Case Studies and Nursing Care Plan: Suicide
Case Studies and Nursing Care Plan: Suicide Carol Menendez, a 28-year-old divorcee, is admitted to the mental health unit after a suicide attempt. She swallowed 40 amitriptyline pills, 20 diazepam tablets, and 100 acetaminophen tablets. She tells the nurse, Leslie Hamas, that she has had severe depressive episodes since the age of 13 and that she attempted suicide when she was 22. When she was 11, her father left her mother for another woman. He left the state, and she has not seen him since. Her mother told her that he left because she was a bad child. Her mother often told her she was “ugly and worthless,” and she believed her because she was unpopular in school and her classmates called her “fatso.” Ms. Menendez graduated with high marks and scholarships from high school and college but always felt that she was not as smart as her classmates. Ms. Menendez tells the nurse that she has been “crying at work and in the car for the past month.” A group project she was working on received a poor evaluation from the supervisor, and she blames herself. “It would have been good if it hadn’t been for me,” she says. She has been eating more lately and has gained 20 pounds over 2 months. “I’m just disgusting, ugly, and fat,” she says sadly. She shares that she is unable to sleep. “I can’t go to sleep, and when I do I wake up in a couple of hours. I feel exhausted all the time,” she says. “I just wish I could sleep and never wake up. I’m mad that I woke up after I took the pills. I’m going to do something different next time.” Ms. Menendez believes that her job is “ruined” because of the bad evaluation on the group project, and she feels that she may be fired, although she has always received excellent evaluations. She doesn’t see her friends anymore because she “doesn’t deserve them.” The hobby she usually enjoys the most is playing the violin, but she says, “I don’t have the energy, and it isn’t fun anymore.” She hasn’t been taking her antidepressants because “they haven’t been helping.” Ms. Menendez sits slumped in the chair. She looks sad and speaks in a monotone. Her speech is slow and her expression flat. She is wearing no makeup, her clothes are unkempt, and her hair hasn’t been washed for at least several days. Assessment Objective Data • Previous suicide attempt • History of depression since age 13 • Sad affect • Slow, monotone voice • Flat affect • Nonadherent with medications • Hair unwashed • Clothes unkempt • Wearing no makeup • Insomnia • Weight gain of 20 pounds over 2 months • Crying at work and in the car over 2 months Subjective Data • “Ugly and worthless” • “I don’t have the energy, and it isn’t fun anymore.” • “I’m just disgusting, ugly, and fat.” • “I’m mad that I woke up after I took the pills. I’m going to do something different next time.” Nurse’s Personal Perspective Ms. Hamas is concerned for her client. The fact that she is still actively considering suicide is the primary worry. She notes that the client’s outer appearance reflects her feelings; it is obvious from the state of her clothes, lack of makeup, and her neglected hair. Ms. Menendez is overweight, and the nurse knows from talking with her that she ties her self-worth to her weight. TV, movies, and advertising intensify that tendency in women, the nurse thinks sadly. Ms. Hamas also thinks to herself, “I hope I don’t end up feeling hopeless with this client, as I did the last time I took care of a client with depression. I’m going to remember boundaries and discuss this case with my mentor.” Nursing Diagnosis (Identify 2 priority nursing diagnoses using NANDA format; list all objective and/or subjective data supporting the diagnosis) 1.__________________________________________________________________________ a. (List all objective & subjective data supporting the diagnosis) b. c. d. e. 2. __________________________________________________________________________ a. (List objective & subjective data supporting the diagnosis) b. c. d. e. Outcomes Identification (List all your short and long term goals for this patient): 1. 2. 3.
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