Erica Meyers

3/30/2021
Elderly Suicide Case Study

Overview of Evolving Case Study

Learning Objectives
Description of the Evolving Case Study:
 Purpose
 Identify type learner
 Concept to be presented
Description of the Setting:
The purpose is to develop the assessment skills of the
novice mental health nursing student regarding a patient
who is suffering from depression with suicidal ideations.
Med/Surg Acute Inpatient Setting

Description of Patient
Name L. Osborne
Gender/Age/Weight/Height Female/68 yrs of age/200 lbs./5’4”
Allergies PCN
Past medical history Hypothyroid; COPD; DM Type 2; Gout; Arthritis
History of present illness Exacerbation of COPD
Social history Widowed; On Fixed income; No children; Abused as a child
Primary medical diagnosis COPD
Surgeries and/or procedures with dates N/A

Report that Learners receive to prior start of the Evolving Case Study using SBAR Format
Time of report 0700
Person providing the report Nightshift RN
Situation Patient being discharged after treatment of exacerbation of COPD has
expressed thoughts of suicide.
Background Patient successfully treated for exacerbation COPD however is
exhibiting signs of depression and is recently widowed within last year.
Assessment Patient apathetic about care with flat affect and tearful at times with
poor eye contact.
Recommendation Psychological assessment

Evolving Case Study Progression

Evolving Case Study Actions Learners Socratic Question for each area to
Information to be SHOULD ask learner at end of stage
presented to the Demonstrate
Learner

Stage One (Start You have received Proper assessment of Pathophysiology:

of the case report from the night the patient suffering Patients experiencing multiple
study) shift nurse regarding from depression with medical conditions can experience
a patient on the thoughts of suicide. loss of interest and struggle with
med/surg unit that is Therapeutic thoughts of self-harm. What could
 to be discharged communication. be the possible differences between
today. You are told Ensure patient issues related to medical conditions
that the patient has safety. and feelings of depression?
expressed suicidal Engage in Medical problems can create
ideations. You are therapeutic nurse- change within your body that can
discussing discharge patient cause depression. As your physical
instructions with relationship/establish condition improves, your
Mrs. Osborne a 68- trust. depression will improve. Certain
year-old female who medication used to treat medical
was admitted for conditions cause worsen depression
exacerbation COPD. as well. Depression can also cause a
With several chronic condition to become more
episodes in the past severe by causing more pain,
several months. fatigue, and self-esteem issues.
While you are
assessing the patient Physical Assessment:
and discussing the What assessment should be
possibility of performed to determine the
discharge she begins seriousness of Mrs. Osborne’s
to tell you her thoughts of self-harm?
husband died 6 Use the Suicidal Ideation Attribute
months ago. She Scale (SIDAS) to assess the severity
becomes tearful from 0-10.
when telling you
about her spouse’s
recent death and Pharmacology:
admits to feelings of Are there any medications that
loneliness. She could be contributing to the
reports she feels sad patient’s feelings of depression and
most of the time. thoughts of suicide?
She expresses little
interest in Corticosteroids for treatment of
performing her arthritis and thyroid medication
normal daily could be contributing to her
activities. She has no depressed state.
children and only a
few elderly friends.
She states “I’ve been
feeling depressed
the last couple
months with
thoughts of killing
myself.”
Trigger for Stage Two: The need to further assess the feelings of depression and thoughts of suicide.
Stage Two: You use the scale Conduct focused Pathophysiology:
provided by your assessment of What important question about
facility to perform an depression and suicide must you ask now based on
assessment of Mrs. suicidal thoughts. Mrs. Osborne’s score?
 Osborne’s feelings of Continue with
depression and find therapeutic  Do you have a plan to
that she scores a 5 communication and harm yourself or take
on a scale of 0-10 therapeutic your own life? If so,
with 10 being the relationship describe plan.
most severe. techniques.  Do you have those
resources available to
you to take your life,
such as prescription
pills, knives, gun.
 Have you prepared for
death by writing a letter,
making a will, practicing
the plan, give away prize
possessions?
 Have you told anyone
that you are thinking
about taking your life or
are planning to do this?

Physical Assessment:
What physical characteristics would
be congruent with the subjective
information obtained from Mrs.
Osborne?
Showing signs of withdraw from
others around her, having a flat
affect and tearful at times with
poor eye contact.

Pharmacology:
What could be the possible and
most safe medications for treatment
of Mrs. Osborne’s feelings of
depression? SSRIs
Trigger for Stage Three: The outcome of the depression scale rating.
Stage Three: Based off your Demonstrate proper Pathophysiology:
assessment and patient education Would Mrs. Osborne be a candidate
nursing judgment, and reporting of for alternative treatments for
you notify the health priority information depression such as ECT?
care provider about to health care Yes, she could be a possible
your findings. A provider. Ensure candidate for ECT. It is just taken
psychiatric consult is patient safety. with precaution in the older
ordered as well as Continue using population due to cardiovascular
suicide precautions. therapeutic issues.
The psychiatrist communication.
evaluates Mrs. Physical Assessment:
Osborne and Which actions are necessary to
prescribes her implement suicide precautions?
paroxetine 10 mg Removal of sharp objects, glass
daily at bedtime. or potentially dangerous
equipment or other items. Also
observing patient while
administering all medications.

Pharmacology:
What education is necessary to
teach Mrs. Osborne regarding her
new antidepressant medication?
This medication should not be
stopped abruptly because it could
worsen symptoms. The medication
should be tapered if she no longer
wants to be on the medication. She
will not notice improvement until
after 2-4 weeks of taking the
medication.

Debriefing Questions:
What are risk factors that place the elderly at risk for depression and self-harm?
Mrs. Osborne is at risk due to her current health history, the recent passing of her
spouse, being abused as a child, no financial support, and having little to no
support system.
What are possible treatments options available for depression in the elderly apart
from medication therapy?
Psychotherapy, Cognitive behavioral therapy,
and electroconvulsive therapy (ECT)

What important information needs to be conveyed to Mrs. Osborne regarding her

SSRI therapy and how it effects feelings of depression and thoughts of suicide?
Can result in mood swings and may lead to worsening depression or anxiety.
Taking more than the recommended dose or suddenly stopping use of
antidepressants can increase a patient’s chance of experiencing suicidal thoughts
and behaviors.
What is the importance of the therapeutic relationship and the use of therapeutic
communication when caring for Mrs. Osborne?
The importance of therapeutic communication is to establish trust within the
patient. Because Mrs. Osborne is at risk for self-harm and has little to no support
system to help her during this time it is important to establish a rapport.