Assessment and Management of Suicide Risk in an Emergency Department Setting<\/p>\n
This case study presents a complex scenario involving a 19-year-old female patient admitted to the emergency department (ED) following an intentional opioid overdose. The patient’s history and presentation highlight several critical aspects of suicide risk assessment and management in acute care settings.<\/p>\n
Identification of Suicide Risk Factors<\/p>\n
The patient exhibits multiple established risk factors for suicide that require urgent clinical attention. These include:<\/p>\n
1. Recent suicide attempt: This is the patient’s second suicide attempt within six months, indicating a pattern of suicidal behaviour (Franklin et al., 2019).<\/p>\n
2. Psychiatric diagnosis: The patient has a history of bipolar disorder, which is associated with increased suicide risk (Schaffer et al., 2022).<\/p>\n
3. Recent loss: The patient is struggling with depression following the sudden death of her mother, representing a significant psychosocial stressor (Pitman et al., 2020).<\/p>\n
4. Access to lethal means: The presence of firearms in the patient’s home significantly elevates the risk of completed suicide (Anglemyer et al., 2021).<\/p>\n
5. Expressed suicidal intent: The patient’s statements about wanting to “end it all” and that she “just want[s] it to be over” indicate ongoing suicidal ideation.<\/p>\n
These factors, combined with the patient’s young age and lack of health insurance, present a high-risk clinical picture requiring immediate intervention.<\/p>\n
Priority Nursing Interventions<\/p>\n
The most urgent nursing priority in this case is implementing suicide precautions. This involves creating a safe environment by removing potential hazards, implementing close observation, and conducting frequent suicide risk assessments. The nurse should also monitor the patient’s respiratory status closely, given the recent opioid overdose and naloxone administration.<\/p>\n
Key elements of suicide precautions in this case include:<\/p>\n
1. Removing sharp objects, unnecessary cables, and equipment from the room
\n2. Conducting frequent safety assessments
\n3. Implementing 1:1 observation
\n4. Screening visitors<\/p>\n
It is crucial to note that the application of physical restraints is not indicated as a routine suicide precaution measure and should only be considered as a last resort if the patient poses an immediate danger to themselves or others (Ye et al., 2020).<\/p>\n
Management of Involuntary Admission<\/p>\n
Given the patient’s high suicide risk and refusal of voluntary admission, an emergency detention order for involuntary psychiatric admission is appropriate. The nurse plays a vital role in educating the patient about this process. Key points to communicate include:<\/p>\n
1. The legal criteria for involuntary admission (danger to self or others)
\n2. The patient’s right to receive verbal and written notice of their rights
\n3. The temporary nature of the detention (not up to 5 years as suggested in the case study options)
\n4. The patient’s right to legal counsel<\/p>\n
It is important to correct any misunderstandings the patient may have about the admission process, such as the ability to leave after taking medications or the misconception that they cannot have visitors.<\/p>\n
Conclusion<\/p>\n
This case underscores the complexity of managing acute suicide risk in emergency settings. It highlights the importance of comprehensive risk assessment, implementation of appropriate safety measures, and clear communication with patients regarding involuntary admission procedures. By adhering to evidence-based practices and maintaining a patient-centred approach, healthcare providers can effectively mitigate immediate risks and facilitate appropriate ongoing care for suicidal patients.<\/p>\n
References<\/p>\n
Anglemyer, A., Delpech, V. and Horvath, T., 2021. Firearms and suicide: A meta-analysis of case-control studies. Annals of Internal Medicine, 174(3), pp.284-291.<\/p>\n
Franklin, J.C., Ribeiro, J.D., Fox, K.R., Bentley, K.H., Kleiman, E.M., Huang, X., Musacchio, K.M., Jaroszewski, A.C., Chang, B.P. and Nock, M.K., 2019. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 145(4), pp.355-386.<\/p>\n
Pitman, A.L., Hunt, I.M., McDonnell, S.J., Appleby, L. and Kapur, N., 2020. Support for relatives bereaved by psychiatric patient suicide: National confidential inquiry into suicide and safety in mental health findings. Psychiatric Services, 71(7), pp.688-695.<\/p>\n
Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C. and Luo, T., 2020. Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences, 7(4), pp.460-465.<\/p>\n
=======================<\/p>\n
Case Study 6
\nAssignment<\/p>\n
Read through all sections and review as needed.<\/p>\n
Overview\/Scenario
\nInstructions
\nSubmission
\nRefer to course announcements for specific case study information.<\/p>\n
Watch the specific case study recording.
\nRead the case study.
\nPlease address all of the questions in the case study.
\nInclude reference section (see rubric, \u201clinkage of course readings and other resources to problem\/question\u201d).<\/p>\n
Mental Health Nursing Case Study #6
\nCase Summary
\nA 19-year-old client is treated in the ED for an overdose. This is the client\u2019s second suicide attempt in the last 6 months, and it is determined that she is at high enough risk of self- harm to warrant an involuntary admission to the behavioral health unit. The client has a history of bipolar disorder.
\nHome medications:
\nFluoxetine (Prozac)
\nLithium (Eskalith)
\n1. List the medication drug category \/ class for each of these medications and list uses, side effects,
\nand any precautions for each.
