Suicide Precaution Policy

Answer

1. Therapeutic and Safe Environment for Suicidal Clients

   Patients with suicidal tendencies first contact the emergency department and may be sent to the psychiatric unit or hospitals (Greenberg, 2020). Therefore, this environment is critical to the safety and healing of the patient. The hospital is implicated in providing a safe environment for the patient and staff. Greenberg (2020) explains that the initial contact is critical to determining how the treatment process will turn out. The purpose of this paper is to show a succinct understanding of the creation of therapeutic and safe surroundings for suicidal patients in the hospital. 

   Creating a Safe Environment

   The initial step to ensuring a safe environment is considering available risk factors that undermine the patients' health or hospital staff's safety. According to Elrefaay (2019), the most prevalent form of injury for suicidal patients include hanging objects such as strong cords and strong showerheads, strangulation facilitated by protruding wall objects like faucet handles and towel bars, suffocation using plastic wrappers and jumping off high areas or into dangerous objects. Elrefaay (2019) notes other predisposing factors, such as the availability of lethal medication and chemicals. From the above risk factors, mitigating the risk of harm and creating a safe environment will involve removing the risk factors. Elrefaay (2019) explains that these precautions are applicable for patients in the ED or those in inpatient care units as they ensure the patients' safety and others. 

   This environment can also entail suicide reduction strategies, delaying spontaneous patient impulses (Barczyk, 2020). This method will also allow the staff to discover the oncoming crisis and reduce them, respectively. The staff will also intervene when necessary and take mitigating actions to protect the patients at the hospital. Collectively, these measures create a safe environment for suicidal patients and other patients in the hospital and staff members. 

   Considerations for an Admitted or Discharged Patient

   Medications are crucial when managing patients who have suicidal tendencies (Miller, 2020). Nonetheless, this treatment is dependent on the fundamental psychiatric diagnosis of the patient. On most occasions, clinicians rely on selective serotonin reuptake inhibitors as the first go-to treatment option for depressive disorders. Miller (2020) points out that these medications are mostly tolerated by patients and have a success rate in reducing suicidal ideologies among patients. At the same time, other medication options are used as the first line of treatment for depressive tendencies. In some other cases, patients may fail to respond to the medication positively or may have other comorbidities like bipolar or schizophrenia. Generally, these patients will be given additional medication as seen fit by the physician. 

   Miller (2020) explains that research shows that different kinds of antidepressants have alleviated suicidal thoughts in individuals. If the patient is being discharged, the nurse should ask about the living conditions of the patient. This includes the availability of harmful objects like firearms, living arrangements with family or friends, and daily activities of the patients (Miller, 2020). Such information is essential for the creation of a suicide prevention plan for the patient while at home. In the case of other people in the home, the nurse should ask them to remove any dangerous objects and ensure the patient's close monitoring. 

   Considerations during the Patient's Length of Stay

   Studies show that during the client's admission period, the relationship between the patient and staff members determines the course of treatment (Tsujii, 2020). Thus, an initial agreement is essential for stressing the collaboration between the patient and nurses, especially at the onset of a crisis. The importance of this agreement also corresponds to Tsujii (2020), who argues that the effectiveness of the treatment process is founded on a therapeutic alliance. 

   Promoting a good relationship means that the nurse should listen to the patients' concerns and needs, provided that they are imperative to the treatment process. After a mutual understanding has been arrived at, patients will be more inclined to accept medication, restraints, and seclusions during different crisis periods. The patient will also voluntarily accept medication and other interventions that will help them prevent future suicide attempts. 

   Allowable and Restricted Personal Items for the Patient

   According to Miller (2020), all items that threaten the patient's safety and nurses should be taken away from them. These items include sharp objects like pens, knives, nail clippers, or sharp metallic cutlery. At the same time, personal items can be confiscated as long as they threaten the credibility of a safe environment. These items include necklaces, strings, and IV tubes. For a suicidal patient, all these items are useful and can potentially end their life. On the other hand, items allowed include blunt objects like plastic spoons, books, mobile phones, and laptops. 

