Suicide A
This event lasts approximately 4-6 weeks, experience of being confronted by a stressor with which the pt is unable to cope and cannot resolve on their own.
The pt may be able to cope due to previous life experience and coping mechanisms. If the pt cannot cope, this may lead to cognitive disorganization, in which the pt's ability to make decisions and solve problems becomes inadequate. Relationships and physical symptoms may develop.
What is crisis?
(External and internal resources must be mobilized to assist the pt to return to at least a precrisis level of functioning, the better a pt's coping strategies, the better they are to cope with a crisis....use simple words and sentences, give concrete, step-by-step instructions to facilitate effective communication)
Name 3 risk factors for suicide.
previous suicide attempt, family history of suicide, adolescent or older age group, presence of mental health disorders, (primarily depression), also possibly psychosis, dementia, substance use disorder in combination with other mental disorder, and dx of terminal illness
Which class of drugs are first-line therapy to treat depression that could lead to suicide?
What are SSRIs?
Citalopram (Celexa), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro)
Relatively low risk of lethal overdose and low side effect profiles
Describe the difference between the terms "addiction" and "tolerance"
Tolerance is needing increased amounts of a substance to achieve the desired effect.
Addiction is the compulsive and ongoing use of a substance despite harmful consequences.
What is the name Maggie gave to her first cadaver?
Larry, Leonard, Louis, or Landon
Who is Leonard?
Maturational crisis: involve normal life transitions that evoke changes in pt's self-perception in role, status, and integrity
Situational crisis: involves an external event that disturbs pt's equilibrium and threatens consistency between self-behaviors and values or beliefs
Adventitious crisis: involves external events that are unpredictable and often engender fear, confusion, and loss of consistency
Give an example of each.
Maturational: birth, graduation, marriage, retirement
Situational: abortion, divorce, loss of job, sudden severe illness
Adventitious: hurricane, tornado, fire
Because a high correlation exists between this disorder and suicide, adequate tx of the disorder is essential in overall treatment of the patient at risk for suicide
What is mood disorder?
While effective in treating depression, these drugs can be highly lethal in overdose and are not a first-line agent, when used, quantity dispensed at any one time should be kept to a minimum and may need to be managed by a family member.
What are tricyclic antidepressants?
amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silanor), imipramine (Tofranil), nortriptyline (Pamelor), trimipramine (Surmontil)
Name 3 risk factors for substance abuse.
mental health disorder: use substances to cope, family history, peer pressure, certain personality traits (low self-esteem, self-criticism, insecure), difficulty with intimacy (sexual identification issues), poor impulse control, thrill seekers, people who have lived with painful experiences, abuse survivors, lack of nurturance in childhood, coping skills deficit, profession: nurses at risk, availability, long hours, stressful job, responsibility
What is Meredith Grey's drink of choice?
Rum, coffee, tequila, La Croix
What is tequila?
If relayed by the patient, what is considered a "danger signal" for suicide?
a suicide plan...........the more specific/detailed the plan, the more likely it is that the pt will carry it out
When is a patient most likely to commit suicide?
When stabilized on antidepressant medications
The pt may lack emotional or psychic energy to act on suicidal ideations..... when they become stablilized on their medication, this may give them the energy needed to carry out the act
These drugs are useful occasionally in treating depressive disorders, however, serious drug and food interactions can occur.
What are MAO inhibitors?
Tranylcypromine (parnate), phenelzine (nardil), osocarboxazid (marplan)
Name 3 signs of an impaired nurse to be cautious of.
absent or late for work, elaborate excuses, signing out more narcotics, can't find on the unit, pupil changes, behavior changes, irritability, mood swings, withdrawn or isolated, decreased quality of work, nurses have an ethical obligation to report impaired nurses
What does Jo keep under the bed in her shared apartment with Alex?
burner phone, cash, diary, gun
What is a gun?
Provide 3 effective nursing interventions for deescalating a violent patient.
Remain calm, maintain pt dignity and self-esteem, identify patient stressors and what his/her need is, use calm and clear tone of voice, nonaggressive body posture, keep large personal space between self and pt, always face pt with an escape route to the back, provide several options to pt, avoid arguing, least restrictive to more restrictive, time-outs when appropriate, debriefing for staff, restraints/medications only as last option when all other measures are attempted.
What is the single most predictive psychiatric disorder for suicide?
What is mood disorder?
Name 3 foods to avoid when following a low tyramine diet.
wines,beer, champagne, cheeses, overripe fruit, foods that have fermented, soy sauce, dried sausages, pepperoni, salami,
List 5 questions to ask when assessing substance abuse.
CAGE screen
Cut down, Annoyed, Guilty, Eye-Opener
What substance/s, time of last use, amount used, route, ever tried to stop, triggers, hospitalized due to use, arrested due to use, how often do you use, unable to recall events, blackout or LOC, changes in bowel patterns, sleep, weight loss/gain, liver problems, stress, sleep disturbances, chronic pain, friends/family concerned, age at onset, periods of abstinence, rehab?, previous withdrawal symptoms, ask about each substance separately, need refill early, dose has to be increased
We first meet Amelia Shepherd on Private Practice. Why does she come to Seattle for her first Grey's Anatomy appearance?
Derek's death, Derek's wedding, Derek's gunshot wound, a medical case
What is Derek's gunshot wound?
Name 5 warnings for suicide.
change in appetite, sleep patterns, personal appearance, personality, use of alcohol and other drugs, as well as bodily complaints, self-deprecating comments, making or changing wills, taking out or increasing life insurance policies, and giving away personal belongings, classroom signs: absenteesim, decline in academic performance, boredom, disruptive behavior, anger and hostility toward authority, relationships: decreased interaction with peers/friends, change in people that pt spends time with, decrease in romantic relationships
Name 3 inpatient nursing interventions to reduce the risk of suicide.
24 hour supervision, when pt becomes less risk, q 15 or 30 minute checks, maintain constant awareness of pt's whereabouts, develop rapport and foster therapeutic relationship with pt, check belongings and remove items that could be used for self harm (belts, shoelaces, sharp objects, drugs, cords ,neck ties, lighters), keep unit free of harmful materials (metal or glass objects that could be altered, electrical or call bell cords, windows locked, count silverware, check gifts brought by family, check for cheeking)
Noncomplicance with a low-tyramine diet for those taking MAO inhibitors can lead to what potentially life-threatening issue?
hypertensive crisis
Name four signs of impending relapse.
HALT: hungry, angry, lonely, tired
old defensive mechanisms instead of honesty and openness, having thoughts about using but not telling anyone
What song does Richard sing to calm down his wife, Adele, during an Alzheimer's episode?
At Last, My Funny Valentine, God Only Knows, Time After Time
What is My Funny Valentine?