Question

A young client is admitted for frequent vomiting, macerated knuckles, with reddened eyes and weighs 60 kgs. The client reports feeling overwhelmed with suicidal ideation, and states they are trying out for cheerleading and have to be a certain weight. She is crying and her mother is at her side and is prescribed fluoxetine. (20 points each)

• Describe the orders the nurse may anticipate from the provider with rational, in priority order.
• List questions the nurse would ask the client to help determine further assessment and treatment, with rationales for each.
• Based on the assessment findings, identify the therapies the provider would potentially initiate for this client and why.
• Identify two members of the multidisciplinary team that should be consulted prior to the client discharge from hospital, with their roles and client goals.

Answer 1

ORDERS FROM PROVIDER THE NURSE MAY ANTICIPATE:

* SSRI'S: FLUOXETINE, SERTRALINE, ESCITALOPRAM - THESE ARE THE ANTI DEPRESSANT DRUGS THAT ARE COMMONLY PRESCRIBED FOR DEPRESSION. THEY ACT ON SEROTONIN RECEPTORS.

* MONOAMINE OXIDASE INHIBITORS: THEY PREVENT THE ACTION OF MONOAMINE OXIDASE.

THE NURSE WILL FOCUS ON THE ASSESSMENT OF SUICIDAL IDEATION IN CLIENT. SHE WILL ASK :

GENERAL QUESTIONS ARE:

• Sometimes people feel that life is not worth living. Can you tell me how you feel about your own life?
• What are some of the aspects of your life that make it worth living?
• What are some of the aspects of your life that may make you feel or think that your life is not worth living?
• Do you find yourself wishing for a permanent escape from life?
• How would that happen for you? What might you do to achieve that?
• Have you ever thought of harming yourself or trying to take your own life?

IF PERSON SHARES HIS THOUGHT ABOUT FEELING OF SELF HARM THEN NURSE SHOULD FURTHER ASK :

• When did you begin to experience these thoughts and feelings?
• How strong are they?
• Can you describe them?
• How frequently have you had these thoughts and feelings?
• Have you ever acted upon these thoughts?

IF PERSON TELL ABOUT PREVIOUS SUICUDE ATTEMPT THE NURSE SHOULD ASK:

• What were your thoughts just before you harmed yourself?
• What did you anticipate would be the outcome of your self-harm or suicide attempt?
• How did you feel after your attempt? Did you feel relief or regret at being alive?
• Did you receive treatment after your attempt? Did you get medical and/ or psychiatric, emergency help?  

THERAPIES THE NURSE CAN RECOMMENT TO CLIENT:

• COGNITIVE BEHAVIORAL THERAPY : IT HELPS THE PEOPLE WITH DEPRESSION IN RESTRUCTURE THE NEGATIVE THOUGHT.
• INTERPERSONAL THERAPY : IT HELPS PEOPLE UNDERSTAND AND WORK THROUGH TROUBLE RELATIONSHIP THAT MAY CAUSE THEIR DEPRESSION.
• ELECTROCONVULSIVE THERAPY: ARTIFICIAL GRAND MAL SEIZURES ARE PRODUCED TO TREAT DEPRESSION.

TWO MEMBERS THAT ARE NEEDED TO CONSULT PRIOR DISCHARGE OF PATIENT ARE:

• BEHAVIORAL CARE MANAGER: A behavioral health care manager is a behavioral health professional, typically a counselor, clinical social worker, psychologist or psychiatric nurse, who performs all of the care management tasks including offering psychotherapy when that is part of the treatment plan
• PSYCHIATRIST CONSULTANT: This role can be performed by any psychiatric expert who can assist the primary care team diagnosis, treatment planning and recommendations about changes in treatment when the patient is not at least 50% improved after 10-12 weeks on any given treatment plan.