NUR 381 Applications of Mental Health Nursing Concepts
Suicidal Ideation Case Study
Case Scenario:
Laura is a 17-year-old Caucasian female that arrives to your psychiatric unit. She was recently transferred from a local emergency room for suicidal ideation and anxiety. You will be the nurse doing her admission. During your initial assessment she reports to you, “I worry about everything all the time.” “I can’t ever sleep, and I feel anxious and nervous at school”. She reports she has been depressed for the last several months since her parents divorced at the start of the school year. Most recently, she has become increasingly angry and agitated with the school administration after she was suspended for smoking marijuana and drinking alcohol in her car in the school parking lot. She denies any previous suicidal attempts; however, reports “I just want to end everything. I have no hope for my future. I might as well end it all now. I’d be less of a burden on everyone.” She denies any active suicidal plan.
Past Medical History: migraines with aura since age 12, dysmenorrhea
Psychiatric History: No previous psychiatric inpatient care. Does recall seeing a therapist around the age of 15 for mild anxiety. No psychotropic medication history. Denies any past suicidal attempts.
Substance Use: Does smoke marijuana nightly as she reports it helps her fall asleep and stay asleep. Reports alcohol use socially. Denies use of tobacco.
Trauma History: Denies any past history of trauma.
Safety: No weapons in the home.
Medications:
• Aleve 200 mg, 2 tablets q, 12-hour prn for pain.
• Imitrex 25 mg PO x 1 at start of migraine, may repeat in 2 hours if migraine remains.
Mental Status Exam:
General: Alert and oriented X 4, Appearance normal dress and appropriate, behavior speech appropriate. Calm and cooperative.
Movement: No tremors or tics; normal gait and stance; no involuntary movements.
Speech: Normal rhythm, rate, speed, tone and volume of speech, logical connection of thoughts expressed.
Mood: No dysthymic or depressed appears moderately anxious, not dysphoric, euphoric, angry, elevated, expansive, irritable only when more anxious.
Affect: Full-ranging, not blunted or constricted, correlates to mood expressed.
Language: No language abnormalities; speech fluent; no dysphonia; no stuttering; language fluent and intact for naming, normal sentence structure.
Cognition: Patient oriented X4, no disorientation, short-term memory impairment, reduced abstraction ability, ** stated diminished cognitive functioning only when anxiety is at highest, worries grade will decline, worries will fail out of school
Thought Content: No thought content impairment; denies homicidal ideations, denies delusions or hallucinations, denies paranoid ideations,
Insight and Judgment: No impaired insight, impaired judgment, poor problem-solving.
Questions:
1. List the risk factors for suicide that Laura exhibits and identify two priority nursing diagnoses and interventions for this patient.
2. (Please review C-SSRS Tool). You completed an initial C-SSRS on Laura. She answers yes to question 1 and no to question 2. What are the next steps in caring for this patient?
3. The provider starts Laura on Lexapro 10mg PO daily. As her nurse what patient education will you provide Laura about this medication? Any contraindications with the medication she is currently taking? If so, what are they?
** A minimum of (3) peer-reviewed references from nursing journals (within the past 5 years) is required to support your answers.