UNIVERSITY OF THE ASSUMPTION College of Nursing City of San Fernando, Pampanga SCIENTIA, VIRTUS et COMMUNITAS

Case analysis
(Suicide)
SUBMITTED BY:

Angelika L. Flores Elizabeth Maliwat Group A2

SUBMITTED TO:

Mrs. Jennifer Del Rosario, R.N, M.A.N

BEHAVIORAL EMERGENCIES CASE 1: SUICIDE A 22 year old female has taken an overdose of Aspirin. She responds to your questions about what, when, and how much was taken. 1. What is the first step for the victims care? 2. Discuss suicide risk factors mnemonic SAD PERSONS. 3. What is the treatment? 4. Discuss fables and facts about suicide. Aspirin (Salicylates, many over the counter products, oil of wintergreen) Toxic Dose: Single dose exceeding 200-280 mg/kg. Peak Gastric absorption occurs within 2 hr of ingestion. Aspirin overdose An overdose of aspirin means you have too much aspirin in your body. This can happen in two ways: If a person accidentally or intentionally takes a very large dose of aspirin at one time, it's called an acute overdose. If a normal daily dose of aspirin builds up in the body over time and causes symptoms, it's called a chronic overdose. This may happen if your kidneys do not work correctly or when you are dehydrated. Chronic overdoses are usually seen in older patients during hot weather. Poisonous Ingredient: Acetylsalicylic acid What is the first step for the victims care? Check and monitor the person's airway, breathing and pulse. If necessary, begin rescue breathing and CPR. Do not induce emesis (vomiting) for ingestions of salicylates. If a drug overdose is discovered or suspected and the victim is unconscious, having convulsions or not breathing, call for emergency medical help immediately.

What to Expect at the Emergency Room Induce vomiting with syrup of ipecac or perform gastric lavage; administer activated charcoal to decrease absorption. IV fluids, sodium bicarbonate (which enhances secretion), potassium replacement; volume expanders as needed to support circulation. Vitamin K for bleeding tendencies (Chronic poisoning)

Glucose for hypoglycemia Hemodialysis in severe cases.

Discuss suicide risks factors mnemonic SAD PERSONS SAD PERSONS ASSESSMENT SCALE An essential aspect of assessment is direct questioning about suicidal intent. An assessment tool referred to as the SAD PERSONS Assessment Scale is often used to determine suicidal intent. Sex: Men commit suicide more frequently than women do; however, women make more suicide attempts. Women are three times more likely and women are four times more likely. Age: Those at greater risk of suicide are younger than 19 and older than 45 years. Depression: The risk of suicide increases with depression. Many people with depression who have suicide ideation, lack the energy to implement suicide plans but research has shown that antidepressant treatments actually can give clients with depression the energy to act on suicidal ideation (Sudak, 2005). Previous Attempts: The rate of suicide increases among people with a history of suicide attempts. The first 2 years after an attempt represent the highest risk period, especially the first three months. Those with a relative who committed suicide are at increased risk for suicide: the closer the greater the risk. One possible explanation is that the relatives suicide offers a sense of permission for acceptance of suicide as a method of escaping a difficult situation. Ethanol or alcohol abuse: The rate of suicide is higher among alcoholics than among the general population. Rational Thinking: Individuals who experienced impaired judgment (e.g. psychosis, substance abuse, neurologic disorder). Close to 95 % of individuals who commit suicide have a psychiatric disorder. Eighty percent of these persons have a depressive disorder. Ten percent are schizophrenic. Social support: Individuals who lack support systems are at greater risk. Organized Plan: The more organized the plan for committing suicide, the greater the risk. No spouse: Single, divorced, widowed, or separated individuals are at greater risk for suicide than those who are married. The incidence of suicide in married persons is 11 per 100,000, significantly less than for those who are no spouse. Single and

widowed persons have a rate that is nearly doubled that of married persons while divorced persons have a rate that is nearly four times higher than married persons. Sickness: Individuals who experience a chronic or debilitating illness are at greater risk.

What is the treatment? Treatment includes: Involve the client in her own treatment. This is to encourage the client to assume responsibility for and control of her behavior. Convey to the client that she is a worthwhile human being. Providing environment that includes the presence of a family member or other companion for the first few days post-suicidal attempt. Asking client to identify triggers for suicidal thoughts. Asking client how she is feeling at intervals during the day. Inquiring if client is having recurrent thoughts of self harm at intervals during the day. Provide a therapeutic environment. Encouraging client to plan with the family around her needs during the recovery period. Supporting client in seeing mental health care provider and attending groups. Review signs and symptoms of depression, warning signs of suicidal thoughts, and effects of medication, including any special precautions, with the client and family.

