A nurse is caring for a client who has right-sided weakness and difficulty swallowing after a stroke. The nurse should ensure the client has referrals to which of the following members of the interprofessional care team? (Select all that apply.)

Rationale:

A. A client who has narcissistic personality disorder and refuses to be alone in their room: Clients with narcissistic personality disorder typically display a need for admiration and may fear abandonment, but they are not at increased risk for physical injury.

B. A client who has social anxiety disorder and refuses to attend group therapy: Avoidance of social settings is a hallmark of social anxiety disorder. While it may lead to isolation, it does not place the client at increased risk for physical injury.

C. A client who has bipolar disorder and exhibits impulsive behaviour: Impulsivity during manic episodes in bipolar disorder can lead to high-risk activities such as reckless driving, substance use, or unsafe sexual behavior. These behaviors significantly elevate the client’s risk for accidental or intentional physical injury.

D. A client who has panic disorder and exhibits paresthesia: Paresthesia, such as tingling or numbness, is a common symptom during panic attacks but does not directly increase the risk for physical injury. While distressing, it typically resolves and is not associated with unsafe behaviors.

Rationale:

A. Speech pathologist: A speech pathologist evaluates and treats dysphagia (difficulty swallowing) and communication impairments following a stroke. This referral is essential to assess swallowing safety and prevent aspiration.

B. Respiratory therapist: A respiratory therapist assists with pulmonary care, oxygen therapy, or ventilatory support. Unless the client has respiratory complications, a referral is not typically indicated solely for stroke-related weakness or swallowing difficulty.

C. Occupational therapist: An occupational therapist helps the client regain the ability to perform daily activities (e.g., dressing, grooming) that may be impaired by right-sided weakness. This referral supports independence and rehabilitation.

D. Physical therapist: A physical therapist works to improve mobility, balance, and strength in clients with musculoskeletal impairments after a stroke. Right-sided weakness makes this referral highly appropriate for motor recovery.

E. Pharmacist: A pharmacist ensures appropriate medication management, but a direct referral is not typically required for stroke rehabilitation unless there are specific medication concerns or complexities.