Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example

Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example

Clinical: SOAP Note 

Consent: Verbal consent for psychiatric interviewobtained from the client and her mother.

Client ID: 14-year-old Caucasian female

Subjective.

Chief complaint: The mother is concerned that the client “is planning to kill herself tonight. Source of reliability: Client and the mother.

Present Illness: The client is a 14-year-old female checked in at the emergency department by her mother, who believes she intends to kill herself tonight. The client has a history of depression and self-harm. The client denies being worried and describes her mood as “scrap.” The clients admit to not wanting to do anything or care about anything.  The client constantly argues and quarrels with the mother, and today, they had a massive fight. She feels the relationship with the mother is getting worse while her brother gets whatever he wants. She notes that her mother must always “have a go” on her. She is neither delusional nor hallucinating. She reports cutting her legs every day but does not think of harming others. She lies in bet the whole day thinking about dying all the day by “jumping from a bridge” or a “train track.” She has no plan to commit suicide, and she is worried her mom will be upset with her actions. She admits looking up bus timetables to take her to the bridge tonight. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Current psych meds:  None reported.

Past psychiatric history: None reported.

Past Medical Hx: Denies CNS, endocrine, cardia, respiratory, or neurological issues. No surgical history. Denies history of chronic problems.(Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Allergies: NKFDA.

Substance use/abuse: Occasionally drinks. No drugs.

Past family, social history: Lives with the mother and brother. No legal trauma. Have constant arguments/quarrels with the mother, and the relationship is growing worse.(Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Family psych hx: None reported.

Education/Employment/Disability: No education or employment reported.  No disability.

Primary support system: Mother.

Hobbies: None reported.

Review of systems:

Constitutional: No weight loss, fever, or chills.

Eyes: No vision loss.

ENT: Hearing and smelling senses are intact. No sore throat.

Cardiac: No chest pains.

Respiratory: No cough or wheeze.

GI: Normal bowel sounds. No abdominal pain.

Skin: Moist and warm

Neurologic: No fatigue, seizures, or numbness.

Endocrine: No frequent or burning urination.

Musculoskeletal: No joint swelling or pain.

Objective:

Vitals: BP: 119/71 P: 71 Ht: 4”9” Wt: 85lbs BMI: 18.4 kg/m²

Appearance: Appropriately dressed in casual attire.

Attitude/interaction: Positive and cooperative.

Activity level/behavior: Calm. Maintains fair eye contact.

Orientation: Alert and oriented × 3.

Speech: Fluent and clear.

Thought content/process/perception: Resigned. Negative thoughts about self were noted during the assessment.(Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Mood/affect: Describes her mood as “scrap.” Effect is flattened.

Judgment/insight/cognitive/memory: Poor judgement and insight.Difficulty with abstract thought.

Concentration: Appropriate for the occasion.

Stability: Unstable. Acute risk to self is high.

Testing UDS negative.

Alcohol: Positive

Assessment:

1. Major Depressive Disorder (MDD). ICD-10 code is F33.2. The client experiences recurrent episodes of MDD characterized by depressed mood nearly every day marked diminished pleasures in all activities, psychomotor agitation, and recurrent thoughts of death, unplanned suicide ideation, and feelings of worthlessness (American Psychiatric Association, 2013). This is the primary diagnosis.
2. Oppositional Defiant Disorder (ODD). ICD-10 code is F91.3. The client experiences ODD diagnostic symptoms, including a pattern of irritable mood and argumentative behavior associated with distress from a family member (American Psychiatric Association, 2013), often resentful and blames the mother for her misbehavior. This diagnosis is refuted. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)
3. Persistent Depressive Disorder (PDD). ICD-10 code is F34.1. The client experiences PDD diagnostic symptoms, including depressed mood for most of the day, low self-esteem, and hopelessness, causing clinically significant distress (American Psychiatric Association, 2013). This diagnosis is refuted. The depressed mood should be observed for at least two years and is better explained by MDD. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)
4. Generalized Anxiety Disorder (GAD). ICD-10-CM code is F41.1.The client presents symptoms associated with GAD diagnosis, including excessive worry, restlessness, and irritability that cause significant distress (American Psychiatric Association, 2013). This diagnosis is refuted. MDD better explains the client’s condition. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)
5. Disruptive Mood Dysregulation Disorder.  ICD-10 code F34.8. Recurrent temper outbursts characterize DMDD manifested verbally inconsistent with an individual’s development level, occurring at least three times a week, and irritable (American Psychiatric Association, 2013). This criterion is observed before the age of 10. Therefore, this diagnosis is refuted. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Plan:

