Suicide
True or False:
Mention of the word suicide will cause the suicidal individual to actually commit suicide.
False
What is the difference between anger and aggression?
Anger is a normal feeling that is an emotional response to frustration as perceived by the individual.
Aggression is typically goal-directed with the intent of harming a specific person or object.
Name a therapeutic communication technique or intervention when communicating with a pt at risk for suicide.
When questioning the pt about suicide, always use a follow-up question if the first answer is negative.
Establish a trusting therapeutic relationship.
Limit the amount of time the pt spends alone.
Involve significant others in the treatment plan.
Carry out tx plans for a pt who has a comorbid disorder, such as dual diagnosis of substance use disorder.
What is the name Maggie gave to her first cadaver?
Larry, Leonard, Louis, or Landon
Who is Leonard?
Name one class of medication that are given to prevent suicide.
SSRIs, Benzodiazepines, mood stabilizers, second-generation antipsychotics
Although the ______ gender is more likely to attempt suicide, these groups are more likely to have a completed suicide.
female
adolescent, middle, and older adult males
Name one comorbidity that could place a pt at risk for aggression/violence.
Depressive disorders, PTSD, Alzheimer's disease, personality and psychotic disorders
Name a nursing consideration for the use of mood stabilizers.
lithium
The pt can minimize GI effects by taking medication with food or milk.
Maintain a healthy diet, and exercise regularly to minimize weight gain.
Maintain fluid intake of 2-3 L/day from food and beverage sources
Maintain adequate sodium intake.
Encourage the pt to comply with laboratory appointments needed to monitor lithium effectiveness and adverse effects.
What is Meredith Grey's drink of choice?
Rum, coffee, tequila, La Croix
What is tequila?
Name a nursing consideration for the use of SSRIs
Citalopram, Fluoxetine, Sertraline
decreased risk of overdose compared to other antidepressants
don't stop taking suddenly
can take 1-3 weeks for effects, up to 2 months for maximal response
Avoid hazardous activities (driving, operating heavy machinery) until action is known, adverse effects nausea, HA, CNS stimulation (agitation, insomnia, anxiety)
Sexual dysfunction can occur
Follow a healthy diet, as weight gain can occur with long-term use
Monitor for indications of increased depression and intent of suicide
Name two groups at risk for suicide.
Active military personnel/veterans, those who are lesbian, gay, bisexual, transgender, people who have a comorbid mental illness, such as depressive disorders, schizophrenia, substance use disorders, bipolar disorder, and personality disorders
Name one nursing consideration for the use of seclusion and restraints.
Must be used only according to national guidelines and should be the interventions of last resort after less restrictive options have been tried.
New initiatives are being proposed to reduce or eliminate the use of mechanical restraints.
Seclusion and restraints do not usually lead to positive behavior change.
Seclusion and restraint can keep individuals safe during a violent outburst, but the use of restraint can be dangerous and has led to death of pts due to suffocation and strangulation.
IM medication may need to be given if aggression is threatening and if no medications were previously administered.
Remove the restraint as soon as the crisis is over and when the pt attempts reconciliation and is no longer aggressive.
This type of treatment is effective in decreasing suicidal ideation in pts who have a depressive or psychotic disorder.
What is electroconvulsive therapy?
What does Jo keep under the bed in her shared apartment with Alex?
burner phone, cash, diary, gun
What is a gun?
Name a nursing consideration for the use of benzodiazepines.
diazepam, lorazepam
Observe for CNS depression, such as sedation, lightheadedness, ataxia, and decreased cognitive function
Avoid the use of other CNS depressants, such as alcohol
Caffeine interferes with desired effects
Advise the pt who wants to discontinue a benzo to seek the advice of the HCP, do not abruptly discontinue, the HCP should gradually taper the dose over several weeks.
What two cultural groups are at the highest risk for suicide?
American Indian and Alaskan Natives
Name three s/s that a potentially violent patient might exhibit that identifies that the potential for violence is escalating.
Hyperactivity such as pacing, restlessness, defensive response when criticized, easily offended, eye contact that is intense, or no eye contact at all, facial expressions, such as frowning or grimacing, body language, such as clenching fists, waving arms, rapid breathing, aggressive postures, such as leaning forward, appearing tense, verbal clues such as loud, rapid talking, drug or alcohol intoxication
Name two facts concerning the no-suicide contract.
It is not legally binding.
It can be beneficial, but it should not replace other suicide prevention strategies.
It can be used as a tool to develop and maintain trust between the nurse and the pt.
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?
Risperidone, Olanzapine
Preferred over first generation due to decreased adverse effects
To minimize weight gain, advise pt to maintain healthy diet and exercise regularly.
Instruct the pt to report agitation, dizziness, sedation, and sleep disruption to the HCP, as the medication might need to be changed.
List 5 assessment questions that should be asked to a client at risk for suicide.
Does the client have a plan?
How lethal is the plan?
Can the client describe the plan exactly?
Does the client have access to the intended method?
Has the client's mood changed?
Has the client attempted suicide in the past? What method was used? How many attempts?
Name 3 interventions for handling aggressive behavior.
Respond quickly, remain calm and in control, encourage the pt to express feelings verbally, (reflective techniques, silence, active listening), allowing the pt as much personal space as possible, maintaining eye contact and sitting or standing at the same level as the pt, communicating with honesty, sincerity, and nonaggressive stance, avoiding accusatory or threatening statements, describe options clearly and offer choices, reassure the pt that staff members are present to help prevent loss of control, set limits for the pt, "I need you to stop yelling and walk with me to the day room where we can talk", use physical activity such as walking to deescalate anger and behaviors.
Inform the pt of the consequences of his behavior, such as loss of privileges.
Use pharmacological interventions if the pt does not respond to calm limit-setting.
Plan 4-6 staff members to be available and in sight of the pt as a "show of force" if appropriate.
A no-harm contract is discouraged for pts who are in crisis, under the influence of substances, psychotic, very impulsive, and/or very angry/agitated.
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?
List 5 suicide precautions/nursing interventions that can be implemented.
One-on-one constant supervision around the clock. Documentation should indicate which staff member is accountable (include start and stop times).
Document the pt's location, mood, quoted statements, and behavior q 15 minutes or per protocol.
Search the pts belongings with the pt present. Remove all glass, metal silverware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers, matches, razors, perfume, shampoo, plastic bags, and other potentially harmful items.
Allow the pt to use only plastic utensils, count them when brought in and out of the room.
Check the environment for hazards (windows that open, overhead pipes, non-breakaway shower rods, non-recessed shower nozzles)
Ensure that the pt's hands are always visible.
Do not assign to private room, keep door open at all times
Ensure that the pt swallows all medications.
Identify whether the pt's current medications can be lethal with overdose.
Restrict visitors from bringing possibly harmful items to the pt.