Psychotic Disorders: Initial Plan of Care for a Client Who Has Schizophrenia (RN QSEN - Patientcentered Care, Active Learning Template - System Disorder, RM MH RN 10.0 Chp 15)
• Provide a structured, safe environment (milieu) for the client to decrease anxiety and to distract
the client from constant thinking about hallucinations
• Promote therapeutic communication to lower anxiety, decrease defensive patterns, and
encourage participation in the milieu.
• Program of assertive community treatment (PACT): Intensive case management and
interprofessional team approach to assist clients with community-living needs.
Depressive Disorders: Priority Findingsto Share with Treatment Team (RN QSEN - Teamwork
and Collaboration, Active Learning Template - System Disorder, RM MH RN 10.0 Chp 13)
• Suicide risk: Assess the client’s risk for suicide and implement appropriate safety precautions.
• Self-care: Monitor the client’s ability to perform activities of daily living and encourage
independence as much as possible.
• Communication: Make observations rather than asking direct questions, which can cause
anxiety in the client. For example, the nurse might say, “I noticed that you attended the unit
group meeting today,” rather than asking, “Did you enjoy the group meeting
Legal and Ethical Issues: Right to Refuse Treatment (RN QSEN - Patient-centered Care, Active
Learning Template - Basic Concept, RM MH RN 10.0 Chp 2)
• Freedom from harm related to physical or pharmacological restraint, seclusion, and any physical
or mental abuse or neglect
• A psychiatric advance directive that includesthe client’s treatment preferences if an involuntary
admission is necessary
• Provision of care with the least restrictive interventions necessary to meet the client’s needs
without allowing him to be a threat to himself or others
Sexual Assault: Communicating with a Client (RN QSEN - Safety , Active Learning Template -
Basic Concept, RM MH RN 10.0 Chp 33)
• Perform a self-assessment. It is vital that the nurse who works with the client who has been
sexually assaulted be empathetic, objective, and nonjudgmental. If the nurse feels emotional
about the assault due to some event or person in his own past, it can be better to allow another
nurse to care for the client.
• Perform an initial and ongoing assessment of the client’slevel of anxiety, coping mechanisms,
and available support systems. The nurse should also assess for indications of emotional and/or
physical trauma.
• Provide a private environment for an examination with a specially trained nurse-advocate, if
available. A sexual assault nurse examiner (SANE) is a specially trained nurse who performs such
examinations and collects forensic evidence.
Brain Stimulation Therapies: Transcranial Magnetic Stimulation (Active Learning Template -
Therapeutic Procedure, RM
MH RN 10.0 Chp 10)
• TMS is a noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of
the brain
• TMS is approved by the United States Food and Drug Administration (FDA) for the treatment of
major depressive disorder for clients who are not responsive to pharmacological treatment
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