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UNIT 3 ■ Care of Patients With Psychiatric Disorders
11. When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. Provide large motor activities to relieve the client’s pent-up tension. b. Administer a dose of prn olanzapine to keep the client calm. c. Call for sufficient help to control the situation safely. d. Convey to the client that their behavior is unacceptable and will not be permitted. 12. A client has been diagnosed with schizophrenia. The client has been socially isolated and hear- ing voices telling them to kill their parents. The client has been admitted to the psychiatric unit from the emergency department. Which is the most important initial intervention for this client? a. Give the client an injection of haloperidol. b. Assess the client to evaluate their safety toward themself and others. c. Place the client in restraints. d. Order the client a nutritious diet.
IMPLICATIONS FOR EVIDENCE-BASED PRACTICE
without SMI. The annual incidence of dementia diagno- ses per 1,000 person-years at 66 years of age was 52.5 among individuals with schizophrenia and 4.5 among individuals without SMI and increased to 216.2 and 32.3, respectively, by 80 years of age. IMPLICATIONS FOR NURSING PRACTICE: Several symptoms of schizophrenia overlap with those of demen- tia, so differential diagnosis can be a challenge. One of the most prominent symptoms in dementia, however, is recent memory loss, and when nurses assess this to be prominent in the older adult with schizophrenia the nurse can play an active role in collaborating with team members to recommend further testing. Nurses also play an active role in educating patients and families regard- ing lifestyle factors that may decrease risks for dementia such as weight management, diabetes management, and strategies to reduce risk for cardiovascular disease. Careful assessment and collaboration with team mem- bers has treatment implications as well, because anti- psychotic medication use in the patient with dementia has been associated with many risks, including sudden death.
Stroup, T. S., Olfson, M., Huang, C., Wall, M. M., Goldberg, T., Devanand, D. P., & Gerhard, T. P. (2021). Age-specific prevalence and incidence of dementia diagnoses among older US adults with schizophrenia. JAMA Psychiatry, 78 (6), 632–641. https://doi.org/10.1001/jamapsychiatry .2021.0042 DESCRIPTION OF THE STUDY: This study sought to estimate the age-specific prevalence and incidence of dementia in older adults with schizophrenia by com- paring them to older adults without schizophrenia. This was a retrospective cohort study of 8,011,773 Medicare recipients 66 years and older. It is known that the risk of dementia among those with schizophrenia is high, and this study sought to clarify the magnitude and timing of this increased risk. RESULTS OF THE STUDY: At 66 years of age, the preva- lence of diagnosed dementia was 27.9% among individ- uals with schizophrenia compared with 1.3% in the group without serious mental illness (SMI). By 80 years of age, the prevalence of dementia diagnoses rose to 70.2% in the group with schizophrenia and 11.3% in the group
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