A person diagnosed with bipolar disorder ran out of money, did ...

[skymedlock]

A person diagnosed with bipolar disorder ran out of money, did not refill a lithium prescription, and then relapsed. After assaulting several people in the community, this person was convicted and sentenced.
 
  Prior to parole, which outcome has priority for the correctional nurse to achieve? The person:
 
  a. agrees in writing to continue lithium therapy.
  b. is reestablished on an appropriate dose of lithium.
  c. lists community resources for prescription assistance.
  d. agrees to a follow-up appointment in an outpatient clinic.

Question 2

A person diagnosed with serious mental illness has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center.
 
  Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? Select all that apply.
 
  a. Discourage potentially stressful activities such as groups or volunteer work.
  b. Develop written plans that will help the patient remember what to do in a crisis.
  c. Help the patient identify and anticipate events that are likely to be overwhelming.
  d. Encourage health-promoting activities such as exercise and getting adequate rest.
  e. Accompany the patient to a National Alliance on Mental Illness support group.

[pikon]

Answer to Question 1

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

Answer to Question 2

ANS: B, C, D, E
Basic interventions for coping with crises involve anticipating crises where possible and then developing a plan with specific actions to take when faced with an overwhelming stressor. Written plans are helpful; it can be difficult for anyone, especially a person with cognitive or memory impairments, to develop or remember steps to take when under overwhelming stress. Health-promoting activities enhance a person's ability to cope with stress. As the name suggests, support groups help a person develop a support system, and they provide practical guidance from peers who learned from experience how to deal with issues the patient may be facing. Groups and volunteer work may involve a measure of stress but also provide benefits that help persons cope and should not be discouraged unless they are being done to excess.