lOMoARcPSD|5967629
lOMoARcPSD|59676
Student-Suicide and Non-Suicidal Self-Injury- Unfolding
Reasoning
Nursing (Northwest Arkansas Community College)
Suicide and Non-suicidal Self-
Injury (NSSI)
UNFOLDING Reasoning
J. Thompson, 18 years old
Primary Concept
Coping – Maladaptive
Interrelated Concepts (In order of emphasis)
• Stress
• Anxiety
• Mood and Affect
• Cultural competence
• Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
, lOMoARcPSD|5967629
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
• Pharmacological and Parenteral Therapies 12-18%
• Reduction of Risk Potential 9-15%
• Physiological Adaptation 11-17%
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved
UNFOLDING Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
J. Thompson is an 18-year-old African-American transgender male with a history of major depressive disorder (MDD)
and suicidal ideation and self-harm behaviors. He arrives to the emergency department (ED) per emergency medical
services (EMS) for evaluation of suicidal ideation and a recent attempt to harm himself. He became upset this morning
following an argument with his roommate at his group home and cut self repeatedly on his left inner thigh using a metal
tack. The patient thinks about how it would be easier to just go to sleep and never wake up. He denies any recent drug or
alcohol use. He denies any thoughts of harm to others (homicidal ideation)
Personal/Social History:
The patient’s legal name is Jenny Thompson but prefers to use the name Jordon. Assigned female at birth, Jordon has
identified as a transgender male since age 14. Jordan’s mother died of a drug overdose when he was an infant has no
family that are involved in his life. He is a ward of the state and his county social worker is his closest support person.
He plans to initiate gender-affirming surgery in the near future.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
Major Depressive Disorder (MDD) There is history of attempted suicide due to MDD, this event could have
Suicidal Ideation been an unsuccessful suicide attempt or relapse.
Recent attempt to self-harm
RELEVANT Data from Social History: Clinical Significance:
No family support system Having no family or support could be the reason for self harm and root of
Mother died from a drug overdose depression
He is a war of the state with only his
social worker as his support person.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 98.5 F/36.9 C (oral) Provoking/Palliative:
P: 88 (regular) Quality: Denies
R: 16 (regular) Region/Radiation:
BP: 128/82 Severity:
O2 sat: 99% room air Timing:
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
lOMoARcPSD|59676
Student-Suicide and Non-Suicidal Self-Injury- Unfolding
Reasoning
Nursing (Northwest Arkansas Community College)
Suicide and Non-suicidal Self-
Injury (NSSI)
UNFOLDING Reasoning
J. Thompson, 18 years old
Primary Concept
Coping – Maladaptive
Interrelated Concepts (In order of emphasis)
• Stress
• Anxiety
• Mood and Affect
• Cultural competence
• Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
, lOMoARcPSD|5967629
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
• Pharmacological and Parenteral Therapies 12-18%
• Reduction of Risk Potential 9-15%
• Physiological Adaptation 11-17%
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved
UNFOLDING Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
J. Thompson is an 18-year-old African-American transgender male with a history of major depressive disorder (MDD)
and suicidal ideation and self-harm behaviors. He arrives to the emergency department (ED) per emergency medical
services (EMS) for evaluation of suicidal ideation and a recent attempt to harm himself. He became upset this morning
following an argument with his roommate at his group home and cut self repeatedly on his left inner thigh using a metal
tack. The patient thinks about how it would be easier to just go to sleep and never wake up. He denies any recent drug or
alcohol use. He denies any thoughts of harm to others (homicidal ideation)
Personal/Social History:
The patient’s legal name is Jenny Thompson but prefers to use the name Jordon. Assigned female at birth, Jordon has
identified as a transgender male since age 14. Jordan’s mother died of a drug overdose when he was an infant has no
family that are involved in his life. He is a ward of the state and his county social worker is his closest support person.
He plans to initiate gender-affirming surgery in the near future.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
Major Depressive Disorder (MDD) There is history of attempted suicide due to MDD, this event could have
Suicidal Ideation been an unsuccessful suicide attempt or relapse.
Recent attempt to self-harm
RELEVANT Data from Social History: Clinical Significance:
No family support system Having no family or support could be the reason for self harm and root of
Mother died from a drug overdose depression
He is a war of the state with only his
social worker as his support person.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 98.5 F/36.9 C (oral) Provoking/Palliative:
P: 88 (regular) Quality: Denies
R: 16 (regular) Region/Radiation:
BP: 128/82 Severity:
O2 sat: 99% room air Timing:
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
