A nurse in a mental health facility is assessing a client.

• The client has a medical history of major depressive disorder for 20 years, anxiety disorder, suicide ideation during teenage years, and psychotherapy for the past 10 years with a therapist.
• The client's mother committed suicide when the client was 25 years of age, and the father died of heart disease 10 years ago.
• The client has a history of alcohol misuse, attended in-patient rehabilitation 4 years ago with no alcohol use since that time.
• The nurse notes indicate good physical health with no reported morbidities.

For each client assessment finding, specify if the finding is a potential risk for suicide or a protective factor against suicide.

Rationale:

Choice A: While social isolation can be a risk factor for suicide, spending time with close friends can actually be protective. This statement alone does not suggest an increased risk.

Choice B: Religious involvement and participation in religious activities can be protective factors against suicide by providing support, meaning, and a sense of belonging. This statement does not indicate a specific risk.

Choice C: Consistent, healthy sleep patterns are generally associated with positive mental health and are not indicative of suicidal ideation. This statement does not raise concerns for suicide risk.

Choice D: Exposure to suicide, particularly within one's social circle or among individuals one admires, is a significant risk factor for suicide due to the phenomenon of "social contagion." The recent suicide of the adolescent's favorite actor increases his vulnerability and necessitates immediate assessment and intervention.

Social contagion refers to the tendency for suicidal behaviors to spread within a community or group, particularly among adolescents and young adults. Exposure to a suicide can trigger suicidal thoughts and feelings in vulnerable individuals, especially if they identify with the deceased or perceive the suicide as a viable coping mechanism.

The adolescent's age (15 years) is also a crucial factor. Adolescence is a period of heightened emotional vulnerability and increased risk for suicidal ideation and behavior due to various developmental and psychosocial challenges.

The father's concern suggests that the adolescent may be exhibiting other concerning behaviors or changes in mood or behavior. The nurse should gather more information and conduct a comprehensive suicide risk assessment to determine the level of risk and implement appropriate interventions.

Additional considerations:

The nurse should inquire about the nature of the adolescent's relationship with the deceased actor, his emotional state since the suicide, and any other potential stressors or vulnerabilities he may be facing.

The nurse should involve the parents in the assessment and intervention process, providing them with education and resources on suicide prevention and support.

If the assessment indicates a high risk of suicide, the nurse should immediately refer the adolescent to a mental health professional or emergency department for further evaluation and treatment.

Remember: Suicide is a serious public health issue, and early identification and intervention are crucial in preventing tragic outcomes. School nurses play a vital role in recognizing warning signs and providing timely support and resources to adolescents at risk.

To calculate the amount of fluoxetine to administer, we can use the following steps:

Step 1: Identify the desired dose, which is 40 mg.

Step 2: Identify the available dose, which is 20 mg/5 mL.

Step 3: Set up the equation to solve for the unknown, which is the volume in mL. The equation is (Desired Dose ÷ Available Dose) × Volume = Volume to Administer.

Step 4: Substitute the known values into the equation: (40 mg ÷ 20 mg) × 5 mL = Volume to Administer. Step 5: Solve the equation: 2 × 5 mL = 10 mL.

So, the nurse should administer 10 mL of fluoxetine.