Question

Sally Morton, a 65 year old female diagnosed with major depression and suicidal ideation, is receiving home health nursing following a 5 day admission to a psychiatric hospital. She lives with her 75 year old partner and they have no children. This is Sally’s first admission for depression and her first referral for home care. The physician had ordered 20 mg citalopram per day and assessment of the client’s adjustment to home. She has no other medical problems but has lost 35lbs in the last 6 months.

The home care nurse arrives at Sally’s home; however Sally does not greet the nurse when she arrives. When introduced by her partner, Sally tells the nurse, “I don’t need any help; I know what to do.” Sally’s partner adds that his wife has taken the medication as the physician prescribed.

Sally appears to be older than her age of 65. She is neatly dressed but appears tired and eager to have the nurse leave. Sally answers some questions but supplies only short answers. She refuses to discuss suicidal thoughts, informing the nurse that it is none of her business. Sally’s only complaints are of a dry mouth and occasional dizziness. Sally’s partner seems concerned and tells the nurse at the door that his wife just does not seem right, but he is pleased that she dressed herself today. He states, “Sally seems to have more energy even though she looks tired.”

The client is 5ft, 6in and weighs 107lbs, which was her weight at the time of discharge from the hospital. Her blood pressure is 110/70, her heart rate is 88 beats per minute (bpm), her respirations are 20 breaths per minute, and her oral temperature is 37.0 C.

Laboratory test results from the hospital are within normal ranges. Her physician has not ordered any further tests.

1. Considering the client’s family structure, discuss what social, physical and emotional aspects should be incorporated into her plan of care. (4 marks)
2. Develop 3 nursing diagnosis that would be relevant for the client and provide rationale. (6 marks)
3. Discuss 3 of your personal biases regarding depression and suicide and how they may potentially impact your ability to provide care? (3 marks)

Answer 1

Sally Morton, a 65 year old female diagnosed with major depression and suicidal ideation, and he has got discharged from the hospital after 5 days of admission and referral for home care. She is of 65 years old and looking more than her age.

The main reason for the suicidal ideation and depression for the present case study is mainly due to their life events. The couples don't have any children and because of that maybe she is very emotionally upset and depression may be started from the unusual thoughts and stress. She maybe thinks that during the old age no one is there to care of her and husband and they are alone during the old age.

While planning care to the present case we have to consider all these aspects. She has to consider her present psychosocial situation and identify the reason for the psychosocial crisis or the psychosocial stressors that maybe lead her for the suicidal ideation. By identifying the psychosocial situation the nurse can help the patient to mobilize the external supports. By planning this way can help the patient to protect from the suicidal risk.

We have to appreciate the positives of the individual patient and make her think in such a way that improves the coping skills, positive thinking style and the psychological needs of the patient.

2.

a.The risk for suicide related to family situations

The risk for suicide is the priority diagnosis when the patient has both suicidal ideation and a plan to carry out the suicidal intent. The patient is in a stage of chronic stage of depression, she may not be in a stage of obeying or non-compliance to the instructions.

.b. Imbalanced nutrition less than body requirements related to increased suicidal ideation

c. Hopelessness related to chronic history of depression.

From the family history of the patient, we can conclude that she doesn't have any hope regarding life and she thinks only the negatives in her life. She may think that no one is taken the care for us during the old age.

d. Chronic low self-esteem related to chronic stressors in life.

She didn't think about the positives and create negatives in her life.

Implementing suicide precautions is the only option related to patient safety. The other options, related to nutrition, self-esteem, are important but are not priorities. but these problems do not affect patient safety as urgently as a suicide attempt.

3. Already as a home care nurse, we know that the patient is in a stage of severe depression and suicidal ideation. When we are attempting to discuss with the suicidal thoughts if the patient refuses. First of all, build a good rapport with the patient and make her co-operative. Then clearly discuss regarding nature of crisis and reason for the thinking the suicide.

As a nurse, we have to identify the strength and vulnerabilities of the patient. We have to identify coping skills and psychological needs.

Here the patient complaints regarding dry mouth and occasional dizziness, as a nurse we have to thoroughly explain the reason for that. Eg: this may be due to the effect of medication or less nutrition while taking medication.

And make or help her to manage the situation.