he would do it. You recall that there are two types of suicide methods based on lethality: Higher-risk or hard methods, and lower-risk or soft methods. 7. Which of these would be considered soft methods of suicide? Select all that apply. a. Using a gun b. Slashing one’s wrist c. Hanging d. Poisoning with carbon monoxide e. Ingesting pills f. In haling natural gas 8. What immediate interventions would you carry out for J.B.? Case Study Progress The psychiatrist on call comes in to evaluate J.B. After meeting with J.B., the psychiatrist writes an order for escitalopram (Lexapro) 10mg daily at bedtime. J.B. is scheduled to see the psychiatrist the day after he is discharged from the hospital. 9. Identify two treatments that are available for depression. 10. Would J.B. be a candidate for electroconvulsive therapy (ECT)? Why or why not?

Case Study Progress

The psychiatrist on call comes in to evaluate J.B. After meeting with J.B., the psychiatrist writes an order for escitalopram (Lexapro) 10mg daily at bedtime. J.B. is scheduled to see the psychiatrist the day after he is discharged from the hospital.

11. What special instructions will you give him regarding the Lexapro? Select all that apply.

a. The full effects of the medication might not be seen for 4 to 6 weeks.

b. The medication may cause nausea, dry mouth, sedation, and insomnia

c. There are no known food interactions.

d. The herbal product St. John’s wort will enhance the action of the Lexapro.

e. Taking a glass of wine at bedtime will help him go to sleep.

12. Why do you think that a drug in the SSRI class was chosen over a tricyclic antidepressant or a monoamine oxidase inhibitor (MAOI)?

Case Study Progress

J.B.’s daughter visits him in the hospital, and they have a long talk. She is shocked when she realizes that her father is lonely to the point of considering suicide and tell you that she will do all she can to help him when he goes home.

13. What important information needs to be conveyed to J.B.’s daughter about the first few weeks of therapy with the SSRI?

CASE STUDY OUTCOME

J.B. is discharged to home with a psychiatric home health nurse scheduled to visit him twice a week for 4 weeks. J.B.’s daughter also plans to check-in on him daily and makes an effort to include him in more family activities. He is also considering a move to an assisted living facility.

Answer 1

1. we can collect information about monophobias,substance & alcohol abuses, irritability, sleep disturbances, ability to concentration, personel hygeine, self harming nature etc..

ask the client does he have a plan for suicide, collect the history of attempts if so,

2. following charecteristics of J.B put him risk for suicide:

• client is alone
• depression
• recent losses (friends ,wife)
• poor nutrition and physical illness ( heart problem, diabetes etc..)
• social isolation

3. following psychiatric disorders can result in suicidal ideations.

• delirium
• depression
• anxiety disorders
• bulimia nervosa etc..

4. following questions can be asked:

alterations in sleep patterns?

• use of increasesed alcohol?
• felling of intese anxiety or anger?
• suicidal thoughts or plans?
• anorexia and weight loss?
• constipation and urinary retention?
• feeling of hopelessness and guilt?

5. depression can occur inthe elderly, but it is not normal part of ageing. it s treatable.usually depressed elder will show persistent sadness,excessive worries, frequent tearfulness, social withdrawal etc...

6. most common signs of depression are follows:

• somatic complaints
• withdrawal from social activities
• difficulty in concentrating
• insomnia
• pacing or fidgeting
• feeling worthless or helpless
• excessive worries
• nutritional cahanges etc..

7. soft metods:

options :

• b. Slashing one’s wrist
• e. Ingesting pills
• f. In haling natural gas

8. immediate interventions:

• initiate suicide precautions
• remove harmful objects
• do not leave the client alone
• provide non judgemental caring attitude
• encourage the client to talk about feelings and to identify positive aspects about self.
• identify support systems
• do not allow the clent to leave the unit unless accompanied by by a staff.
• continue to asess the clients suicide potential.

9. treatment:

• psychotherapy
• drugs - antidepressants
• ECT

10. J.B is not a candidate for ECT. because he is a heart patient. most common side effect of ECT in eldery patient is heart and pulmonary complications.

11.

a. The full effects of the medication might not be seen for 4 to 6 weeks

b. The medication may cause nausea, dry mouth, sedation, and insomnia

d. The herbal product St. John’s wort will enhance the action of the Lexapro.

12.

• cost effective
• SSRI are more effective
• lack of sedation
• reduced risk of toxicity

13.

• Do not stop taking escitalopram without talking to your doctor.
• Do not drive a car or operate machinery until medication affects
• remember that alcohol can add to the drowsiness caused by this medication.
• The medication may cause nausea, dry mouth, sedation, and insomnia
• Escitalopram may cause other side effects. Call the doctor if you have any unusual problems while taking this medication