Suicide Prevention-Exam 3

What are the levels of Care for suicide?

• Primary: risk screening, brochures, billboards, commercials, education

  • Essentially prevention

• Secondary: risk assessment, in pt observation, assess belongings of the in pt client

  • Essentially treatment

• Tertiary: refer survivors to an aftercare group, ensure 24. supervision upon discharge

  • Discharge

What are the Protective & Risk factors for suicide

• Protective

  • Currently pregnant, social competency, resilient temperament, overall satisfaction w/ life, religious/cultural beliefs, access to adequate medical care, effective coping and problem-solving skills, optimism abt future/goals, restricited access to highly lethal means, feeling responsibility toward partner/children, presence/perception of adequate support system

• Risk/Warnings

  • Isolation, severe insomnia, victim of bullying, fam hx, post-deployed veteran, giving belongings away, physical illness/chronic pain, impulsive aggressive tendencies, unemployed/financial burdens, psychosis w/ command hallucination, lack of mental health services, loss of loved one, previous attempt

  • Whites at highest risk (men over 80, then adolescents)

  • Decrease risk w/ religious/cultural belief

  • High/low class greatest risk

  • Single person twice the risk of married person

  • Women attempt more but men succeed more w/ lethal means

What are the inpatient interventions for suicide prevention? (Nursing Process)

• Assessment

  • Physical assessment and suicide assessment (will help determine if previous attempts)

  • Assess RF

  • Ask directly:

    • Are you thinking of hurting or killing yourself?

    • Do you have a plan? (More specific higher risk)

    • Do you have a means to carry out this plan?

    • Is the means lethal? (gun)

  • Assess for behavioral clues (giving things away, improved mood)

  • Assess for verbal clues (this is the last time I’ll see you)

• Nursing dx

  • Risk for suicide, hopelessness

• Outcome Identification

  • Smart goals

    • Client will develop a safety plan by noon on Aug 7th, 2023

    • Client will not harm self between 0630-1830 on Aug 7th 2023

    • Client will discuss suicidal thoughts with the nurse by noon on August 7th, 2023.

• Planning

• Implementation/Intervention

  • Ensure hopeless pt not left alone

  • Contract for safety (short term and frequent)

  • Make rounds every 15 mins and at infrequent intervals

  • Offer support groups for survivors of others success

  • Ensure all meds are swallowed and check for cheeking

  • Establish trust and offer hope (realistic)

  • Plastic eating utensils and count once returned

  • Increased suicide risk during shift change

  • Pt can’t keep underwire, shoe strings, string in hoodie

  • Search belongings, remove all glass, cigs and lighter, meds from home, metal belts, cords, plastic bags, razor and shaving cream

  • 1:1 round clock supervision for pt who refuses safety plan

What are the discharge considerations for a pt admitted for suicidal ideation

• Make a safety plan

• Ensure 24 hr supervision until at least the next Dr appt

• A no-suicide contract may build trust and decrease the pt’s risk for suicide

What are the medication considerations for a pt admitted for suicidal ideation?

• SSRI (fluoxetine and citalopram)

  • Max potential in 2-4 wks

  • Not w/ SJW, MAOIs (phenelzine)=serotonin syndrome

  • Not w/ lithium=can increase lith level

  • Increased bleeding risk w/ NSAIDs, anticoagulants (warfarin)

  • Abt 2 wks in to tx pt will have an increase in energy before experiencing hope that their future can be fulfilling

Involuntary Hold

• 72 hrs; after this need a psychiatric commitment preceded by a formal legal hearing

• 3 day hold allows pt to receive basic medical tx and recover from psychotic episodes. The goal is safety, and allow pt time to understand need for further help

• This doesn’t show up on background check

• For pt who

  • Lack insight related to self harm/others

  • Are imminent risk for self-harm/others

  • Responding to command hallucinations of self harm/others

  • Minimal impulse control and threatening to self harm/others

  • Hx of self harm/others and currently threatening the same

  • Experiencing “grave disability”—need assistance for everything, may not be able to if pt has support system that can help

  • Need order for 72 hr hold then need legal hearing after