A 62-year-old female is admitted to the general medical unit upon recommendation from her oncologist because of "low blood counts."

CASE 6-34 Performance and Quality Evaluation and Improvement of the Health Information Management Department You have just been hired as the HIM quality coordinator.
November 13, 2019
During a client assessment, the nurse notes the costal angle is greater than 90° degre and anterior/posterior lateral chest ratio
November 13, 2019

A 62-year-old female is admitted to the general medical unit upon recommendation from her oncologist because of "low blood counts."

A 62-year-old female is admitted to the general medical unit upon recommendation from her oncologist because of “low blood counts.” She has had multiple recent hospital admissions for this same condition resulting from Myelodysplastic Syndrome in which the bone marrow does not produce enough healthy cells. She also has had recent valve surgery for aortic stenosis. During this admission, she received Neupogen, a protein to stimulate her bone marrow and white blood counts, with no success. The patient has expressed the wish to die.

She was then transferred to the Psychiatric Unit for close observation and evaluation for the possible diagnosis of Major Depression. On the psychiatric unit, the nurses notice that she has one cousin who comes to visit, but no other visitors have been seen. The patient has verbalized that she is “tired of all the admissions and sometimes wishes she would just die.” You as the nurse come in to assess the patient and find her lying in bed staring at the ceiling. The patient looks at you when spoken to but there is no verbal response. The morning shift nurse tells you that the patient refused to eat breakfast and would not get out of bed to get cleaned up. Vital signs: BP 118/62, HR 62-regular, RR 14, Temp 98.6

  1. Provide a nursing diagnosis with rationales to explain your initial assessment.
  2. Explain the screening process for this patient with suicidal thoughts and behaviors.
  3. State two questions you would ask this patient to assess the current suicidal risk.
  4. List symptoms of major depression from the DSM5. Does this patient demonstrate any of these symptoms?
  5. Which screening tool would you use to assess this patient and why?
  6. Describe 4 nursing interventions for this patient. Two interventions should be pharmacological and two should be non-pharmacological.
 

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