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86 y.o. Female Voluntary admit. Depression with suicide ideation (Signs…
86 y.o.
Female
Voluntary admit.
Depression with suicide ideation
Possible NDX:
Ineffective coping
Hopelessness
Risk for suicide
Social isolation
Self care deficit
Disturbed thought process
Risk factors for depression:
Family hx and a personal previous hx of depression
Female > male
Age > 65 years old
Deficiency of serotonin = affects mood, sleep, sex, hunger and pain preception
Deficiency in norepinephrine = affects attention, and behavior
Stressful life events
Poor social support
Substance abuse
Presence of medical illness
Deficiency in GABA, dopamine, and acetylcholine
Risk factors for
suicide:
Untreated depression
Feelings of powerlessness
Loss of employment of finances
Substance abuse
Change in functional status
Loss of loved one
Terminal/progressive
illness
White, older adult
Access to lethal weapons
Treatment
Medication
admin
Venlafaxine (Effexor)
SNRI
Counseling
Problem-solving
Increase coping abilities
Change negative
thinking to positive
Increase self-esteem
Using available
community resources
Group therapy
CBT
Signs and symptoms
of depression:
Anergia
Anhedonia
Anxiety
Report of sluggishness
Anorexia
Sleep disturbances (insomnia or hypersomnolence)
Fatigue
Slowed speech and delayed response
Increased pain
Flat or blunt affect
Slowed physical movement
Social isolation with little interaction or effort
Poor grooming
Nursing
interventions:
SAFETY
Milieu therapy
Monitor ability to perform ADL
and encourage indepence
Communication = trust, make time,
make observations, allow time for response
Assess mood and affect
(worthiness, guilt, helplessness, anger)
Assess physical symptoms
(pain, gi ^ ,sleep ^, self harm,energy)
Assess suicide plan
Verbal and written safety contract
Search belongings for potential harmful items
Round Q 15 min, 1 on 1 supervision
Signs + symptoms
of suicidism:
Giving away
belongings
Covert statements =
"Everything will be better soon"
"I just want out"
Overt statement =
"No reason for me to live"
"I'm going to end it all"
Physical markings of self harm
Frequent talk of death