Assignment
Case Study
Sally Morton, a 64-year-old female diagnosed with major depression and suicidal ideation, is receiving home health nursing following a 5-day admission to a psychiatric hospital. She lives with her 75-year-old partner, and they have no children. This is Sally's first admission for depression and her first referral for home care. The physician had ordered 20 mg citalopram per day and assessment of the client's adjustment to home. She has no other medical problems but has lost 35lbs in the last 6 months.
The home care nurse arrives at Sally's home; however, Sally does not greet the nurse when she arrives. Sally is sitting in the living room staring off at the wall. When introduced by her partner, Sally tells the nurse, "I don't need any help; I know what to do." Sally's partner adds that his wife has taken the medication as the physician prescribed.
Sally appears to be older than her age of 64. She is neatly dressed but appears tired and eager to have the nurse leave. Sally answers some questions but supplies only short answers. She refuses to discuss suicidal thoughts, informing the nurse that it is none of her business. Sally does not maintain eye contact with the nurse during the interview. Sally's only complaints are of a dry mouth, occasional dizziness and feeling nauseated twice in the last 5 days. Sally's partner seems concerned and tells the nurse at the door that his wife just does not seem right, but he is pleased that she dressed herself today. He states, "Sally seems to have more energy even though she looks tired."
The client is 5ft, 6in and weighs 107lbs, which was her weight at the time of discharge from the hospital. Her blood pressure is 110/70, her heart rate is 88 beats per minute (bpm), her respirations are 18 breaths per minute, and her oral temperature is 37.0 C.
Laboratory test results from the hospital are within normal ranges. Her physician has not ordered any further tests.
Task
A. Discuss 4 factors that place the client at risk for suicide and developing a mental illness.
B. Discuss 3 further assessment data needed to determine the seriousness of the client's suicidal intentions?
C. What is the relationship between increased energy in a depressed patient and the risk of suicide? (Be specific)
D. Discuss 4 keys points to include when teaching the client and her partner about the newly prescribed medication.
E. Considering the client's family structure, discuss what social, physical, and emotional aspects should be incorporated into her plan of care.
F. Develop 3 specific nursing diagnosis that would be relevant for the client and provide rationale for each diagnosis.
G. Discuss 3 of your personal biases regarding depression and suicide and how they may potentially impact your ability to provide care?