Question

A 62-year-old female is admitted to the general medical unit upon recommendation from her oncologist because of "low blood counts." She has had multiple recent hospital admissions for this same condition resulting from Myelodysplastic Syndrome in which the bone marrow does not produce enough healthy cells. She also has had recent valve surgery for aortic stenosis. During this admission, she received Neupogen, a protein to stimulate her bone marrow and white blood counts, with no success. The patient has expressed the wish to die.

She was then transferred to the Psychiatric Unit for close observation and evaluation for the possible diagnosis of Major Depression. On the psychiatric unit, the nurses notice that she has one cousin who comes to visit, but no other visitors have been seen. The patient has verbalized that she is "tired of all the admissions and sometimes wishes she would just die." You as the nurse come in to assess the patient and find her lying in bed staring at the ceiling. The patient looks at you when spoken to but there is no verbal response. The morning shift nurse tells you that the patient refused to eat breakfast and would not get out of bed to get cleaned up. Vital signs: BP 118/62, HR 62-regular, RR 14, Temp 98.6

1. Provide a nursing diagnosis with rationales to explain your initial assessment.
2. Explain the screening process for this patient with suicidal thoughts and behaviors.
3. State two questions you would ask this patient to assess the current suicidal risk.
4. List symptoms of major depression from the DSM5. Does this patient demonstrate any of these symptoms?
5. Which screening tool would you use to assess this patient and why?
6. Describe 4 nursing interventions for this patient. Two interventions should be pharmacological and two should be non-pharmacological.

Answer 1

Ineffective coping mechanism related to disease condition as evidenced by verbalization

Subjective data

• Verbalising wish to die
• Feeling exhausted by repeated admission

Objective data

• Looking vague
• Lack of social involvement, poor responding to others ,lack of interest  
• Hopelessness
• Suicidal thoughts
• Lack of conversation

Nursing intervention and rationale

• Assess the patient mental status to get thebaseline data to provide care
• Provide psychotherapy to relieve patient sadness loneliness ,this enables the patient to speak out the pain and frustration
• Provide diversional therapy
• Administration antidepressants, to cease brain's chemical  activity
• The Selective serotonin reuptake inhibitor acts directly on patients seratonin in brain responsible for depression

The best way to screen a patient for suicidal thought and behaviour are asking questions directly about the patients intents of suicidal thoughts

Assessing for depression symptoms (social isolation ,feeling sad and loneliness, talking about the way of death and suicide)

The questions which can be asked to this patient are

• Do you feel to end your life yourself?
• How do you feel or what do you think or manage  when the disease is really hurting or painful?
• Any suicidal attempts previously?
• Are you satisfied with your life?

The symptoms of major depression are

• Feeling low frequently or everyday
• Lack of interest in activities ,decreased energy
• Weight loss
• Diminished cognitive functions like thoughts, thinking process, speech,decreased motor activity
• Feeling of worthlessness
• Recurrent thinking of death

Here the patient exhibited symptoms like thoughts of dying, tired physically and emotionally due to repeated admission. Lack of attention when the nurse communicates due to depressed mood.

The depression assessment tool for this patient are

Geriatric depression scale

Zung depression scale

Patient health questionnaire