Suicide and self harm

suicide risk factors

-Depression -Family disruption and history of suicide -Substance abuse problems -previous suicide attempts; feeling helpless/hopeless -Result of series of difficulties over time -impulsive and aggressive -chronic physical illness -cut off from others/isolation

High Lethal Methods

-Gun -Jumping -Hanging -carbon monoxide poisioning -Barbiturates and prescription sleeping pills -Tylenol and aspirin in high doses -Car crash -Exposure to extreme cold antidepressants

How to recognize a self mutilator

-Wear long sleeves, baggy clothes, even in hot weather to cover their actions -May have unusual need for privacy, don't undress in front of others

What is important to know about a patient with suicidal ideation?

-always take an individual very seriously if some form of suicidal ideation is mentioned -always ask "are you thinking of (killing) yourself?" -Find out if they have the means -listen very carefully to what he or she does or does not say

Purpose of lethality assessment

-to predict the likelihood of suicide -Provides basis for planning intervention/approach to tx - Aids in distinguishing btw potential lethality & self-injurious behviour that is not meant to end life, but to express or relieve distress - Helps the provider deal w/ own anxiety or doubt by giving a clear picture of client's status

Maximum Suicide Precautions

1-1 watch always - Must be w/in arms' reach at all times - do not allow client to leave the unit for tests or procedures -maintain 1 to 1 supervision even with visitors -check the client's belongings -serve the client's meals on isolation trays, no glass, no metal silverware -do not D/C without psychiatrist order

Basic suicide precautions

15 minute checks must keep door open to their room stay with client when taking medications look through client belongings for harmful objects check all articles brought in by visitors maintain protocol until D/C by psychiatrist

You are admitting Joel, a 39 year old patient with depression. Which assessment statement(s) would be appropriate to ask Joel to assess suicide risk? A. Do you ever think about suicide? B. Are you thinking of hurting yourself? C. Do you sometimes wish you were dead? D. Has it ever seemed as if life is not worth living? E. If you were to kill yourself, how would you do it? F. Does it seem as if others might be better off if you were dead?

A. Do you ever think about suicide? B. Do you sometimes wish you were dead? C. If you were to kill yourself, how would you do it? D. Does it seem as if others might be better off if you were dead?

Which intervention(s) maximize the safety of a patient who is actively suicidal on an inpatient mental health unit? A. Place the patient on every 15 minute checks B. Place the patient in a room near the nurses' station C. Allow the patient periods of time alone for reflection to promote self-awareness D. Install breakaway curtain rods, coat hooks, and shower rods E. Allow the patient to keep personal objects such as a razor and hair dryer in his room to demonstrate trust.

A. Place the patient on every 15 minute checks B. Place the patient in a room near the nurses' station D. Install breakaway curtain rods, coat hooks, and shower rods

A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention related to this medication should be initiated to maintain this client's safety upon discharge? A. Provide a 6-month supply of Elavil to ensure long-term compliance. B. Provide a 1-week supply of Elavil with refills contingent on follow-up appointments. C. Provide a pill dispenser as a memory aid. D. Provide education regarding the avoidance of foods containing tyramine.

ANS: B The health-care provider should provide a 1-week supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the client's safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential.

A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse's priority at this time? A. Give the client off-unit privileges as positive reinforcement. B. Encourage the client to share mood improvement in group. C. Increase frequency of client observation. D. Request that the psychiatrist reevaluate the current medication protocol.

ANS: C The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act-out self-destructive behaviors prior to the client attaining the full therapeutic effect of the antidepressant medication.

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. What should be the nurse's priority intervention at this time? A. Obtaining an order for locked seclusion until client is no longer suicidal B. Conducting 15-minute checks to ensure safety C. Placing the client on one-to-one observation while monitoring suicidal ideations D. Encouraging client to express feelings related to suicide

ANS: C The nurse's priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation.

A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention, and the rationale for this action? A. Administering lorazepam (Ativan) prn because the client is angry about the discovery of the note B. Establishing room restrictions because the client's threat is an attempt to manipulate the staff C. Placing this client on one-to-one suicide precautions because the more specific the plan, the more likely the client will attempt suicide D. Calling an emergency treatment team meeting because the client's threat must be addressed

ANS: C The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide.

lethality assessment

An attempt to predict the likelihood of suicide

The nurse is caring for an actively suicidal patient on the psychiatric unit. What is the nurse's priority intervention? A. Discuss strategies for the management of anxiety, anger, and frustration B. Provide opportunities for increasing the patient's self-worth, morale, and control. C. Place client on suicide precautions w/ one-on-one observation. D. Explore experiences that affirm self-worth and self-efficacy.

C. Place client on suicide precautions w/ one-on-one observation

nursing diagnoses for self mutilation

Ineffective impulse control Risk for self-mutilation

suicide

NOT a disorder or Axis 1 Dx A completed suicide occurs every 18 minutes in the US 11th leading cause of death Highest risk among caucausian males 65 years and older

Are self harmers suicidal?

Not necessarily, this is a coping measure

nursing interventions for self mutilation

Provide medical treatment for injuries - Assess for risk of suicide or other self-damaging behaviors - Assess for signs of psychiatric disorders including depression, anxiety etc. - Monitor the patient's behaviors closely, using engagement and support as elements of safety checks - Establish trust, listen to patient, convey safety and assist in developing positive goals for the future - Assess ability to enter into a no-self harm contract

Suicide Risk Assessment (SAD PERSONAS)

Sex-male Age-elderly or adolescent DEPRESSION Previous suicide attempt Ethanol abuse Rational thinking is lost Social supports are lacking Organized plan to commit suicide No spouse (divorced widowed single Sickness physical illness

comorbidity

Suicide occurs more frequently among those w/ major depression, bipolar disorder, schizophrenia, alcohol & substance use disorders, borderline & anti-social personality disorders, panic disorders

suicide threat

a warning, direct or indirect, verbal or nonverbal, that a person is planning to take his or her own life. Also making arrangements like funeral, getting their will in order. Also may exhibit mood swings, a decline in work or school performance

self-injurious behavior

behavior causing injury or mutilation of oneself, such as head banging, self biting, cutting usually in individuals with severe and multiple disabilities

self injury is most commonly associated with which mental disorders

borderline person. disorder, depression, anxiety, substance abuse, PTSD, eating disorders

the most common type of self-harm

cutting the skin with a sharp object

High lethality methods for suicide

gun, jumping, hanging, drowning, carbon monoxide, barbiturates, car crash, TCA-antidepressants

assessing a suicidal plan

how detailed is the plan -how lethal is the proposed method -how available is the proposed method in carrying out the plan

self-mutilation

injury or disfigurement made to one's own body AKA as self injury

self-injury

intentionally causing injury to one's own body in an attempt to cope with overwhelming negative emotions

nursing interventions for suicide

self awareness protection and safety increasing self-esteem regulating emotions and behaviors support pt and family education assess medication effectiveness

suicide guidelines

take any threat seriously talk about suicide openly implement precautions when needed search the client's room House the client where there is easy observation do not make unrealistic promises, "I won't let you kill yourself"

Clinical signs of improvement

they can verbalize a range of options they make long term plans they verbalize hope they respond to antidepressant meds show more energy can verbalize hope sleeping better have a wide range of affective responses

Suicide ideation

thoughts of killing oneself

Less Lethality (Suicide) methods

wrist cutting house gas nonprescription meds (excluding aspirin and Tylenol) TRANQUILIZERS

Low Lethality

wrist cutting, house gas, nonprescription medications excluding Tylenol and aspirin