Ch. 27 - Community Mental Health Nursing

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 in a case management system.

stress

A large number of significant events occurring in close proximity decrease a person's ability to deal with ___________.

Diagnosis-related groups (DRGs)

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

d. Prolixin decanoate

John, a homeless person, has 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

c. conducting a behavioral and needs assessment for John

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 for John d. Helping John apply for SS benefits

35-65

Midlife crises are not defined by a specific number. Various sources in the literature identify these conflicts as occurring anytime between age ______ and _______.

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

Mrs. W, a 78-yo widow who lives alone, 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?

crisis intervention at the primary level failed and the individual is unable to function socially or occupationally.

Nursing care at the secondary level of prevention with clients undergoing situational crises occurs only if

primary

Nursing in __________ prevention is focused on the targeting of groups at risk and the provision of educational programs.

secondary

Nursing in ____________ prevention focuses on recognition of symptoms and provision of, or referral for, treatment.

tertiary

Nursing in _____________ prevention focuses on helping clients learn or relearn socially appropriate behaviors so that they may achieve a satisfying role within the community.

-Counseling with the couple or with one of the spouses on a one-to-one basis -Referral to a couples' support group -Identification of the problem and possible solutions; support and guidance as changes are undertaken -Referral to a sex therapist -Referral to a financial advisor -Referral to parent effectiveness training

Nursing intervention at the secondary level of prevention with individuals encountering marriage problems may include one or more of the following:

-Encouraging honest communication -Determining what each person expects from the relationship -Discerning whether or not each individual can accept compromise

Nursing interventions at the primary level of prevention with individuals in the marriage stage of development involve:

adolescents

Nursing interventions with ______________ at the primary level of prevention focus on providing support and accurate information to ease the difficult transition.

a. Teaching a class in parent effectiveness training

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.

deinstitutionalization

aim of treatment is to manage the severity of mental illness and assist the patient to live at the highest, most independent level of functioning within the community

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

focus of primary prevention

is accomplished through early identification of problems and prompt initiation of effective treatment

focus of secondary prevention

preventing complications of the illness and promoting rehabilitation that is directed toward achievement of the individual's maximum level of functioning

focus of tertiary prevention

-Self-esteem and body image -Peer relationships -Education and career -Values and ideals -Sexuality -Drug and alcohol abuse -Physical appearance

issued faced by adolescents during maturational crises

-Synchronization of two lives -Differences in religion, ethnicity, social status, or race -Need for communication and compromise

issued faced by married people during maturational crises

Deinstitutionalization

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

primary prevention

reducing the incidence of mental disorders within the population; methods are used before the person gets the disease to prevent the disease from occuring

secondary prevention

reducing the prevalence of psychiatric illness by shortening the course of the illness; is used after the disease has occurred, but before the person notices that anything is wrong

tertiary prevention

reducing the residual defects that are associated with severe and persistent mental illness; targets the person who already has symptoms of the disease to present the disease from causing other problems

-Age-related physiological changes -Relationship with adult children -Relationship with aging parents -Death of parents -"Empty nest" syndrome

Issues in the midlife stage of development include

-Negative feelings related to lack of productivity -Loss of self-worth; depression Financial issues

Issues in the retirement group of development include

secondary

Nursing care at the _____________ level of prevention during midlife becomes necessary when the individual is unable to integrate all of the changes that are occurring during this period.

b. Individuals living in poverty

Three predominant client populations have been identified as benefiting most from psychiatric home health care. Which of the following is not included among this group? a. Elderly indviduals b. Individuals living in poverty c. Individuals with severe and persistent mental illness d. Individuals in acute crisis situations

poverty

A number of studies have identified ___________ as a direct correlation to emotional illness.

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.

Schizophrenia

What is the most common mental illness among the homeless?

poverty, high rate of life change events, environmental conditions, trauma

What populations are at risk for a situational crises?

b. Providing support in the emergency room to a rape victim

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

c. Risk for injury

Ann is a psychiatric home health nurse. She has just received an order to begin regular visits to Mrs. W, a 78-yo widow who lives alone. Mrs. W's primary-care physician has diagnosed her as depressed. Based on a needs assessment, which of the following problems would Ann address during her first visit? a. Complicated grieving b. Social isolation c. Risk for injury d. Sleep pattern disturbance

b. Mrs. W is physically too weak to travel without risk of injury

Ann is a psychiatric home health nurse. She has just received an order to begin regular visits to Mrs. W, a 78-yo 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 depned 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

a. Serving as case manager for a mentally ill homeless client

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

-Prepared childbirth classes: These classes present what most likely will happen, but with additional information about possible variations from that which is expected. -Information about what to expect after the baby arrives -Stages of Growth and Development. It is very important for parents to understand what behaviors should be expected at what stage of development. It is also important to know that their child may not necessarily follow the age guidelines associated with these stages. However, a substantial deviation from these guidelines should be reported to their physician.

Nursing intervention at the primary level of prevention with those in the parenthood developmental stage include:

adolescence, marriage, parenthood, midlife, retirement

Which populations are at risk for a maturational crises?

Cost-effectiveness in provisions of medical care

Why is there a shift from inpatient to outpatient?

Situational

____________ crises are acute responses that occur as a result of an external circumstantial stressor.

Storefront Clinics

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

secondary

Exacerbation of mental illness symptoms requires intervention at the ____________ level of prevention.

-Physical, emotional, or sexual abuse of a child -Physical or emotional neglect of a child -Birth of a child with special needs -Diagnosis of a terminal illness in a child -Death of a child

Intervention at the secondary level of prevention with parents can be required for a number of reasons. A few of these include:

Maturational

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

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.

lack of affordable health care, domestic violence, addiction disorders

Several factors that may contribute to homelessness have been identified. They include

secondary

The need for intervention at the ______________ level of prevention in adolescence occurs when disruptive and age-inappropriate behaviors become the norm, and the family can no longer cope adaptively with the situation. All levels of dysfunction are considered.

a. You may feel dizzy when you stand up, so go slowly when you get up from sitting or lying down

The physician orders trazadone for Mrs. W (depressed and old) 150 mg to take at bedtime. Which of the following statements about his 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 be sure and not eat any chocolate while you are taking this medication 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.

prospective payment

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

case manager

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