Unit 7 Suicide and Non Suicidal Behavior Chapter 25

Question 1

What is Suicide?

Answer 1

Suicide is death caused by self-directed inju- rious behavior with the intent to die as a result of the behavior

Suicide is the intentional act of end- ing one’s life by any means.

Question 2

What is suicidal ideation?

Answer 2

Suicidal ideation is thinking about death, including the wish to be dead, considering methods of accomplishing death, and formulating plans to carry the act out.

Question 3

What is a suicidal attempt?

Answer 3

A suicide attempt, also referred to as a suicidal act, is engaging in potentially self-injurious behavior with the intention of death. These attempts may result in death, injuries, or no injuries. Suicide is the intentional act of end- ing one’s life by any means.

Question 4

Which of the following members of society is at #1 risk for suicide?

A. Military personels
B. Nurses
C. Fire fighters
D. Police men

Answer 4

A. Military personels

Military is increasingly concerned about suicide rates

Veterans are at high risk for suicide

Question 5

What is a risk factor for suicide?

Answer 5

Previous suicide attempt
* Hx of suicide in the family
* Substance use
* Mood disorders – Depression, Bipolar
* Access to lethal means
* History of Trauma or Abuse
* Professionals are considered a higher
risk for suicide. Law enforcement, sales
personnel, mechanics, insurance agents
and lawyers
* Losses and other events
* Breakup(a breakup can feel like the end of the world)
* Death
* Bullying
* Legal difficulties(fraud or bankruptcy)
* Financial difficulties(job layoff , losing all of your money in the stock market, tripling debt)
* Academic failures
* Chronic Physical illness including chronic
pain

• Exposure to the suicidal behavior of
  others

Question 6

What is an example of a patient who is Exposed to the suicidal behavior of
others?

Answer 6

their favorite celebrity committing suicide, which induces them to commit suicide as well

Question 7

What is the number one nursing intervention when a patient expresses suicidal ideation?

A. verbal deescalation
B. initiate restraints
C. initiate Seclusions
D. 1-to-1 watch

Answer 7

D. 1-to-1 watch

Question 8

S/S of a possible suicidal attempt ?
WARNING FACTORS

Answer 8

• Talking or writing about death, dying or suicide
• Comments about being hopeless, helpless or worthless
• Expressions of having no reason for living
• Increase alcohol and/or drug misuse
• Withdrawal from friends, family and community
• Dramatic mood changes
• Talking about feeling trapped or being a burden to others

Question 9

Who is at greatest risk for suicide?

A. 26 year old female who has a suicide attemptted at 25 years old
B. 12 yer child who’s dog has past
C. wife who lost her husband
D. 26 year old who just got fired from his job

Answer 9

A. 26 year old female who has a suicide attemptted at 25 years old

Attempted suicide in the past (especially past 12 months)
HIGHEST PREDICTOR OF SUICIDE

Question 10

Your patient has been selling all of his possessions following the start of antidepressants. what is the priority nursing intervention?
A. assess for suicidal ideation
B. initiate 1 to 1 observation
C.

Answer 10

like giving away possessions, sudden mood brightening, just starting antidepressants, organizing affairs, etc..

Question 11

What is cheeking?

Answer 11

not taking medication , nonahderance to medication

Question 12

Suicidal Precautions

Answer 12

 1:1 observation
 Remove any object that could be potentially harmful
 Hands always in view
 Monitor swallowing medications  Etc.

Question 13

Assessing the suicidal plan

Answer 13

Do you have a plan? (Even if no plan, take the threat SERIOUSLY
they can always get another plan)
 establish rapport
 Ask about the plan
 do they have a plan, is it detailed
how lethal is the plan
 do they have access to do it

Question 14

Which of the following patient at the GREATEST risk of committing suicide?

A. a 12 year old child who has been bullied at school about her appearance.
B. A women who has lost her keys.
C. A police men who has lost his family due to a tsunami and his home
D. A foster child

Answer 14

C. A police men who has lost his family due to a tsunami and his home

Question 15

Assessing Lethality

Answer 15

• cutting is less lethal than having a gun
  -do thy have car to drive off a mountain but they live in Florida not California

Question 16

What are some protective factors for suicide?

