NURS 660 Exam 1 Study Guide 2023

NURS 660 Exam 1 Study Guide 2023. What are the reasons for living and those for dying?  What has prevented the patient from carrying out the act, or  How has s/he managed to evade the act of suicide thus far?  Is there anything different now or anticipated to be different in the near future?  Has the suicidal ideation been shared with anyone else besides the therapist?  Who has been or could be helpful in managing the ideation?  This will allow for the involvement of family and/or significant others who can assist in obtaining data about the patient and provide containment and feedback during treatment, as part of the safety plan, but such collaboration should be with the patient’s permission. 3 Suicide Risk Scale  Sex: men kill selves 3x more frequently than women.  Age: greater risk among 19 yrs or younger, and 45 yrs or older.  Depressed: 30x more than non-depressed.  Previous attempters: 64x that of general population.  Ethanol abuser: about 15% of alcoholics commit suicide.  Rational Thinking loss: psychosis, mania, depression or OBS.  Social support lacking: especially a recent loss of support.  Organised plan: either directly or indirectly communicated.  No spouse: single, divorced, widowed or separated.  Sickness: severe, chronic or debilitating illness.  Scoring: 1 point is scored for each factor present.  0-2 allow home with follow up.  3-6 consider hospitalisation depending on confidence in follow-up.  7-10 suggests either hospitalisation or commitment.  Other Identified Risk Factors for Suicide - Have had psychiatric hospitalization within the past year - Have had a recent or impending loss - Have a history of impulsive or self destructive behavior - Have committed violence in the past year - Have access to guns - Have a family history of suicide - Are socially isolated - Have a chronic, terminal or painful medical disorder - Are newly diagnosed with serious medical problems - Are male age 65 or older - Have lost a child either to suicide or in early childhood - Have a history of physical or sexual abuse in childhood. - Top high risk diagnosis for completed suicides:  Depression, especially with psychic anxiety, agitation and/or significant insomnia  Bipolar disorder  Alcohol and substance use disorders  Schizophrenia  Borderline personality disorder Assessment Following an Attempt  After an act of para-suicide, it important to determine the degree of suicidal intent existing at the time.  What is the explanation for the attempt in terms of likely reason(s) and goal(s)? 4  Does patient intent to die now?  What problems confront the patient?  Is there psychiatric disorder and if so how relevant is it to the attempt?  What are the patient’s coping resources and support?  What kind of help might be appropriate, and is the patient willing to accept such help?  A high degree of suicide intent is indicated by the following: - Planning beforehand. - Precaution taken to avoid discovery. - No attempt made to seek help afterwards. - A dangerous method was used: shooting, drowning, hanging. - There was a final act: will, suicide note. - Extensive premeditation. - Admission of suicidal intent. Documentation of Assessment. The clinical record should reflect that the:  Suicide risk assessment has taken place,  What the findings are, and  What intervention plans are in place to contain, manage or mitigate the identified suicidal risk.  The ideation and risk, along with the positive and negative findings, should be noted in the clinical record, either in the mental status exam section or in a clinical note. Mental Status Exam  Merck Manuals (n.d.). How to do the mental status exam (5:43 minutes). Mental status is the total expression of a person’s emotional responses, mood, cognitive function, and personality. It is closely linked to the individual’s executive functioning, i.e. motivation, initiative, goal formation, planning and performing, self-monitoring, and integration of feedback The Mental Status Examination (MSE) is one component of an exam and may be viewed as the psychological equivalent of the physical exam. It is an important component to a neurological evaluation. The full MSE is a lengthy exam. You assess many components of the 5 MSE in your normal work up of a patient. When you need to do a shorter neurological screening exam, you may shorten the MSE to the Mini Mental Status Exam (MMSE). Why do NP’s need to do MSE’s? Emotional and behavioral changes are often the first signs of organic brain disease. How frequently does the patient see his or her primary provider Brain tumors, subdural hematomas, small infarcts, and cerebral atrophy may be undetected on routine neurological examination, whereas the cognitive effects of these lesions may be apparent on an MSE. Major Components of the full MSE 1. Appearance  Age  Gender  Race  Body build  Posture  Eye contact  Dress  Grooming  Manner  Attentiveness to examiner  Emotional facial expression  Alertness 2. 3. Motor  Behavior: Pleasant? Cooperative? Appropriate for the particular situation?  Hesitancy  Agitation  Abnormal movements