Chapter 22 - Prioritization, Delegation, and Assignment 2023 A+

The nurse is working at a community clinic that specializes in assisting patients who need medication and therapy for mental health disorders. Which patient is the *most* likely candidate for depot antipsychotic therapy? •Older man with psychosis secondary to dementia who lives with his daughter •Homeless veteran with schizophrenia who occasional sleeps in a nearby shelter •Housewife with bipolar disorder who is prone to psychotic features during the manic phase •Student with recently diagnosed schizophrenia who lives at home with his parents - ANS-•Homeless veteran with schizophrenia who occasional sleeps in a nearby shelter •Depot antipsychotic therapy uses long-acting injectable medications. These medications are used for longterm maintenance for schizophrenia for patients who may have some difficulties with adherence to taking medications. The homeless veteran has the least amount of social support and stability, which are factors in medication adherence. For the older adult patient with dementia and psychosis, identifying underlying factors and then behavioral therapies would be recommended first. Psychotic features in the manic phase of bipolar disorder would be treated as an acute episode. The student has the support of family, and the health care team will try to work with the patient and the family to build behaviors that support lifetime adherence to therapy. The nurse is caring for patients who have schizophrenia. In addition to medication, multidisciplinary nondrug therapies are available. What is the nurse's *most* important role in helping the patients to benefit from this comprehensive approach? •Help identify patients who would benefit from conventional psychotherapy •Refer patients to a psychiatric nurse specialist for education about the disease •Suggest that patients talk to vocational specialists for additional training •Establish a therapeutic relationship with patients and encourage participation - ANS-•Establish a therapeutic relationship with patients and encourage participation •The nurse and the psychiatric nursing assistant spend more time with the patients than any of the other members of the health care team; thus, establishing a good therapeutic relationship is essential to building trust; increasing social skills; and encouraging participation in educational, socialization, and vocational opportunities. Conventional psychotherapy is generally not used with patients with schizophrenia. A patient with a diagnosis of hypochondriasis has made multiple clinic visits and undergone diagnostic tests for "cancer," with no evidence of organic disease. Today he declares, "I have a brain tumor. I can feel it growing. My appointment is tomorrow, but I can't wait!" What is the *most* therapeutic response? •Present reality: "Sir, you have been seen many times in this clinic and had many diagnostic tests. The results have always been negative." •Encourage expression of feelings: "Let me spend some time with you. Tell me about what you are feeling and why you think you have a brain tumor." CONTINUES...