intentional overdose

**canoehead, BSN, RN** · Dec 8, 2005

I'd need a little more information on this one. If she had been researching how to do this on the internet the day before I'd kick her back out into a snowbank.

truern · Dec 8, 2005

anonymous, is there something you'd like to talk about?

anonymous207 · Dec 8, 2005

its not me! i have an essay on how to deal with this situation and can't find anything on protocol (psych student)

Still Riding · Dec 8, 2005

I'd need a little more information on this one. If she had been researching how to do this on the internet the day before I'd kick her back out into a snowbank.

How supportive...LOL

anonymous207 · Dec 8, 2005

Still Riding - that actually doesn't seem to be an uncommon response unfortunately. how would you deal with it?

Nurse Ratched, RN · Dec 8, 2005

How would you handle it? What would be the patient's most immediate needs in such a case (think Maslow)? Help us brainstorm and we'll see where your thinking takes us :).

anonymous207 · Dec 8, 2005

i'm thinking that the most pressing concern is the physical aspect - need to assess the patient and make sure they are stable. we have been told that a referral to a crisis centre would be necessary, but i'm not sure if that would come before a psych assessment or after, as they could get lost in the system and not receive help if they are sent off somewhere else. is this what would happen if the situation did arise?

hbncns35 · Dec 8, 2005

Well Primary - You get her stabilized medically,ask what she took and how much and when. In the meantime you get Psyche to come down and evaluate her. You don't directly question her if you are an ER nurse. If you are seeing her as a psyche nurse you evaluate whether she is a danger to herself or others. You determine whether she is safe and whether or not she will agree to be safe (contract). You put her in a room near the nurse's station and continue to gain her trust and assure her that she is safe. Once you have done that you can slowly question her by giving her an option to answer. You ask general questions then more specific as to her comfort level. You give her time and check on her frequently. You give the rest of the team your info and resolve to find therapeutic interventions. Usually these people are so distraught they block it from their memories 48 hours later. Being compassionate is key but also reminding her the seriousness of her actions and determining what would be best for her when she leaves. Developing some good tools to work on while in the hospital helps if she is faced with the situation again. Good Luck!!hb:wink2:

Noryn · Dec 8, 2005

Are you planning on becoming a psychologist? If so then the appropriate response for nurses which most of us are is going to be different. As far as nursing measures go this will be really generalized but a lot depends on the time frame all of this has happened.

If the overdose of pills has been within a few hours, then first assess the patient to make sure they are breathing and are stable. Get as much information about the pills as you can and relay that information to the doctor or in our case we would notify poison control who would give us guidelines and recommendations. Do this while hooking the patient up to telemetry if appropriate and starting an IV.

Based on the poison control recommendations which need to be ordered by the doctor you will probably be inserting a NG or oral tube to lavage (clean out the stomach). I havent done this in years and it may have changed but we would put normal saline down the tube until it came back clear of pill fragments. Then you will probably put activated charcoal down the tube.

This is VERY GENERALIZED because we dont know a time frame and amount of pills they have taken. Also while you were getting the orders from the doctor or even poison control you notify or have the ward clerk notify the local police. You have to report assaults to them regardless of the patients wishes but you can ask the patient and notify her that you have to.

The sexual assault as bad as it sounds is not really going to be the first priority here. It can and probably will cause years of pain for the patient but you have to think in your head--I have to treat what is going to kill the patient first.

Anyway after I would get the treatment for the drug overdose underway then I would go into detail with the patient about the sexual assault. When did it happen, and what exactly happened. You may have to open up a rape kit which your ER should have protocol for and the doctor will need to do an examination. It will be important to note whether they have had sex since the assault, if they have bathed and if they have changed underwear.

Also during this time frame you would have had someone notify security and other hospital resources based on the policies of your institution.

My biggest concern in answering your question is that I dont know what your field of study is. The answer is going to be much different based on that.

anonymous207 · Dec 8, 2005

would admittance to a psych ward be advised? or would it be better to discharge to family member?

anonymous207 · Dec 8, 2005

i'm studying nursing with psychology