Diagnosis 3: Risk of serious malnutrition and existing malnutrition indicated by greater than 1 lb weight loss in a week, which is probably related to this current illness. The patient's feeling of heaviness of limbs, back, head, and aches in the same areas; loss of energy and fatigability, difficulty eating without the staff urging poses risks for further malnutrition. Gastrointestinal symptoms of dry mouth and somatic psychic gastrointestinal symptoms of depression manifested by wind, indigestion, diarrhoea, cramps, belching may aggravate the decreased appetite. Slight retardation at interview may indicate lassitude, and irritability may further aggravate loss of appetite, since it may represent inner tension representing feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to panic, dread or anguish that may lead to further loss of desire for food.
Priority 1: Diagnosis 1: Risk for Injury related to hopelessness and impaired pro...
ion manifested by suicide attempt in the current admission and sadness, suicidal thoughts, dejection, or episodes of weeping on assessment and feeling of rejection, despondence, self-reproach, and hopelessness indicated by expressions of feelings of discouragement, despair, pessimism about future, which cannot be dispelled. Also, current serious attempts of suicide and helplessness and worthlessness indicated by patient's statement on interrogation.
Rationale of the Priority 1: Depressed individuals have negative evaluation of their worth, which often is unrealistic. They are known to have guilty preoccupations or ruminations about minor past failings, where always they blame themselves. It is very common for these individuals to misinterpret neutral or trivial everyday events as due to failure of his or her person. Their exaggerated sense of responsibility for untoward events makes them very commonly feel hopeless, helpless, worthless and powerless. Due to her previous history of paranoid schizophrenia, it would be natural to expect possibility of disorganized thought processes, such as circumstantial or tangential thinking. Although there is no evidence of such in examination or history, there is a high possibility of hallucinations and delusions. Any assessment of depression requires that the risk of self-harm or suicide be assessed. This is the first priority since patient safety if the first nursing priority. In this patient, due to attempted suicide and related admission, this becomes a greater priority. In depressed patients, self-harm and suicide are very prevalent. Anyone showing symptoms of severe depression, especially psychomotor retardation and/or psychotic symptoms should be regarded as at high risk of suicide, as should anyone who has previously