Yet another care plan question..... psych nurses, help!

he wouldn't be in the psych ward if his respiratory symptoms need attention. that i can tell you from working in an acute hospital that had locked psych wards. the psych wards never took any patients that had medical problems that needed medical attention. the poor nurses on the medical units just had to deal with the psych patient's behavior until they were well enough to get turfed (transferred) to the psych ward. a suicide case would have had sitters placed round the clock on them or the patient was put in the icu for one-on-one care until they could be transferred to the psych ward.

i had a copder who actually did attempt suicide while i was on duty. he watched our routines very carefully. but he needed o2 and without it became hypoxic. he could not ambulate without assistance. the evening before his attempt he gave away some of his possessions, a warning signs of what he was about to do. no one got the hint. at around 5am while it was quiet and most of us were catching up on our charting he took a razor blade from his shaving supplies and slashed both of his wrists and both sides of his neck attempting to slash is carotid arteries. the sad thing is that he was so weak that he failed to do much if any damage. he also removed his oxygen. when i went into his room around 6am to give him his medications i found him in high fowler's position and unresponsive, barely breathing. i couldn't arouse him because he was so hypoxic and cyanotic. he had the razor blade in his hand and i noticed his wounds which were hardly bleeding. it took his doctor over 2 hours to suture all the lacerations. sadly, the man was found face down, dead, over his dinner tray that next evening. natural causes. he never would have been transferred to the psych ward because of his medical condition and his doctor who spent a good deal of time with him that morning felt he was no longer a danger to himself.

a more likely scenario (i've seen this happen, too) is that your patient gets round the clock sitters and on your shift the sitter decides to take a potty break while the patient "seems" to be napping. while she's gone, the patient uses the opportunity to paw through the sitter's purse and finds himself a weapon which he uses later the next shift. a pair of scissors or a knife should do nicely. i had a patient who took a pair of scissors from their makeup kit and stab themselves in the chest with them. a pair of shears would make a great weapon for a teenage male. sitters are not known to be the smartest tacks in the box and this is a highly plausible situation. many sitters are not even certified cnas. all they have to do is literally sit and watch the patient.

the diagnoses for someone who has just attempted suicide are

• risk for suicide r/t prior suicide attempt, chronic illness aeb a suicide plan, talk of suicide and suicide cues
  
• hopelessness r/t deteriorating condition, perceived helplessness, powerlessness, perception of a discouraging future aeb poor affect, lacks motivation and no interest in moving forward in life
  
• ineffective coping r/t situational crisis, inadequate resources, poorly developed social skills aeb inability to problem solve appropriately, destructive behavior, doesn't meet role expectations
  

the only time i saw them put anyone in leathers and/or the lock down room was if they were violent to other patients or themselves or as a punishment. otherwise, they were allowed to walk around the unit, but the unit itself was locked. only the staff had keys to the door of the unit so they could get in and out. they would have made sure that there were no dangerous objects that the patient could get their hands on. doors to the pantry or utility rooms were closed and locked at all times. i mean the unit was barren of things like lamps (which an angry person could pick up and throw at someone) or a vending machine which someone could put their fist through. when i did my psych rotation on a schizo unit there were a number of people who were suicidal walking around and talking about offing themselves. it was sad. we were told to sit and listen to them. it's when they stop talking about it that the staff starts to worry. that usually means that they have decided to do it and the time for talking about it (indecision) is past.

sure, put him on a mild dose of ativan or valium...something like that.

so, you're getting him after a suicide attempt and you don't know that he's going to try again and be successful. so, when he comes to you he's still despondent. use hopelessness r/t deteriorating condition and perceived helplessness aeb poor affect, despondency, doesn't want to get involved in doing his breathing treatments anymore, lacks motivation to help self. your long-term outcome for him is that he will express the will to live. goal is that he will begin doing his own breathing treatments again and start to attend counseling.

we had 3 locked psych units. there were several deaths on them, i heard. one was a hanging with sheets. the other was someone who took a dive out a window (these units were 8 stories up--don't know what genius made that decision). there had to be people who were not paying attention for these things to happen. then again, like my little copder, patients who are determined to carry out a plan can and will succeed.