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. Discuss and explain 4 factors that place the client at risk for suicide and developing a mental illness. (4 marks)
2. Discuss and explain 3 further assessment data needed to determine the seriousness of the client’s suicidal intentions? (3 marks)
3. What is the relationship between increased energy in a depressed patient and the risk of suicide? (3 marks)
4. Discuss and explain 4 keys points to include when teaching the client and her partner about the newly prescribed medication. (2 marks)

Answer 1

1) Mental illness is defined as the abnormal behavior or thinking by an individual. Mental illness is classified under Diagnostic and statistical manual of mental disorders into mood disorders, depression,anxiety,phobia,panic attacks.

Four factors that place the client at risk for suicide and developing a mental illness:

- The factors contributing to the mental illness includes : post traumatic stress, helplessness, feeling of isolation, loss of loved ones, psychosomatic illness. Intake of certain drugs like opioids, cannabis, alcohol will induces mental illness like psychosis and schizophrenia.

Age contributes to mental illness, increasing age leads to emotional instability. Hereditary component of mental illness spreads from one person to another. Certain social factors like isolation, sexual or physical abuse, negative life events increases the risk of mental illness.

2) Assessment data needed to determine the seriousness of the client’s suicidal intentions:

- Initiate a trustful environment with the patient. Collect comprehensive information about the suicidal ideation that patient experiences during past,recent and at the present days.

- Family history of any mental illness or suicidal attempt should be collected to understand the hereditary transmission of mental illness from one generation to other.

- Ask patient what kind of suicidal thoughts he often thinks, and the way he behaved at the time of suicidal tendencies.

- Suicidal severity rating scale help nurses to screen patients with mental illness.

3) relationship between increased energy in a depressed patient and the risk of suicide:

- Depression without any coping strategies forces patients to commit suicide.Increased energy in a depressed patient is a warning sign that they are going to self harm behavior.

4) Citalopram is commonly a class of drug categorized under Selective serotonin re uptake inhibitor.It is commonly used to treat depression. It increases serotonin a neurotransmitters levels in the brain. SSRI selectively block only serotonin thereby preventing depression.High doses of SSRI leads to lethal arrhythmias. The drug increases the risk for bleeding ,nurses helps to understand patient to prevent any external injuries. Nurses responsibilities involves checking lab values like CBC, blood glucose. Monitor vitals (BP) before and after drug. Observe for cardiovascular rhythm changes and alteration in neurological functions. Monitor sleep pattern disturbances of the client. Advise patient to take SSRI only in bedtime as side effects of drug is dressiness.