Mental Health Test 3 Chapter 27 - Community Mental Health Nursing

Adolescence (Secondary Prevention)

-occurs when disruptive and age-inappropriate behaviors become the norm-family can no longer cope adaptively with the situation-inpatient care may be required for: conduct disorders, adjustment disorders, eating disorders, substance related disorders, depression, and anxiety disorders Marriage (Secondary

Parenthood (Primary Prevention)

-primary prevention must begin long before the child is born-provide information about: prepared childbirth classes; what to expect after the baby arrives (parent-infant bonding, changing communication patterns and relationship styles, clothing and equipment, feeding, and other baby care); stages of growth and development

Types of Mental Illness Among the Homeless

- schizophrenia (most common)-bipolar disorder-substance addiction-depression-personality disorder-neurocognitive disorders

John, a homeless person, has a history of schizophrenia and noncompliance with medications. Which of the following medications might be the best choice for John? a. Haldol b. Navane c. Lithium carbonate d. Prolixin decanoate

d

Tertiary Prevention - Treatment Alternatives

-Community Mental Health Centers-Assertive Community Treatment (ACT) = team based treatment model that provides multidisciplinary, flexible treatment and support to people with mental illness 24/7-Partial Hospitalization Programs (Day/Evening Programs) = designed to prevent institutionalization or to ease the transition from inpatient hospitalization to community living-Community Residential Facilities = period of structured reorientation to the community in a living situation that is supervised and monitored by professionals-Psychiatric Home Healthcare = client must show that he or she is unable to leave the home without considerable difficulty or the assistance of another person-Care for Caregivers = home healthcare provides support and assistance to primary caregivers

Contributing Factors to Homelessness Among Individuals with Mental Illness

-Deinstitutionalization-Poverty-Scarcity of Affordable Housing = concern that shelters are becoming mini-institutions for individuals with serious mental illness-Lack of Affordable Healthcare-Domestic Violence = 57% of homeless women identify domestic violence as the primary reason for homelessness-Addiction Disorders

Types of Resources Available for Homeless Population

-Homeless Shelters-Healthcare Centers and Storefront Clinics = operated by NPs who work in consultation with physicians in the area; clinics administer medications, assess VS, screen for TB and other communicable diseases, give vaccines, change dressing, and administer first aid; operate under severe budgetary constraints and frequently are low on supplies and staff and are in high crime neighborhoods; lack of follow through in follow in return appointments)-Mobile Outreach Units (teams drive or walk around and seek out homeless individuals in need of assistance; most target the mentally ill segment of the population)

Adolescence (Primary Prevention)

-Identity vs. Role Confusion-there is commonly conflict over issues of control-need to know parents (or surrogate parents) are available for support if needed-issues include: self-esteem and body image, peer relationships, education and career selection, establishing a set of values and ideals, sexuality and sexual experimentation, drug and alcohol use, and physical appearance-focus on providing support and accurate information to ease the difficult transition they are going through

Primary Prevention of Maturational Crisis - Populations at Risk

-adolescence-marriage-parenthood-midlife-retirement

Health Issues of Homeless Population

-alcoholism is common (40% of homeless individuals abuse alcohol putting them at greater risk for neurological impairment, heart disease, hypertension, chronic lung disease, GI disorders, hepatic dysfunction, and trauma)-thermoregulation (due to exposure to all kinds of weather; compounded problem for homeless alcoholic)-TB (crowded shelters provide ideal conditions for spread of respiratory infections; risk increased by prevalence of alcoholism, drug addiction, HIV, poor nutrition, and lack of access to medical care)-Dietary Deficiencies-STIs (HIV is prevalent; staying in shelters can be life threatening due to exposure to infectious diseases of others)-Needs of Homeless Children (more vulnerable to asthma, ear infections, stomach problems, and speech problems; experience more mental health problems such as anxiety, depression, and withdrawal; twice as likely to experience hunger and four times as likely to have delayed development)

Poverty

-direct correlation to emotional illness-may have to do with: inadequate and crowded living conditions, nutritional deficiencies, medical neglect, unemployment, and homelessness

Midlife (Secondary Prevention)

-individual may be unable to integrate all of the changes that are occurring during this period-may result in depression, anxiety, or substance abuse that the individual may require help to resolve

Trauma

-individuals who have encountered trauma must be considered at risk for emotional illness-includes trauma experiences outside the usual range of human experience: rape, war, physical attacks, torture, or natural or man made disasters

High Rate of Life Changing Events

-large number of significant events occuring in close proximity tend to decrease a person's ability to deal with stress; physical or emotional illness may result-some life changing events: death of loved one, divorce, being fired from job, physical illness, change in living conditions, change in body image (loss of body part or function)

Homeless Population (Cont.)

