Natalie is a 21 year old woman who was admitted to an acute psychiatric unit following a suicide attempt. She had taken an overdose of quetiapine (~800 mg).

Natalie is a 21 year old woman who was admitted to an acute psychiatric unit following a suicide attempt. She had taken an overdose of quetiapine (~800 mg).

A flat mate found her difficult to rouse in the bath in the early evening (~ 2 hours latter) and called an ambulance. Natalie had previously presented with generalised anxiety disorder and hypomanic symptoms at the student health clinic and she had been prescribed quetiapine (200 mg daily) after consultation with a visiting psychiatrist.
Context
Natalie was admitted to the emergency department. She initially presented with drowsiness tachycardia (160 / min) hypotension (90/60) and akathisia. After gastric lavage and 2mg lorazepam IV she was monitored for 8 hours before transfer to the psychiatric ward at 2200 hrs.
You are the nurse assigned to care for her on the morning shift and to complete an initial assessment.
Handover
Natalie is a 21 year old student who attempted overdose yesterday afternoon on Seroquel. She was transferred to us at 2200. She was quite drowsy at the time and not very coherent but did indicate that she had intended to die and did not anticipate her flatmates discovering her so soon. She has been experiencing considerable stressors recently: She has been struggling with her studies She is in her second semester at University studying statistics and believes she is failing She recently split up with a boyfriend of several years who lives in her home town (about three hours drive away) because of the difficulty maintaining a relationship over such a distance and she appears to have depleted most of her savings by gambling on an on-line casino several months ago.
Natalie was fairly sleepy so we didnt glean much more history from her. Her obs are all fine weve been checking hourly. She has a ferociously dry mouth and shes drunk approximately 2 litres of water over night. Shell need to see the psychiatrist this morning and have repeat bloods.
Natalie has been admitted to the ward for post-attempted suicide for monitoring. The Health team (nurses) will have to gain a better understanding on Natalies background and future thoughts. For instance Natalie is a college student and therefore will constantly be under pressure for submission of assessments. The following questions seek to establish why Natalie tried to commit suicide:
? Whether she is under any form of stress?
? What is the relationship between Natalie and the boyfriend teachers and students at college?
? What is pushing Natalie to commit suicide?
? Does Natalie take illegal drugs/ substance?
Taking these questions into account the nurses will professionally formulate the clinical strategies that will seek to address Natalies problem. In order to come up with these strategies the nurse will critically reason professionally. The nurse from her findings will formulate a working policy to be used by the psychiatrist and expected medical treatment. This therefore demands that Natalie should be given special and proper attention by the mental health facility whilst in her condition. The nurse should try as much as possible to check on Natalie from time to time to see whether there are changes. By doing so the nurse should keep records for both negative and positive changes on Natalie. This will enable the psychiatric to make necessary recommendations on Natalie. (Scheffer & Rubenfeld 2000)
Scheffer B. and Rubenfeld M. (2000). A consensus statement on
critical thinking in nursing. Journal of Nursing Education 39 352-359
Clinical reasoning strategies are needed to establish a working formulation by nurse to handle the situation effectively with Natalie by asking questions such as;
? Are suicidal thoughts present?
? When did these thoughts begin?
? How persistent are they?
? Can you control them?


 

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