A registered nurse (RN) is creating a client care assignment for a licensed practical/vocational nurse (LPN/VN) in a psychiatric ward.
The nurse should assign the client
A registered nurse (RN) is creating a client care assignment for a licensed practical/vocational nurse (LPN/VN) in a psychiatric ward.
The nurse should assign the client
A. taking amitriptyline who is currently grinding their jaw and grimacing
[17%]
B. with dementia who is currently confused and disoriented
[67%]
C. with bipolar disorder with a lithium level of 2.2 mEq/L, mmol/L [0.6 – 1.2 mEq/L, mmol/L]
[9%]
D. with chronic alcoholism showing early signs of delirium tremens
[7%]
Statistics
Subject/Lesson
Subject
Leadership & Management
Lesson
Assignment/Delegation
Client Need
Test Plan
Management of Care
Related Topic
Establishing Priorities
Item Type
Item Type
Analysis
Explanation
Choice B is correct. Confusion and disorientation in a dementia client are common findings. Dementia is a slow, progressive deterioration of mental functioning that impairs the client's cognition (i.e., memory, thinking, judgment, ability to learn, etc.). Symptoms of dementia often include memory loss, difficulty expressing language and performing activities, personality changes, general disorientation, confusion, and disruptive or inappropriate behavior. In the absence of any new or acute changes in the mental status of this specific client, the LPN/VN is fully qualified to care for this client and is, therefore, the appropriate client for the RN to designate to the LPN/VN for care.
Choice A is incorrect. Based on this client's symptoms, this client is not an appropriate client for the RN to assign to the LPN/VN. Amitriptyline, a tricyclic antidepressant, has been associated with various movement disorders, including dystonia and dyskinesias. Based on the exhibited symptoms, the RN should be concerned that the client may be experiencing a dystonic reaction (potentially from the client's medication) which would require immediate intervention(s). Although this client likely requires transfer to a higher level of care to receive the appropriate medical care, at this time, this client should be cared for by a qualified registered nurse with psychiatric experience.
Choice C is incorrect. Lithium, a mood stabilizer, is used primarily to treat bipolar disorder. A therapeutic lithium level ranges between 0.6 to 1.2 mEq/L, mmol/L, with levels of 1.5 mEq/L or greater considered toxic. This client's lithium level of 2.0 mEq/L indicates the client is experiencing severe lithium toxicity, therefore necessitating the client receive care over and beyond that which a licensed practical nurse (LPN) can provide. Based on this client's lab result, following an immediate discussion with the client's health care provider (HCP), the RN should initiate steps to transfer the client to a higher level of care to receive the appropriate medical care.
Choice D is incorrect. Delirium tremens (DTs) is a form of severe alcohol withdrawal typically accompanied by profound confusion, autonomic hyperactivity, and/or cardiovascular collapse. When caring for a client with DTs, initial minor withdrawal symptoms are often characterized by anxiety, insomnia, palpitations, headache, and/or gastrointestinal symptoms, usually occurring as early as six hours after the client's last alcohol intake. As the hours and days progress, DTs are often associated with a number of complications, including hallucinations, respiratory depression, seizures, arrhythmias, and/or aspiration pneumonitis. Based on the unpredictable and unstable outcomes demonstrated by clients experiencing DTs, this client requires a level of care above which the LPN/VN is capable of providing and is therefore inappropriate for the RN to assign to the LPN/VN. Additionally, the RN should immediately assess this client, speak with the client's primary health care provider (PHCP), and arrange for the client to be transferred to a higher level of care to receive the appropriate medical care.
Related Videos
2 Key Topics
LPN Delegation
15.7 Delegation
Additional Info
✓ Typically, psychiatric wards care for psychiatric clients who have received medical clearance from an internal medicine health care provider (HCP) and any necessary specialist(s) (i.e., the client has been cleared medically to allow the focus of the care to be on the client's psychiatric issues). Although the client may have an acute medical issue such as diabetes, for example, any such issue must be well-controlled to avoid poising any significant medical threat(s). Additionally, certain items (such as intravenous line tubing, for example) cannot be left in a psychiatric client's room. Therefore, when a psychiatric client being cared for on a psychiatric ward develops a medical complication or concern, the client is typically transferred to a medical floor based on the level of care necessary for the client's medical needs (with the necessary psychiatric precautions implemented).
✓ Dementia is a progressive disease, with symptoms progressing to the point where the client can no longer function, causing them to become fully dependent on others.
✓ Diagnosis is based on clinical symptoms, physical examination, and mental status testing. Additionally, blood and imaging tests are utilized to determine the cause.
✓ Treatment focuses on client safety and maintaining mental function for as long as possible while providing support as the client's cognitive function declines.
✓ Medications used in the treatment of dementia may include one or more of the following: cholinesterase inhibitors (specifically, donepezil, rivastigmine, and galantamine); an NMDA (N-methyl-d-aspartate) antagonist (often used with a cholinesterase inhibitor); antipsychotics; nonanticholinergic antidepressants (preferably, a selective serotonin reuptake inhibitor (SSRIs)).
✓ In the advanced stages of dementia, clients are entirely dependent on others for care, as they lose the ability to ambulate, speak, or perform any routine activities of daily living.
