An adolescent who attempted suicide and was admitted to an ...

[saliriagwu]

An adolescent who attempted suicide and was admitted to an inpatient mental health unit had been assessed as being at high risk of self-harm, but he has shown improvement. His doctor is now considering discharge and asks the nurse's opinion.
 
  Which of the following observations most reliably indicates that he may be ready for discharge to outpatient care? a. He denies that suicide ideation and intent are present.
  b. His family agrees to observe him closely at home.
  c. His SAD PERSONS score has gone from a 4 to a 2.
  d. He focuses on problem solving and hope for the future.

Question 2

Which nursing progress note would most suggest that the treatment plan of a severely depressed and withdrawn patient has been effective?
 
  a. Slept 6 hours straight, sang with activity group, eager to see grandchild..
  b. Slept 8 hours, attended craft group, ate half of lunch, denies suicidal ideation..
  c. Slept 10 hours, personal hygiene adequate with assistance, lost one pound..
  d. Slept 7 hours on and off, reports food has no taste, no self-harm noted..

[cclemon1]

Answer to Question 1

D
Demonstrating effective problem-solving abilities and demonstrating hopefulness and a future orientation (looking forward to what lies ahead) are indicators that the internal turmoil underlying suicide risk is resolving. Denial of suicide ideation and intent may or may not be genuine; patients sometimes deny risk quite convincingly to evade treatment or precautions and resume their efforts to commit suicide. Although his family's willingness to monitor him closely at home will be helpful, it does not mean that the patient himself is ready for discharge. A SAD PERSON score, or any similar rating score, is not in and of itself sufficiently reliable in an individual case to determine that a person is safe. Such assessments are screening tools designed to determine what response should be made at the beginning of treatment, not when a person is safe to discharge.

Answer to Question 2

A
Sleeping 6 uninterrupted hours, actively participating in a group activity, and showing renewed interest in aspects of life previously important to the patient are indicators of progress. In the other choices, the patient attended activities but did not participate and maintained disinterest in food and/or impaired sleep. Patients may falsely deny suicide ideation, so self-reports are not fully reliable indicators, and no self-harm noted, while desirable, also does not necessarily indicate that the desire to die has passed.