Alzheimer’s Delirium and Dementia Q 44
A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client?
A. Income level and living arrangements.
B. Involvement of family and support systems.
C. Reason for inpatient admission.
D. Reason for refusal to take medications.
Correct Answer: D. Reason for refusal to take medications
The first area for assessment would be the client’s reason for refusing medication. The client may not understand the purpose of the medication, may be experiencing distressing side effects or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication.
Option A: It can be because the medicine is hard to swallow, tastes unpleasant, or causes side effects such as nausea. If this situation arises, you should raise it with the person who prescribed the medication. The prescriber will be able to decide whether or not the person has the capacity to decide for themselves not to take their medication. If the person does not have capacity, then the prescriber will be able to make a decision about what is in their best interests.
Option B: The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. If it is decided that taking the medication is the best option, then this should be done through the least restrictive means available. In some situations, taking the drug in a different form may be easier than swallowing a pill. For example, some dementia and painkiller drugs are available as a patch or an oral solution.
Option C: The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission. When making this decision, the prescriber should talk to the person’s relatives and carers, and other professionals involved in the person’s care. If a health and welfare Lasting power of attorney has been set up, it is up to the attorney to make the decision, with the help of the prescriber.