Suicide and Suicidal Behaviour

MANAGEMENT OF SUICIDE ATTEMPT

Suicide attempt is a psychiatric emergency and therefore collaborative interventions should be implemented.

Aims of management:
(1). To prevent self harm.
(2). To restore the patient’s functional state.
(3). To restore patient’s self esteem.

1. Establish a positive nurse patient relationship, that will help you in dealing with the patient i.e. attain the patient’s cooperation and trust.
    Immediately sign a caution card for such a patient for easy observation. The patient should be handed over and taken
   over physically using a caution card.
2. Immediate admission of the patient to an isolated room while taking brief history and waiting for the doctor.
3. Create a safe environment for the patient i.e. remove all potentially harmful objects from the patient’s vicinity e.g. sharp objects, belts, glass items, drug tray.
4. Immediate assessment of the patient for; Vital observations, physical injuries of the patient and if they are life threatening we give urgent emergency treatment i.e. arresting of hemorrhage incase ruptured arteries, if cyanotic administration of prescribed oxygen, gastric lavage for ingested poison, immobilization incase of fractures.
5. Also observe patient’s behavior’s like talking about ending his or her life (suicide).Handling dangerous objects, Refusing food,
   Accumulating drugs, Giving away property, Observe feeding since some starve themselves to death, and observe sleep pattern.
6. Assess the patient’s mental status by interviewing the patient, attendants or family member to identify any underlying mental illnesses.
7. Administration of prescribed drugs while re-assuring the patient if conscious
   >  Hydrocortisone 100mg to 200mg 3 times to 4 times incase of poisoning         > Chlorpromazine 100mg nocte incase psychosis induced suicidal attempt
   >   Amitriptyline 75mg nocte incase of depression induced attempted suicide
   >  Prophylactic antibiotics e.g. cloxacillin 500mg qid for 5 days incase of wounds.
8. Chemotherapy 97% of patients with suicidal tendencies have depression hence give;
   > Antidepressants: e.g. Laroxyl 25mg-75mg ddd, Imipramine
   25mg-75mg ddd
   > Mood stabilizers e.g. Carbamazepine, Lithium carbonate,
   Sodium valproate
9. The psychiatrist may order for therapeutic modalities to the patient e.g.
   >  ECT incase of severe depression, 2-3 shocks per week.
   >  Cognitive therapy incase of maladaptive feelings and behaviors
   > Psychotherapy e.g. group therapy, cognitive therapy, individual therapy, family therapy, Occupational therapy to divert the mind from the worries.

Nursing Concerns

1.  Encourage the patient to express his feelings including anger.
2.  Enhance self esteem of the patient by focusing on his strengths rather than his weaknesses.
3. Rehabilitation to acquire skills to earn a living.
4. Occupation of the patient in different activities like board games, football e.t.c to divert his mindset from suicidal thoughts
5. Diet: provision of foods liked by the patient to stimulate his appetite
6. Ensuring 24 hour around the clock close monitoring and observation of the patient
7. Minimizing the number of nurses caring for this patient
8.  Ensuring a good nurse patient relationship
9.  Teaching the patient relaxation techniques incase of stress
10.  Involvement of family members in the management of this patient i.e.
    >  Advising them to keep out reach items that the patient might use to harm herself
    >  Advise them to avoid being discriminative and be more of supportive to patient’s adaptation
    of suicide free life

Advice on Discharge.

•  Patient should take treatment as prescribed.
•  Patient should come back for review.
•  Report any side effects to the nearest health center.
•  Avoid psychosocial stresses others that may cause relapse.
•  Avoid abuse of addictive drugs and alcohol.
•  Family involvement in supporting the patient.
•  Advise community and family members not to isolate the
  patient.