-many homeless individuals are children and young adults; due to parental homelessness, being trauma victims, or family intolerance to LGBTQ identity-children "on the run" are a high risk, vulnerable population who often have a history of trauma as well as additional trauma posed by homelessness and sex trafficking*30% of the homeless population suffers from some form of mental illness

Homeless Population

-mental illness is the third largest reason for homelessness; substance use disorders are common comorbidity-person is considered homeless when he or she lacks a fixed, regular, and adequate night-time residence; or has a night-time residence that is (A) a supervised publicly or privately operated shelter designed to provide temporary living accommodations, (B) an institution that provides a temporary residence for individuals intended to be institutionalized, or (C) a public or private place not designed for a regular sleeping accommodation for human beings

Retirement (Primary Prevention)

-negative feelings related to lack of productivity-loss of self-worth; individuals who are unable to adapt satisfactorily may become depressed-financial issues-primary prevention involves proving information and support to individuals who have retired or are considering retirement and assessing individual needs with regard to continuing employment in older adulthood-one-to-one basis of support

Midlife (Primary Prevention)

-occurs anytime between ages 35 and 65-alteration in perception of the self (changes in the body)-alteration in perception of others (change in relationship with adult children & aging parents)-death of parents (coming to terms with their own mortality)-empty nest syndrome (adjustment period parents experience when the last child leaves home to establish an independent residence; often more profound for the mother)-primary prevention involves providing accurate information regarding changes that occur during this time and support for adapting to these changes effectively

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

Parenthood (Secondary Prevention)

-reasons for intervention include: psychical, emotional, or sexual abuse of child; physical or emotional neglect of child; birth of a child with special needs; diagnosis of a terminal illness in a child; and death of a child-being able to recognize the physical and behavioral signs that indicate possible abuse of a child is important-teaching effective methods of disciplining children aside from physical punishment (positive reinforcement)-parents should be informed about behavioral expectations at the various levels of development-nurses can assist parents who are grieving loss of a child or birth of a child with special needs by helping them express their feelings associated with loss (shock, denial, anger, guilt, powerlessness, and hopelessness need to be expressed in order for parents to progress through the grief response)

Individuals with Severe and Persistent Mental Illness (Tertiary Prevention)

-serious mental illness defined as "mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or major life activities"-characterized by significant, ongoing, functional impairment and major disability-creates serious interpersonal difficulties

Primary Prevention Situational Crises - Populations at Risk

-situational crises are acute response that occur as a result of external circumstantial stressor-poverty-high rate of life changing events-environmental conditions-trauma*primary prevention for situational crises is aimed at maintaining the highest possible level of functioning while offering support and assistance with problem solving during the crisis period

Retirement (Secondary Prevention)

-when individuals are unable to successfully grieve for the loss of this aspect of their lives, it can result in depression and suicidal ideation-more likely to occur when individuals have not planned for retirement or when they have derived most of their self esteem from their employment

Marriage (Primary Prevention)

Issues include:-synchronization of two lives-difference in religion, ethnicity, social status, or race-need for communication and compromise*focus on education regarding what to expect at various stages of marriagePrimary Prevention involves:-encouraging honest communication-determining what each person expects from the relationship-discerning whether or not each individual can accept compromise

which of the following represents a nursing intervention at the tertiary level of prevention? a. serving as case manger for a mentally ill homeless client b. leading a support group for newly retired men c. teaching a prepared childbirth class d. caring for a depressed widow in the hospital

a

Secondary Prevention

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

tertiary prevention

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

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 during the first home visit? a. complicated grieving b. social isolation c. risk for injury d. sleep pattern disturbance

c

The physician orders trazadone (Desyrel) for Mrs. W, a 78-year old widow w/ depression, 150mg to take at bedtime. Which is appropriate teaching? a. "you may feel dizzy when you stand up, so go slow..." b. "You must be sure and no eat any chocolate..." c. "We will need to draw blood every month..." d. "if you don't feel better right away with this med, the doctor can order a different one..."

a

which of the following issues have been identified as contributing to the rise in the population of those who are homeless? SATA 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

abcd

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 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 prefer to 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 schizo to ensure med compliance

b

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

Community Mental Health Centers Act (1963)

called for the construction of comprehensive community mental health centers; cost of which would be shared by federal and state governments

Marriage (Secondary Prevention)

common problems in marriage include:-substance abusedisagreements on issues of sex, money, children, gender roles, and infidelitynursing intervention may include:-counseling wit the couple or on a one-to-one basis-referral to a couples' support group-identification of the problem and possible solutions-referral to sex therapist-referral to financial advisor-referral to parent effectiveness training

Maturational Crises

crucial experiences that are associated with various stages of growth and development

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. "Have you been thinking about harming yourself in any way?"

d

Community

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

Deinstitutionalization

moving people with psychological or developmental disabilities from highly structured institutions to home- or community-based settings

primary prevention

services aimed at reducing the incidence of mental disorders within the population

Prospective Payment System

the payment amount or reimbursement with a set rate for certain procedures is known in advance