A patient diagnosed with schizophrenia has had multiple relapses. ...

[Mollykgkg]

A patient diagnosed with schizophrenia has had multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication.
 
  Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply as the patient transitions from hospital to community?
 
  a. Administer a second-generation antipsychotic to help negative symptoms.
  b. Use a quick-dissolving medication formulation to reduce cheeking.
  c. Prescribe a long-acting intramuscular antipsychotic medication.
  d. Involve the patient in decisions about which medication is best.

Question 2

A family discusses the impact of a seriously mental ill member. Insurance partially covered treatment expenses, but the family spent much of their savings for care. The patient's sibling says, My parents have no time for me.
 
  The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful?
 
  a. Acknowledge their concerns and consult with the treatment team about ways to bring the patient's symptoms under better control.
  b. Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one.
  c. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families.
  d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.

[diesoon]

Answer to Question 1

ANS: D
Persons with schizophrenia are at high risk for treatment nonadherence, so the strategy needs primarily to address that risk. Of the options here, involving the patient in the decision is best because it will build trust and help establish a therapeutic alliance with care providers, an essential foundation to adherence. Intramuscular depot medications can be helpful for promoting adherence if other alternatives have been unsuccessful, but IM medications are painful and may jeopardize the patient's acceptance. All of the other strategies also apply but are secondary to trust and bonding with providers.

Answer to Question 2

ANS: D
The family has raised a number of concerns, but the major issues appear to be the effects caregiving has had on the family and their concerns about the patient's future. The National Alliance on Mental Illness (NAMI) offers support, education, resources, and access to other families who have experience with the issues now facing this family. NAMI can help address caregiver burden and planning for the future needs of SMI persons. Improving the patient's symptom control and general functioning can help reduce caregiver burden but would likely be a slow process, whereas NAMI involvement could benefit them on a number of fronts, possibly in a shorter time period. The family will need more than financial planning; their issues go beyond financial. The family is distressed but not in crisis. Crisis intervention is not an appropriate resource for the longer-term issues and needs affecting this family.

[Mollykgkg]

Thanks for the timely response, appreciate it

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Gracias!