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Suicide (Implementation (Nasogastric Tube Care (To give medication (clamp…
Suicide
Implementation
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Inform visitors of the restrictions, assess for any harmful objects patient could use.
Doctor has ordered soft wrist restraints. Monitor patient every 30 minutes. Restraints should be loosened or removed every two hours for repositioning or toileting. Assess for neuromotor functioning of the hands and fingers.
Monitor the patient depending on risk level (low, moderate, high). A one on one observation should be maintained if the patient is actively suicidal.
Assess extremities for compartment syndrome. check for swelling, extreme pain, pallor, pulses in the extremity, paralysis, and paresthesia
Maintain a safe environment for the patient. Remove anything harmful from the environment (medicine, weapons, sharp objects, belts, ropes, ties, etc.)
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Assess IV sight for signs of infection, extravasation, infiltration, and placement
Patient is recent postop. with a foley catheter. Assess the foley catheter for placement and infection. Assess output for clarity, color, odor. Take I & O every 2 hours.
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Nasogastric Tube Care
Verify placement of tube. Gastric residual volume should be assessed before giving anything through the tube
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Make sure any PO medication about to be giving is not enteric-coated or delayed release capsules. This medication cannot be crushed
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Assessment
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Reported feelings of helplessness, hopelessness, paranoia, and suicidal ideation
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“I wanted to hurt myself, and I wanted to hurt my husband.”
Motor activity was restless. Affect was agitated. Speech was soft. Judgment was poor impulse control and maladaptive.
Determine level of suicide risk patient is at. (low, moderate, high)
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Police reported the patient was aggressive towards her husband with scissors, then she attempted to cut herself on the wrists.
Family history of other psychiatric disorders and suicide (mother - schizophrenia and alcohol dependency; niece committed suicide)
Ask patient questions
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“If you began to have thoughts of harming or killing yourself again, what would you do?”
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Diagnosis
Self-harm/suicidal ideation related to feelings of helplessness and hopelessness as evidence by psychiatric disorder bipolar disorder, family history of suicide, and previous suicide attempts
Depression
Assessment
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Assess for symptoms of depression and suicidal thoughts: "Have you had thoughts of suicide?", "Do you have a plan?"
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Ask questions like, "What things would lead you to feel more or less hopeful about the future?"; "If you began to have thoughts of harming or killing yourself again, what would you do?"
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Reported feelings of helplessness, hopelessness, and depression
Motor activity was restless; affect was agitated; speech was soft; judgment was poor impulse control and maladaptive; mood was depressed and anxious
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Interventions
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Assess the patient for suicide risk (low, moderate, high)
Due to soft wrist restraint orders, evaluate the patient every 30 minutes. Loosen or remove restraints every two hours for repositioning or toileting. Assess for neuromotor function of the hands and fingers.
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Cast care
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Clean area around the cast, avoid getting water or cleansers on cast
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Assess IV sight for signs of infection, extravasation, infiltration, and placement
Patient is recent postop. with a foley catheter. Assess the foley catheter for placement and infection. Take I & O every 2 hours.
Assess extremities for compartment syndrome.check for swelling, extreme pain, pallor, pulses in the extremity, paralysis, and paresthesia
NG Tube and Medications
Make sure medications patient is prescribed are able to be given through NG tube (Doctor has approved, medications aren't enteric coated or delayed release)
Make sure to turn suction off before administering medications through NG tube; verify the placement of the tube by aspirating stomach contents, reinstall, and flush with 30 ml of water;
Clamp tubing and attach syringe; pour the mixture of water and medication and attach syringe; unclamp tubing and allow medication to run by gravity; flush the tubing and reclamp
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Diagnosis
Ineffective individual coping related to situational crisis as evidence by depressed mood, alcohol consumption, recent divorce, attempted cutting of wrists, and suicidal thoughts.
Bipolar Disorder
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Implementation
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Check wrist restraints at least every 30 minutes. Assess patients circulation and neuromotor function
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Long term: later in the patient’s treatment process, help the patient dress herself, give step by step instructions
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Drug possibilities: lithium, carbamazepine, lamotrigine, risperidone. Give drugs as ordered by the provider
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Have a staff meeting with all people involved with the patients care, be sure all involved are aware of patients capabilities and diagnoses
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Assessment
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Patient reports decreased need for sleep, euphoric feeling, and racing thoughts
Patient appears restless, disheveled, and agitated
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Evaluation
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Were the drugs given as prescribed, and did the patient take the medication?
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Planning
Be sure all staff aiding in treatment of the patient is aware of the possibility of violence, even though the patient is currently in restraints
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