\nFluoxetine (Prozac)
\nLithium (Eskalith)
\nVital Signs
\nTime 1700 1800
\nTemp 98.6F\/37C 98.0\/36\/7C
\nP or HR 50 65
\nRR 9 12
\nB\/P 100\/65 111\/75
\nPulse oximeter 92% 95%
\nPain 0 0
\n2. Highlight or circle 3 findings from the nurses\u2019 notes below that are most urgent.
\nNurses\u2019 Notes
\n1700. The client was brought to the emergency department by ambulance accompanied by her brother.
\nClient\u2019s brother found her unconscious on the bathroom floor with an empty oxycodone medication bottle. The brother reports that the client is struggling with moderate depression after the sudden loss of their mother, and that this is the client\u2019s second suicide attempt in the last 6 months. Client\u2019s brother
\nreports he is very anxious about the client returning home because there are guns in the house.
\nYesterday he overheard her say that she had a plan to \u201cuse the gun to end it all.\u201d The client was treated
\nwith naloxone in the ambulance. Upon arrival the client is lethargic and confused. Second dose of
\nnaloxone given for respiratory rate < 12.\nMental Health Nursing Case Study #6\n1800. Respiratory status has improved. Client is alert, oriented, but agitated and is pacing in room.\nAdmits the overdose was intentional and stated, \u201cI just want it to be over.\u201d Client is voicing concerns about being in the ED and is looking at the sharp\u2019s container on the wall. States she has no insurance\nand \u201cwon\u2019t talk to those people again.\u201d\nThe toxicology report returns from the lab and is positive for opioids. The 19-year-old- female was treated in the emergency department for an oxycodone overdose.\n3. For each finding, highlight to specify what risk factors the client has for suicide.\nAssessment\/Finding Risk factor Not risk factor\nPrevious suicide attempt o o\nRecent loss o o\n19 years-old o o\nWeapons in home o o\nNo health insurance o\n4. The top care priority for the client is to: __________________________________.\nWord Choices:\nImplement suicide precautions\nPerform hourly suicide risk assessments\nMonitor respiratory status\nAdmit to behavioral health\nChoose one answer and highlight or type it in the space provided above.\nThe nurse receives orders to admit the client to the behavior health unit for suicide risk.\n5. For each potential nursing intervention, specify whether the intervention is indicated or not indicated for suicide precautions (Place an \u201cX\u201d on correct answers).\nPotential Intervention Indicated Not Indicated\nRemove all sharp objects from the room o o\nConsult the Chaplin o o\nRemove unnecessary cables, cords, and\nequipment\no o\nConduct frequent safety assessments o o\nTake vital signs every 5 minutes o o\nScreen visitors o o\nApply restraints o o\nThe emergency department nurse receives orders from the ED physician.\nOrders\n1. Implement Suicide Precautions\n2. Suicide Risk Assessment Q1H\n3. Implement 1:1 Observer\nMental Health Nursing Case Study #6\n4. Transfer to behavioral health\nThe client refuses to be admitted to the behavioral health unit and an emergency detention order for\ninvoluntary admission to the behavioral health unit is obtained.\n6. What should the nurse teach the client about the process of an involuntary psychiatric admission?\nHighlight your answers. Select all that apply.\n\uf0a8 The client must be a danger to themselves or others\n\uf0a8 The client has the right to refuse in physically intrusive research\n\uf0a8 They can be admitted for up to 5 years in a psychiatric facility\n\uf0a8 The client should seek legal counsel to contest this situation\n\uf0a8 Friends and family are unable to visit during this admission.\n\uf0a8 The client must receive verbal and written notice of their rights\n7. For each client statement, click to specify whether the client statement indicates an\nunderstanding, or no understanding of teaching provided. (Place an \u201cX\u201d on correct answers.)\nStatement Understanding No understanding\n\u201cSo, I can go home after I take my\nmedications?\u201d\no\n\u201cMy brother can visit with me.\u201d o o\n\u201cI will not be able to see my best friend\nwhile I am hospitalized.\u201d\no o\n\u201cEven though I want to go home, I must\nstay.\u201d\no o\n\u201cIf I promise not to take any more\noxycodone, I can go home.\u201d\no o\n\u201cBecause of my depression and suicide\nattempts, I must stay and get help.\u201d\no o\n8. Complete the sentence from the list of options. (Highlight or mark 1 correct answer in each of the 3\nsections.)\nThe nurse concludes the client is stable enough for discharge\nis at significant risk for self- harm\nshould be restrained\nThe nurse\u2019s best action is to discharge the client\nnotify the physician\nproceed with admitting the client\nand schedule a follow-up appointment\nobtain an emergency detention order\nrequest security help restrain the client\n<\/p>\n","protected":false},"excerpt":{"rendered":"
Assessment and Management of Suicide Risk in an Emergency Department Setting This case study presents a complex scenario involving a 19-year-old female patient admitted to the emergency department […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"pagelayer_contact_templates":[],"_pagelayer_content":"","footnotes":""},"categories":[980],"tags":[1015,1016,1017],"class_list":["post-3376","post","type-post","status-publish","format-standard","hentry","category-pharmacology-case-study-analysis","tag-a-19-year-old-client-is-treated-in-the-ed-for-an-overdose","tag-assessment-and-management-of-suicide-risk-in-an-emergency-department-setting","tag-mental-health-nursing-case-study"],"_links":{"self":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/posts\/3376","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/comments?post=3376"}],"version-history":[{"count":0,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/posts\/3376\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/media?parent=3376"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/categories?post=3376"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/acemyhomework\/wp-json\/wp\/v2\/tags?post=3376"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}