A recently divorced man with severe depression exhibits poor sleep and impaired concentration, leading him to function poorly at work. Inattention to hygiene and irritability with others aggravate problems at work
Co-workers do not recognize that he is depressed and instead assume his behavioral changes are due to drug abuse. One day he is fired. Work had been his one remaining source of self-worth. The man presents at the emergency room seeking medication to help him sleep. Which of the following responses would be most important for the triage nurse to take at this time? a. "Have you considered seeking treatment for the depression itself?"
b. "Tell me what you have already been trying to help improve your sleep.".
c. "We usually don't prescribe sleep medications in the emergency room.".
d. "You said you are depressed; have you thought about harming yourself?"
D
Approximately two-thirds of depressed people contemplate suicide. Depressed patients who exhibit feelings of worthlessness are at higher risk. Significant losses (divorce and loss of job) and depressed mood are major risk factors for suicide. Suicide should be directly assessed. Seeking further information about his sleep habits and exploring treatment options related to depression are desirable but are not as high a priority at this time as assessing possible risk to self. Advising him that sleep medications are not provided by the emergency room could be seen as further rejection and could lead the patient to terminate the assessment prematurely.
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