Community Mental Health Nursing: Chapter 36 - Summary and Key Points

Prospective payment

The program of cost containment within the health-care profession directed at setting forth preestablished amounts that would be reimbursed for specific diagnoses.

Deinstitutionalization

The removal of mentally ill individuals from institutions and the subsequent plan to provide care for these individuals in the community setting.

The physician orders trazadone (Desyrel), 150 mg to be taken at bedtime, for Mrs. W., a 78-year-old widow with depression. Which of the following statements about this medication would be appropriate for the home health nurse to make in teaching Mrs. W. about trazadone? A. "You may feel dizzy when you stand up, so go slowly when you get up from sitting or lying down." B. "You must not eat chocolate while you are taking this medicine." C. "We will need to draw a sample of blood to send to the lab every month while you are on this medication." D. "If you don't feel better right away with this medicine, the doctor can order a different kind for you."

A

Which of the following represents a nursing intervention at the primary level of prevention? A. Teaching a class in parent effectiveness training. B. Leading a group of adolescents in drug rehabilitation. C. Referring a married couple for sex therapy. D. Leading a support group for battered women.

A

Which of the following represents a nursing intervention at the tertiary level of prevention? A. Serving as case manager for a mentally ill homeless client. B. Leading a support group for newly retired men. C. Teaching prepared childbirth classes. D. Caring for a depressed widow in the hospital.

A

Community

A group, population, or cluster of people with at least one common characteristic, such as geographic location, occupation, ethnicity, or health concern.

Case management

A health-care delivery process, the goals of which are to provide quality health care, decrease fragmentation, enhance the client's quality of life, and contain costs. A case manager coordinates the client's care from admission to discharge and sometimes following discharge. Critical pathways of care are the tools used for the provision of care in a case management system.

Diagnosis-related groups (DRGs)

A system used to determine prospective payment rates for reimbursement of hospital care based on the client's diagnosis.

Shelters

A variety of places designed to help the homeless, ranging from converted warehouses that provide cots or floor space on which to sleep overnight to significant operations that provide a multitude of social and health-care services.

Which of the following issues have been identified as contributing to the rise in the population of those who are homeless? (Select all that apply.) A. Poverty B. Lack of affordable health care C. Substance abuse D. Severe and persistent mental illness E. Growth in the number of family members living together

A, B, C, D

The focus of secondary prevention is:

Accomplished through early identification of problems and prompt initiation of effective treatment.

Ann is a psychiatric home health nurse. She just received an order to begin regular visits to Mrs. W., a 78-year-old widow who lives alone. Mrs. W.'s primary care physician has diagnosed her as depressed. Which of the following criteria would qualify Mrs. W. for home health visits? A. Mrs. W. never learned to drive and has to depend on others for her transportation. B. Mrs. W. is physically too weak to travel without risk of injury. C. Mrs. W. refuses to seek assistance as suggested by her physician, because "I don't have a psychiatric problem." D. Mrs. W. says she would rather have home visits than go to the physician's office.

B

Which of the following represents a nursing intervention at the secondary level of prevention? A. Teaching a class about menopause to middle-aged women. B. Providing support in the emergency room to a rape victim. C. Leading a support group for women in transition. D. Making monthly visits to the home of a client with schizophrenia to ensure medication compliance.

B

Ann is a psychiatric home health nurse. She has just received an order to begin regular visits to Mrs. W., a 78-year-old widow who lives alone. Mrs. W.'s primary care physician has diagnosed her as depressed. Which of these potential problems is a priority to evaluate for during the first home visit? A. Complicated grieving. B. Social isolationg. C. Risk for injury. D. Sleep pattern disturbance.

C

John, a homeless person, has just come to live in the shelter. The shelter nurse is assigned to his care. Which of the following is a priority intervention on the part of the nurse? A. Referring John to a social worker. B. Developing a plan of care for John. C. Conducting a behavioral and needs assessment on John. D. Helping John apply for Social Security benefits.

C

Nurses provide outpatient care for individuals with severe and persistent mental illness in:

Community mental health centers, in day and evening treatment programs, in partial hospitalization programs, in community residential facilities, and with psychiatric home health care.

John, a homeless person, has a history of schizophrenia and nonadherence to his medication regimen. Which of the following medications might be the best choice for John? A. Haldol B. Navane C. Lithium carbonate D. Prolixin decanoate

D

Mrs. W., a 78-year-old depressed widow, says to her home health nurse, "What's the use? I don't have anything to live for anymore." Which is the best response on the part of the nurse? A. "Of course you do, Mrs. W. Why would you say such a thing?" B. "You seem so sad. I'm going to do my best to cheer you up." C. "Let's talk about why you are feeling this way." D. "Are you having thoughts about harming yourself in any way?"

D

Storefront clinics

Establishments that have been converted into clinics that serve the homeless population.

Primary prevention focuses on:

Identification of populations at risk for mental illness, increasing their ability to cope with stress, and targeting and diminishing harmful forces within the environment.

The focus of psychiatric care is shifting from:

Inpatient hospitalization to outpatient care within the community. This trend is largely due to the need for greater cost effectiveness in providing medical care to the masses.

Secondary Prevention

Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness.

Tertiary prevention focuses on:

Preventing complications of the illness and promoting rehabilitation directed toward achievement of the individual's maximum level of functioning.

Mental health care within the community targets:

Primary prevention (reducing the incidence of mental disorders within the population), Secondary prevention (reducing the prevalence of psychiatric illness by shortening the course of the illness), and Tertiary prevention (reducing the residual defects that are associated with severe and persistent mental illness).

Mobile outreach units

Programs in which volunteers and paid professionals drive or walk around and seek out homeless individuals who need assistance with physical or psychological care.

Primary Prevention

Services aimed at reducing the incidence of mental disorders within the population.

Tertiary Prevention

Services aimed at reducing the residual defects that are associated with severe and persistent mental illness.

The community mental health movement began in:

The 1960s with the closing of state hospitals and the deinstitutionalization of many individuals with severe and persistent mental illness.

Homeless person with mental illness provide a special challenge for:

The community mental health nurse. Care if provided within homeless shelters, at health-care centers or storefront clinics, and through mobile outreach programs.

Registered nurses serve as providers of psychiatric-mental health care in:

The community setting.

Case manager

The individual responsible for negotiating with multiple health-care providers to obtain a variety of services for a client.