Mental Health Nsg Exam 2: Suicide

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. 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?

Kara is a 23 year old patient admitted w/ depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara? A. Focus primarily on developing solutions to the problems that are leading the patient to feel suicidal. B. Assess the patient throughly, and reassess the patient at regular intervals as levels of risk fluctuate. C. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior. D. Meet regularly w/ the patient to provide opportunities for the patient to express and explore feelings. E. Administer anti-depressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. F. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

A. Focus primarily on developing solutions to the problems that are leading the patient to feel suicidal. B. Assess the patient throughly, and reassess the patient at regular intervals as levels of risk fluctuate. D. Meet regularly w/ the patient to provide opportunities for the patient to express and explore feelings. E. Administer anti-depressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. F. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

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

Psychological Theories

Anger turned inward Hopelessness Desperation and guilt Hx of aggression & violence Shame & humiliation Development stressors

Sociological Theories

Assisted Suicide: Oregon 1994 Egoistic suicide: separate from mainstream of society Altruistic suicide: excessively integrated into a group Anomic suicide: response to change, fear of loss or support

Suicide in the Elderly

Attempted less often, but has a higher completion rate (methods are more lethal) 2/3 of older adults (> 60 years) were relatively healthy when they died by suicide 66-90% had at least one psychiatric dx; 2/3 were late onset, single episode depression Sx may differ

Griffin is a 19 year old student who volunteers for a depression screening at his college. He identifies himself as gay. Which of the following is true based on current knowledge of the gay, lesbian, and bisexual community and suicide risk? A. Griffin's sexual preference has no bearing on suicide risk. B. Griffin has a higher risk than his heterosexual peers. C. Griffin has a lower suicide risk than this heterosexual peers. D. Griffin may experience a threefold risk for a mood disorder in his lifetime because of his sexual preference.

B. Griffin has a higher risk than his heterosexual peers.

Which person is at the highest risk for suicide? A. A 50 year olf married white male w/ depression who has a plan to overdose if circumstances at work do not improve. B. A 45 year old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide as a teenage. C. A young, single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden. D. An older Hispanic male who is Catholic, is living w/ debilitating chronic illness, is recently widowed, and states, "I wish that God would take me now."

C. A young, single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden.

Which of the following is a misconception about suicide? A. Eight out of ten individuals who commit suicide give warnings about their intentions. B. Most suicidal individuals are very ambivalent about their feelings about suicide. C. Most individuals commit suicide by taking an overdose of drugs. D. Initial mood improvement can precipitate suicide.

C. Most individuals commit suicide by taking an overdose of drugs.

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.

A client w/ a hx of a suicide attempt has been DCed & is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? A. Provide the client w/ a safe & structured environment B. Isolate the client from all stressful situations that may precipitate a suicide attempt C. Observe the client continuously to prevent self-harm D. Assist the client to develop more effective coping mechanisms

D. Assist the client to develop more effective coping mechanisms

Suicide in the Youth

Firearms are the most commonly used method The largest increase in suicide rates is among black males aged 10-19 years Self-report surveys indicate 14.5% HS students had considered attempting suicide in the preceding 12 mo

Risk Factors

Marital status: divorce Gender: men 4x more often than women Age: increases w/ age Race: 2/3 suicides are white males Religion: decreased rates Other: gay/lesbian

Suicide

NOT a disorder or Axis 1 Dx = Sx, behavior A completed suicide occurs every 14 minutes in the US Tenth leading cause of death Highest risk among caucausian males 65 years and older 1 in 5 had contact w/ PCP 45% had contact w/ PCP a month prior IMPORTANT to evaluate/reevaluate sx, closely mtr

Attempted Suicide

One suicide for every 25 suicide attempts Attempts among adolescent are precipitated by interpersonal conlficts (bullying, gender conflicts, lack of support)

Suicide Facts

Outnumbered homicides by 3:2 Suicide by firearm is the most common method for men and poisoning for women Occupations w/ highest risk: physcians, architects, engineers, lawyers, nursing and social work

Interventions

Outpatient vs inpatient Communication techniques: establish rapport (FIRST), avoid note-taking, how do you ask? Outpatient: should not be left alone, establish a "no suicide contract", enlist help of friends/family, daily contact, be direct, use problem solving approach/control, anti-depressants

Analysis of Suicidal Crisis

Precipitating stressors Relevent Hx Life-stage issues Psychiatric/medical Hx Coping strategies

Non-suicidal Self-Injury = Parasuicide

Prevalence: 13-20% adolescents (10-15 years, peaking in late teens) Comorbidity: depression, non-heterosexual orientation, borderline personality disorder Etiology: biological factors (monoamines), cultural factors, societal factors (social media)

Levels of Intervention

Primary: activities that provide support, information, and education to prevent suicide Secondary: treatment of the actual suicidal crisis Tertiary: intervention w/ the family and friends of a person who has committed suicide to reduce traumatic aftereffects

Cultural Factors

Protective Factors African American: religion, role of extended family Hispanic Americans (Fatalismo): Roman Catholic religion, importance of extended family Asian American: adherence to cultural beliefs that tend to emphasize interdependence between individual & society Suicide may be preferable to shame

Biological Theories

Suicidal behavior runs in family Gene variants May be caused by decreased serotonin Physical illness is considered a factor in 11-51% of suicides

Comorbidity

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

Pt Safety Plan

Warning signs: anger, inc/dec appetite, appearance, statements, insomnia, anxiousness De-esculation: distraction, relaxation Places/social settings: comcare crisis Call for help: suicide help line Safe environment: no weapons, drugs, alcohol, lock box for meds