Medical Intervention Research studies have identified various psychotropic drugs of choice in the treatment of suicidal behavior. For example, selective serotonin reuptake inhibitors remain the treatment of choice for depressive disorders. Monitor the clients response to medication, including presence of adverse effects.

Interactive Therapies

Cognitive behavioral therapy is provided to help the client explore the reasons behind suicidal ideation and to provide the client with adequate situational support by parents, friends, or clergy. Encourage the client to engage in an activity that is an outlet for tension and anger. For example, a sport such as volleyball or running, or an activity such as working with sandpaper or pounding wood, allows nthe client to express feelings while also providing her with an opportunity to interact with staff and peers.

Intervention and Prevention 1. Provide a safe home environment by removing objects or items that could be used to inflict injury (eg, knives, guns, medication). 2. Have a client sign a written no suicide contract. Since 1973, nurses, social workers, psychologists, and psychiatrists have endorsed the use of no suicide contract, believing them beneficial in treating suicidal patients. 3. Obtain permission from client to contact the clients health care provider in the event of a crisis or emergency. 4. Recognize changes in mood or behavior that could indicate a plan for self injury (eg, irritability, anger, agitation, withdrawal, or self-deprecating comments) and notify the clients health care provider. 5. Anticipate future stressors and assist client to use appropriate coping skills. 6. Express a kind but firm attitude. 7. Keep a 24 hour emergency hotline phone number readily available. 8. Encourage client to continue with outpatient treatment. 9. Attend a family caregiver support group meeting. 10.Do not hesitate to notify the police if the client exhibits unmanageable self destructive behavior. Fables and Facts about Suicide Myth: People who talk about suicide never commit suicide. Fact: Suicidal people should often send out subtle or not-so-subtle messages that convey their inner thoughts of hopelessness and self destruction. Both subtle and direct

message of suicide should be taken seriously with appropriate assessments and interventions. Myth: Suicidal persons only want to hurt themselves, not others. Fact: Although the self-violence of suicide demonstrates anger turned inward, the anger can be directed toward others in a planned or impulsive action. Physical harm: psychotic people may be responding to inner voices that command the individual to kill others before killing the self. A depressed person who has decided to commit suicide with a gun may impulsively shoot the person who tries to grab the gun in an effort to thwart the suicide. Emotional harm: often, family, friends, health care professionals and even police involve in trying to avert a suicide or those who did not realize the persons depression and plans to commit suicide feel intense guilt and shame because of their failure to help and are stuck in a never ending cycle of despair and grief. Somme people, depressed after suicide of a loved one, will rationalize that suicide was a good way out of the pain and plan their own suicide to escape suicide. Some suicides are planned to engender guilt and pain in survivors; for example, as someone who wants to punish another for rejecting or not returning love. Myth: There is no way to help someone who wants to kill himself or herself. Fact: Suicidal people have mixed feelings (ambivalence) about their wish to die,, wish to kill others, or to be killed. This ambivalence often prompts the cries for help evident in overt or covert cues. Intervention can help the suicidal supports, choose to live, learn new ways to cope and move forward in life. Myth: Do not mention the word suicide to a person you suspect to be suicidal, because this could give him or her idea to commit suicide. Fact: Suicidal persons have already thought of the idea of suicide and may have begun plans. Asking about suicide does not cause a nonsuicidal person to become suicidal. Myth:

Ignoring verbal threats of suicide or challenging a person to carry out his or her suicide plans will reduce the individuals use of these behaviors. Fact: Suicidal gestures are a potentially lethal way to act out. Threats should not be ignored or dismissed nor should a person be challenged to carry out suicidal threats. All plans threats, gestures, or cues should be taken seriously and immediately give that focuses on the problem about which the person is suicidal When asked about suicide, it is often a relief for the client to know that his or her cries for help have been heard and that help is on the way. Myth: Once a suicide risk, always a suicide risk Fact: Although it id true the most people who successfully commit suicide have made attempts at least once before, most people with suicidal ideation can have positive resolution to the suicidal crisis. With proper support, finding new ways to resolve problem helps these individuals become emotionally secure and have no further need for suicide as a way to resolve a problem