Are suicidal thoughts present?
Nursing case study
Background case study 1
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.
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