CASE STUDY 2 (Suicidal Ideation)

Student’s Name: Abella, Erma E. Date: 7/10/2021 Score: ____ /15

CASE: Zeus
Case: A roommate found Zeus in his apartment after an overdose of aspirin. He was taken to the
emergency department and then admitted to the psychiatric unit. Zeus is 35 years old. He recently lost
his job. When his roommate was asked about the overdose. He took approximately 30 pills and assumed
that his roommate knew that he would be home within the hour. The nurse’s physical assessment
revealed that he was quiet and responded slowly to questions. He denied wanting to kill his self and
stated that he just wanted some peace. He said that he had only slept a maximum of four hours per
night in the last month or two and had lost 15 pounds. When Zeus was told he would receive one-to-one
supervision, he became angry and shouted, “I am not a prisoner”
1. Based on these data, what is the level of risk for Zeus’ suicidal act? Provide your rationale (3 pts)
Answer: Moderate risk. Suicidal ideation with plan but no intent or behavior due to the pt. losing his job.
Admission may be necessary depending on risk factor. Develop crisis plan Give emergency/crisis
number.

2. What impact might the job loss have had on Zeus? (3 pts)
Answer: Losing a job can led to depressive mental illness and then to commit suicide. Loss of appetite
and lack of sleep are signs that the pt. is suffering from depression, as stated by the pt. he had only slept
a maximum of four hours per night in the last month or two and had lost 15 pounds.

3. What data provided indicates that Zeus is depressed? (3 pts)

Answer: Losing his job and he had only slept a maximum of four hours per night in the last month or two
and had lost 15 pounds

4. How would you respond to Zeus outburst about one-to-one supervision? (3 pts)
Answer: Maintain eye contact with the patient and just listen. Try to understand the event that
triggered the angry outburst. Explain to the client the purpose of one-to-one supervision and how it will
help him overcome his problem.

5. What other intervention is often used with suicidal clients to focus on their responsibility for their
own action? Describe the intervention. (3 pts)
Answer: Using an Authoritative Role
- The nurse assumes an authoritative role to help clients stay safe. In this crisis
situation, clients see few or no alternatives to resolve their problems. The nurse lets
 clients know their safety is the primary concern and takes precedence over other
needs or wishes.
Providing a Safe Environment
- Staff members remove any item they can use to commit suicide, such as sharp
objects, shoelaces, belts, lighters, matches, pencils, pens, and even clothing with
drawstrings.
- The clients are in direct sights of and no more than 2 to 3 ft away from a staff
member for all activities.
- Staff members usually need to explain the purpose of such supervision more than
once.
- At no time should a nurse assume that a client is safe based on a single statement
by the client.
Creating a Support System List
- The nurses assess support systems and the type of help each person or group can
give a client. Mental health clinics, hotlines, psychiatric emergency evaluation
services, student health services, church groups and self-help groups are part of the
community support system.
- The nurse makes a list of specific names and agencies that the client can call for
support; he or she obtains client consent to avoid breach of confidentiality.

CASE STUDY 3 (Major Depressive Disorder)

Student’s Name: Abella, Erma E. Date: 7/10/2021 Score: ____ /15
Case: Michaela
Case: A 52-year-old female, Micaela, is bookkeeper for a large company. For the past month, Michaela’s
husband has noticed that his wife is irritable, tearful, does not seek out any friends, and has insomnia.
He suggests that she should seek mental health care and accompanies her to the appointment. Michaela
tells the psychiatrist that she has been working long hours, is often alone because her husband travels,
and her only daughter is getting married in three months. Her request for vacation time prior to the
wedding was denied. She expresses feelings of “wanting an end to it all”
The psychiatric nurse documents the following assessment: Michaela has a SAD affect, insomnia, weight
loss, psychomotor retardation, and possible suicidal ideation. The psychiatrist diagnosis Michaela with
depressive disorder and recommends partial hospitalization (day treatment admission) for further
assessment and initial treatment. Michaela agrees and is admitted voluntarily to the partial hospital
program. Admission orders include sertraline (Zoloft) 50 mg. every morning.
1. Identify the client’s priority problems requiring immediate nursing intervention. (5 pts)
Answer:
- Risk for suicide
- Imbalanced nutrition: Less than body requirements
- Anxiety
- Ineffective coping
- Hopelessness
- Ineffective role performance
- Self-care deficit
- Chronic low self-esteem
- Disturbed sleep pattern
- Impaired social interaction
2. Provide the rationale for the priority problems. (5 pts)
Answer:
Nursing intervention
Provide a safe environment for the client
Continually assess the client’s potential for
suicide.
Remain aware of this suicide potential at all times
Reorient the client to person, place, and time as
indicated
Spend time with the client
When approaching the client, use a moderate-
level tone of voice
Use silence and active listening when interacting
with the client. Let the client know you are
concerned and you consider the client a
worthwhile person
Avoid asking the client many questions, especially
questions that require brief answer
Allow the client to cry. Stay with and support the
client if he or she desires. Provide privacy if the
client desires and it is safe to do so
Teach client about positive coping strategies and
stress management skills, such as increasing
physical exercise, expressing feelings verbally or
in a journal, or meditation techniques. Encourage
rationale
Physical safety of the client is a priority. May
common items may be used in a self-destructive
manner.
Clients with depression may have potential for
suicide that may or may not be expressed and
that may change with time
Repeated presentation of reality is concrete
reinforcement for the client
Your physical presence is reality
Being overly cheerful may indicate to the client
that being cheerful is the goal and that other
feelings are not acceptable
The client may not communicate if you are
talking too much. Your presence and use of active
listening will communicate your interest and
concern
Asking questions ad requiring only brief answers
may discourage the client from expressing
feelings
Crying is a healthy way of expressing feelings of
sadness, hopelessness, and despair. The client
may not feel comfortable crying and need
encouragement or privacy
The client may have limited or I knowledge of
stress management techniques or may or have
used positive techniques in the past. If the client
tries to build skills in the treatment setting, he or
 the client to practice this type of technique while she can experience success ad receive positive
in the hospital feedback for his or her efforts.
3. Upon admission to the partial hospital program unit, the client tells the nurse “I don’t really need to
be here” Write a response to the client’s statement. (3 pts)
Answer: “My name is Erma, I’m your nurse today. I’m going to sit with you for a few minutes. If you
need anything, or if you would like to talk, please tell me”