   Client Monitoring

   Sitters are essential when monitoring suicidal patients (Kiley, 2020). Relocating the inpatient units to space closest to the nurses' station will allow clock monitoring from different nurses. The hospital can also add safe rooms specifically designed to contain peculiar behavioral health and allow close monitoring. Other interim safety measures include removing all dangerous items from the units and rooms and using competent sitters to monitor the patients at regular intervals (Kiley, 2020).

   Requirements of Client Monitoring

   Patients are monitored by either nurses or sitters in hospitals (Kiley, 2020). Monitoring patients can be done at regular intervals, like after every 15 or 30 minutes during the day. If the patient shows the danger to themselves or those around them, they can be restrained either physically or chemically or be secluded in a safe room within the hospital. If the safety of the nurse or sitter is at risk, then a security guard can accompany the caregiver to the psychiatric unit.  

   Nursing Considerations

   A nurse should establish a cordial relationship between the patients within the unit (Vandewalle, 2020). This relationship will, in itself, reduce the chances of another suicidal attempt. For a discharged patient, follow-ups are recommended in hospital visits or hospital calls to provide extra support when necessary. 

   Required Documentation

   According to Zhou (2020), documentation is crucial because, in case of any malpractice claims, the documentation helps evaluate patients' management and treatment. Some of the documentation required is patient information, risk assessment forms, the reason for patient assessment, and proceeding treatment methods in the hospital. Medical conclusions and any changes in the medical treatment plan should also be documented. 

   The Roles of CAN, LPN, and RN

   Vandewalle (2020) explains that CAN play a role in observation, reporting, and documentation of behavioral patterns of suicidal patients. LPNs are implicated in providing primary care to the clients, such as ensuring comport, checking their blood pressure, changing their dressing, and inserting catheters. LPNs work together with RNs responsible for reporting the status of the patients to the registered nurses and physicians (Vandewalle, 2020). These processes are carried out while maintaining patient confidentiality within the safe environment of the hospital unit.

   Conclusion

   Suicidal patients first come in contact with the ED in hospitals before being taken to the psychiatric units. To facilitate a smooth treatment, this environment needs to be safe for both patients and staff at admission and length of stay. After patient discharge, follow up activates like phone calls and hospital visits will provide additional support. Collectively, these processes will reduce subsequent suicidal attempts of patients. 

    

    

    

    

    

Answer

Chirality- Isolation of Limonene from Citrus Fruits

INTRODUCTION

The purpose of this experiment is two-fold: (i) to obtain Limonene from citrus fruits through steam distillation and (ii) to analyze the optical rotation and enantiomeric excess (optical purity) of the fruits using polarimetry.

Limonene belongs to a class of aromatic compounds, mainly terpenoids in composition and characterized by several isoprene repeat units (Ludwiczuk, Skalicka-Woźniak & Georgiev, 2017). These include monoterpenes which comprise 2 isoprene units, sesquiterpenes with three isoprene units, diterpenes containing 4 isoprene units and triterpenes with 6 isoprene units (Asia, Nicholas, Segui & Ballivian, 2020).

Limonene is extracted by steam distillation, as aromatics are thermally decomposable under high temperatures (Valderrama & Ruiz, 2017). Subsequently, polarimetry is deployed to determine the chirality of the limonene. Chirality is the “direction of rotation” of the substance (Telo, 2016). Additionally, chirality confirms optical activity and the presence of a chiral center, a carbon attached to four other groups (Weldegirma, 2016; Telo, 2016). Polarimetry is a necessary tool for establishing optical purity through measurement of enantiomeric excess (ee), or optical purity.

Findings from the experiment show the specific rotation to be about “half of the literature value” (Asia, Nicholas, Segui & Ballivian, 2020). Many studies associate this outcome with a high concentration of limonene in the samples being investigated. Similarly, the optical rotation of the sample was found to be 11 (Asia, Nicholas, Segui & Ballivian, 2020). The ee was found to be 11.34%, one possibility for this result could be that our sample was not pure, therefore accounting for the low percentage. A percentage of 100% means a pure enantiomer (Weldegirma, 2016).

Figure 1: Schematic Diagram for Extraction of Limonene

Source: Asia, Nicholas, Segui & Ballivian (2020)

Figure 2: Schematic Diagram for Polarimetry

Source: Asia, Nicholas, Segui & Ballivian (2020)

.