Answer 16

• Effective mental healthcare; easy access
• Strong connections to individuals, family, community, and social institutions
• Problem-solving and conflict resolution skills
• Contact with providers
• Some religions

Question 17

Assessment for suicial ideation and suicide attempt

Answer 17

If there is a history of suicide attempt:
* Assess intent
* Lethality
* Injury
* Medical conditions(Cystic fibrosis - poor prognosis)
* Psychiatric diagnosis
* Current meds(TCA’s -cardio toxic , amtriptiline) weekly rx

Question 18

Assessment for Suicadal patient

Answer 18

Assess risk factors
* Assess protective factors that may be
built upon
*A change from sad or depressed to
happy ad peaceful may be a red flag.
Especially if recently beginning an
antidepressant
* Always assess social supports and
helpfulness of significant others

Question 19

Which of the following behaviors is a red flag in a depressed client?

A. Reports feeling depressed ever since his dog died
B. Telling you that he’s been giving away his valuables away after starting antidepressants.
C. Becomes traumatized every time he hears fireworks
D. Complains of insomnia after taking methylphenidate

Answer 19

B. Telling you that he’s been giving away his valuables away after starting antidepressants.

*A change from sad or depressed to
happy ad peaceful may be a red flag.
Especially if recently beginning an
antidepressant

Question 20

What is an example of a verbal cue of suicidal ideation?
Direct vs Indirect

Answer 20

Verbal and nonverbal clues
* *Direct verbal statement – “I am going to blow my brains out”**
* “I can’t take it anymore.”
* “Life isn’t worth living anymore.”
* “I wish I were dead.”
* “Everyone would be better off if I died.”

• *Indirect verbal statement – “My family would be better off if I weren’t around”**
• “It’s okay now. Soon everything will be fine.”
• “Things will never work out.”
• “I won’t be a problem much longer.”
• “Nothing feels good to me anymore and probably never
  will.”
• “How can I give my body to medical science?”

Question 21

What is an example of a nonverbal cue of suicide?

Answer 21

• Nonverbal –
  sudden brightening of mood and increased energy. THEY HAVE A PLAN
  Giving away prized possessions
  , getting affairs in order

Question 22

What do you do when you suspect someone is suicidal?

Open or closed ended question?

Answer 22

CLOSED ENDED
Yes or NO

What do you do when you suspect someone is suicidal?
* ASK – Directly – “Are you having thoughts of ending your life?” “Are you thinking
about killing yourself?”

Question 23

Should ALL threats of suicide be taken seriously ?

A. Yes
B. Yes

Answer 23

A. Yes

• All threats of suicide are taken seriously

Question 24

Lethality , SOFT VS HARD METHOD

Answer 24

Lethality – How quickly the person would die from that mode
* Hard method: using a gun, jumping from high place, car crash
* Using a gun
* Jumping off a high place
* Hanging
* Poisoning with carbon monoxide * *Staging a car crash

• Soft method: cutting self, ingesting pills

Question 25

What does means relate to according to a suicidal plan

Answer 25

• Means – do they have access
• If the person has access o the proposed method the situation is more serious.
  Nursing Diagnosis with the HIGHEST priority is risk for suicide

Question 26

Interventions for suicide

Answer 26

Prevention is a primary intervention
* Decrease stigma
* Educate about suicide
* Training

Question 27

Treatment for suicide

Answer 27

Treatment
* Safety – increased supervision one to
one

• Safety plan – six-step plan that includes
  identifying warning signals, copping
  strategies, identifying support systems
  and identifying something most important
  to them (worth living for).

Question 28

benefits of lithium

Answer 28

-neuroprotective
-decreases suicidal ideation

Question 29

Primary prevention for suicide

Answer 29

Prevention is a primary intervention and includes activi- ties that provide support, information, and education to pre- vent suicide (Box 25.3).