Goals

• Lear to identify maladaptive thoughts and how to cope with them or replace them with positive ones.
• Report no suicide ideation for at least three weeks
• Learn coping skills, i.e., problem solving and emotion regulation.
• Identify at least three areas of interest and get actively involved.
• Develop safety plan/no-self harm contract (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Treatment

• Triage to an inpatient setting for one-week monitoring.
• Start fluoxetine 10mg PO QD for one week. The dosage is to be increased by 10mg per week with a maximum of 40mg, depending on the patient’s response.
• Start individual therapy.
• Start family therapy. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Referral: Refer to an immediate psychotherapist.

Plan Summary: Counselling, Monitoring and Follow Up

The first choice of plan is to triage the client to an inpatient for one-week monitoring. The client has a history of deliberate self-harm and has a deliberate intent to commit suicide. These risks are acutely elevated. Inpatient emergency department therapeutic intervention for teenagers with acute threats of self-harm/suicide can advance the continuity of care, connecting with follow-up (Asarnow, Babeva & Horstmann, 2017). The inpatient setting provides a safe environment, constant monitoring, and immediate response to a client’s situation. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

The client presents severe major depressive disorder whose symptoms are better managed by fluoxetine in children and adolescents. The FDA approved fluoxetine as an SSRI for MDD intervention in children aged eight years and above (Sohel, Shutter & Molla, 2017). Fluoxetine acts by increasing serotonin in the brain, which helps maintain mental health by treating MDD symptoms. The low dosage should minimize side effects and improve tolerability. However, the bedside nurse/patient/caregiver should monitor and report prolonged side effects, including diarrhea, anorexia, drowsiness, anxiety, and nervousness. Persistent side effects can trigger a change in medication for optimal patient outcomes. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Treatment interventions for suicide ideation beyond emergency admission take time and aim at addressing affected individuals personally. Individuals with low self-directed negative thoughts and low-esteem often view themselves as flawed or unwanted (Hunt, Sandoval-Barrett & Diamond, 2017). Individual cognitive-behavioral therapy increases the frequency and intensity of suicidal thoughts and improves personal and relationship coping skills by identifying and getting involved in exciting activities (Méndez-Bustos et al., 2019). Moreover, individual therapy will help the client learn and implement coping skills, place, process and restore her negative feelings and concerns. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Family therapy recreates and establishes a robust parental attachment as the basis for recuperation following an inpatient admission (Hunt, Sandoval-Barrett & Diamond, 2017). In this case, the relationship between the patient and the mother that escalates suicide ideation would be resolved.  Equally, the psychoeducation with the mother will help resolve persistent conflicts, restore good communication, and establish an appropriate safety plan. Family therapy increases parental insight on a child, increasing their ability to encourage and support the patient to utilize their learned coping skills. Family therapy also explores and helps the family to understand their dynamics, negative stimuli and learn conflict resolution skills. (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.    (Suicidality in Pediatrics and Adolescents Comprehensive Nursing Essay Example)

Sohel, A. J., Shutter, M. C., & Molla, M. (2017). Fluoxetine. Retrieved 22 September 2021, from https://www.ncbi.nlm.nih.gov/books/NBK459223/

Asarnow, J. R., Babeva, K., & Horstmann, E. (2017). The emergency department: challenges and opportunities for suicide prevention. Child and Adolescent Psychiatric Clinics, 26(4), 771-783. https://doi.org/10.1016/j.chc.2017.05.002

Hunt, Q., Sandoval-Barrett, J., & Diamond, G. (2017). Attachment-based family therapy with suicidal adolescents: An overview. Psychiatric Annals, 47(8), 412-415. http://dx.doi.org/10.3928/00485713-20170707-01

Méndez-Bustos, P., Calati, R., Rubio-Ramírez, F., Olié, E., Courtet, P., & Lopez-Castroman, J. (2019). Effectiveness of psychotherapy on suicidal risk: a systematic review of observational studies. Frontiers in psychology, 10, 277. https://doi.org/10.3389/fpsyg.2019.00277