Psych Ch 27: Community Mental Health Nursing
Nursing in __________ prevention is focused on the targeting of groups at risk and the provision of educational programs.
primary
Primary, Secondary or Tertiary Prevention: -Identifying stressful life events that precipitate crises and targeting the relevant populations at high risk. -Intervening with these high-risk populations to prevent or minimize harmful consequences.
primary
John, a homeless person, has a history of schizophrenia and noncompliance with medications. Which one of the following medications might be the best choice for John? a. Haldol b. Navane c. Lithium carbonate d. Prolix decanoate
d
A number of studies have identified ___________ as a direct correlation to emotional illness.
poverty
What populations are at risk for a situational crises?
poverty, high rate of life change events, environmental conditions, trauma
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 rehab c. referring a married couple for sex therapy d. leading a support group for battered women
a
In 1841, ______________________, a former schoolteacher, began a personal crusade across the land on behalf of institutionalized individuals with mental illness. Her efforts resulted in more humane treatment of these clients and the establishment of a number of psychiatric hospitals.
Dorthea Dix
____________________ crises are crucial experiences that are associated with various stages of growth and development.
Maturational
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
Midlife crises are not defined by a specific number. Various sources in the literature identify these conflicts as occurring anytime between age ______ and _______.
35 and 65
______________ experiences outside the usual range of human experience, including: -Military combat -Being a victim of violent personal assault -Undergoing torture -Being taken hostage or kidnapped -Being the victim of a natural or man-made disaster
Traumatic
____________ crises are acute responses that occur as a result of an external circumstantial stressor.
Situational
Which populations are at risk for a maturational crises?
adolescence, marriage, parenthood, midlife, retirement
Nursing interventions with ______________ at the primary level of prevention focus on providing support and accurate information to ease the difficult transition.
adolescents
Which population has these issues when facing a maturational crises: -Self-esteem and body image -Peer relationships -Education and career -Values and ideals -Sexuality -Drug and alcohol abuse -Physical appearance
adolescents
Ann is in psychiatric home health nurse. She has just received and 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 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
Three predominant client populations have been identified as benefiting most from psychiatric home health care. Which of the following in NOT included among this group? a. elderly individuals b. individuals living in poverty c. individuals with severe and persistent mental illness d. individuals in acute crisis situations
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 in psychiatric home health nurse. She has just received and 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. 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
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
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, 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?"
c
refer to differences in access to or availability of health facilities and services
disparities
Health issues in which population: -Alcoholism is common. -Thermoregulation -Tuberculosis -Dietary deficiencies -Sexually transmitted diseases
homeless
Several factors that may contribute to homelessness have been identified. They include:
lack of affordable health care, domestic violence, addiction disorders
Nursing interventions at the primary level of prevention with individuals in this stage of development involve: -Encouraging honest communication -Determining what each person expects from the relationship -Discerning whether or not each individual can accept compromise
marriage
Which population has these issues when facing a maturational crises: -Synchronization of two lives -Differences in religion, ethnicity, social status, or race -Need for communication and compromise
marriage
Issues in which stage of development include: -Age-related physiological changes -Relationship with adult children -Relationship with aging parents -Death of parents -"Empty nest" syndrome
midlife
Nursing intervention at the primary level of prevention with those in the developmental stage include: -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.
parenthood
Primary, Secondary or Tertiary secondary: -Teaching parenting skills and child development to prospective new parents -Teaching physical and psychosocial effects of alcohol/drugs to elementary school students -Teaching techniques of stress management to virtually anyone who desires to learn -Teaching groups of individuals ways to cope with the changes associated with various maturational stages -Teaching concepts of mental health to various groups within the community -Providing education and support to unemployed or homeless individuals -Providing education and support to other individuals in various transitional periods
primary
Primary, Secondary or Tertiary: focused on targeting groups at risk and providing educational programs.
primary
Issues in which group of development include: -Negative feelings related to lack of productivity -Loss of self-worth; depression Financial issues
retirement
What is the most common mental illness among the homeless?
schizophrenia
Exacerbation of mental illness symptoms requires intervention at the ____________ level of prevention.
secondary
Intervention at the _________ level of prevention with parents can be required for a number of reasons. A few of these include: -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
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.
secondary
Nursing care at the _______________ level of prevention with clients undergoing situational crises occurs only if crisis intervention at the primary level failed and the individual is unable to function socially or occupationally.
secondary
Nursing in ____________ prevention focuses on recognition of symptoms and provision of, or referral for, treatment.
secondary
Nursing intervention at the ____________ level of prevention with individuals encountering marriage problems may include one or more of the following: -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
secondary
Primary, Secondary or Tertiary Prevention: -Ongoing assessment of individuals at high risk for illness exacerbation (e.g., during home visits, day care, community health centers, or in any setting where screening of high-risk individuals might occur) -Provision of care for individuals in whom illness symptoms have been assessed (e.g., individual or group counseling, medication administration, education and support during period of increased stress [crisis intervention], staffing rape crisis centers, suicide hotlines, homeless shelters, shelters for abused persons, or mobile mental health units) -Referral for treatment of individuals in whom illness symptoms have been assessed. Referrals may come from support groups, community mental health centers, emergency services, psychiatrists or psychologists, and day or partial hospitalization. Inpatient therapy on a psychiatric unit of a general hospital or in a private psychiatric hospital may be necessary. Psychopharmacology and various adjunct therapies may be initiated as part of the treatment.
secondary
Primary, Secondary or Tertiary prevention: -Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness. -Accomplished through early identification of problems and prompt initiation of effective treatment.
secondary
Retirement can also result in depression for individuals who are unable to satisfactorily grieve for the loss of this aspect of their lives. Nursing intervention at the _____________ level of prevention with depressed individuals takes place in both inpatient and outpatient settings
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.
secondary
_____________ and _______________ mental illness: -Is characterized by functional impairment that interferes with vocational capacity -Creates serious interpersonal difficulties -May be associated with a suicide plan or attempt
severe, persistent
Environmental conditions can create _______________ crises. Examples include: -Tornadoes -Floods -Hurricanes -Earthquakes
situational
A large number of significant events occurring in close proximity decrease a person's ability to deal with ___________.
stress
Nursing in _____________ prevention focuses on helping clients learn or relearn socially appropriate behaviors so that they may achieve a satisfying role within the community.
tertiary
Primary, Secondary or Tertiary Prevention: -Consideration of the rehabilitation process at the time of initial diagnosis and treatment planning -Teaching the client daily living skills and encouraging independence to his or her maximum ability -Referring clients for various aftercare services (e.g., support groups, day treatment programs, partial hospitalization programs, psychosocial rehabilitation programs, group home or other transitional housing) -Monitoring effectiveness of aftercare services (e.g., through home health visits or follow-up appointments in community mental health centers) Making referrals for support services when required (e.g., some communities have programs linking individuals with serious mental disorders to volunteers who serve to develop friendships with the individuals and who may assist with household chores, shopping, and other activities of daily living with which the individual is having difficulty, in addition to participating in social activities with the individual)
tertiary
Primary, Secondary or Tertiary: -Reducing the residual defects that are associated with severe and persistent mental illness. -Accomplished by preventing complications of the illness and promoting achievement of each individual's maximum level of functioning.
tertiary
Aims to soften the impact of an ongoing illness or injury that has lasting effects.
tertiary prevention