Primary intervention is practiced in a wide variety of community settings, such as schools, homes, churches, clinics, hospitals, and work settings. Elementary school children are screened using evidence-based tools that focus on both risk factors and warning signs. High schools are adopting suicide prevention curricula that involve ele- ments of education, peer support, discussions about risk and prevention factors, and warning signs.

** Develop, implement, and monitor effective programs that promote well- ness and prevent suicide and related behaviors.**

Question 30

Goals of the National Strategy for Suicide Prevention

Answer 30

• Integrate and coordinate suicide prevention activities across multiple sec- tors and settings.
• Implement research-informed communication efforts designed to prevent suicide by changing knowledge, attitudes, and behaviors.
• Increase knowledge of the factors that offer protection from suicidal behav- iors and that promote wellness and recovery.
• Promote responsible media reporting of suicide, accurate portrayals of sui- cide and mental illnesses in the entertainment industry, and the safety of online content related to suicide.
• Develop, implement, and monitor effective programs that promote well- ness and prevent suicide and related behaviors.
• Promote efforts to reduce access to lethal means of suicide among individ- uals with identified suicide risk.
• Provide training to community and clinical service providers on the preven- tion of suicide and related behaviors.
• Promote suicide prevention as a core component of healthcare services.
• Promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors.
• Provide care and support to individuals affected by suicide deaths and attempts to promote healing and implement community strategies to help
  prevent further suicides.
• Increase the timeliness and usefulness of national surveillance systems
  relevant to suicide prevention and improve the ability to collect, analyze,
  and use this information for action.
• Promote and support research on suicide prevention.
• Evaluate the impact and effectiveness of suicide prevention interventions
  and systems and synthesize and disseminate findings.

Question 31

Postvention continued(SUPPORT SURVIVORS AND FAMILY OF DECEASED)

Answer 31

**Healthcare providers are often involved in providing men- tal healthcare and support to survivors, which is referred to as postvention. **

Survivors recommend the following suggestions to healthcare professionals:
* If being a survivor is the main reason an individual seeks
treatment, remember that the survivor, not the deceased, is the patient. Focus on the patient’s thoughts and feelings, and do a thorough assessment as you usually would.
* If you are a friend or relative of a suicide survivor, remem- ber that the most difficult time for these survivors is not so much in the immediate aftermath of the suicide. Rather, it is in the weeks, months, and years following their loss. Make frequent efforts to reach out to these individuals, especially on the most difficult anniversary dates. Do not be afraid of talking about the deceased person. In fact, speak of them often. While this may seem counterintuitive and uncomfort- able for most, survivors of suicide want their loved one to be remembered in this way. Talking reduces the hurt, isolation, and stigma.

Question 32

Postvention suicide support

Answer 32

Postvention – support and mental healthcare provided for survivors
* Survivors of Suicide -
* Overwhelming amounts of guilt, shame, abandon – encourage dialogue about their
thoughts and feelings (decreases anxiety)
* Focus on the person’s thoughts and feelings, not the deceased
* Most difficult time may not be immediately, more so in the months to come
* Encourage family and friends to check on each other frequently
* Recommend Community Resource

Question 33

NONSUICIDAL SELF-INJURY

Answer 33

These injuries are deliberate and direct
attempt to inflict shallow but painful injuries
* There is NOT an intent to end one’s life
* Cutting, burning, scratching, scraping
* Intent
* Alleviate psychic pain
* Pierce psychic numbness
Get attention
* Escape a responsibility
* Avoid a situation

Question 34

Tx for wounds

Answer 34

treat it inn a matter a fact way

Question 35

What is a reason why a patient may participate in NSSI BEHAVIORS

Answer 35

To get attention
Numb the pain

These injuries are deliberate and direct
attempt to inflict shallow but painful injuries
* There is NOT an intent to end one’s life
* Cutting, burning, scratching, scraping
* Intent
* Alleviate psychic pain
* Pierce psychic numbness
Get attention
* Escape a responsibility
* Avoid a situation

Question 36

Benefits of CLOZAPINE (2nd gen antipsychotic)

Answer 36

decreases suicidal ideation but puts patients at high risk for infection,