The correctional mental health nurse learns that prior to arrest, ...

[123654777]

The correctional mental health nurse learns that prior to arrest, an inmate with bipolar II disorder had run out of money and had not refilled her lithium prescription, leading to relapse.
 
  While psychotic she had assaulted several people in a convenience store and was arrested, tried, convicted, and sentenced. Which outcome would be most important to achieve prior to release? The patient: a. agrees in writing to take lithium in the community.
  b. lists community resources for medication assistance.
  c. is reestablished on an appropriate dosage of lithium.
  d. agrees to make a follow-up appointment in the clinic.

Question 2

A patient on a medical unit has a history of hostile and menacing behavior toward staff and sometimes even strikes them. Which plan would be best for forestalling such incidents?
 
  a. Give the patient lorazepam (Ativan) every 4 hours to reduce anxiety.
  b. Explain that the response to any violence will be to use restraints.
  c. Arrange for security personnel to stand by during all nursing care.
  d. Point out the problem and help the patient identify things that are causing frustration.

[morrie123456]

Answer to Question 1

B
To increase medication adherence, reduce the risk of relapse, and prevent further criminal activity due to mental illness, the patient's awareness of community resources that can be accessed for medication refills and medication-related services is the most important outcome. Agreeing to take lithium, being reestablished on meds in the jail, and agreeing to follow-up mental health care are all important, but none of these will address the primary reason for her criminal behavior: the relapse caused by inability to access medication in the community.

Answer to Question 2

D
Identification of triggers to violent acting-out incidents allows the patient and nurse to plan interventions to avert such triggers and reduce frustration. This also provides practice in coping more adaptively in general. Benzodiazepines can reduce anxiety but would not give him skills that might also benefit him in other situations; benzodiazepines can also sometimes increase impulsiveness by disinhibiting the patient. Setting limits and indicating what consequences to expect can be a helpful adjunct, but as a primary intervention, it does not teach new skills to use to avoid problem behaviors in the first place; expecting the patient to behave differently without giving him the skills to do so is setting him up for failure and further frustration. Using security personnel would be expensive and disruptive to their work, but it would be a possible intervention if all other options prove unsuccessful.

[123654777]

Thank you

[morrie123456]

No problemo