Chapters 21, 23, 30,31 Flashcards
A major long term mental illness marked by significant functional impairments.
serious mental illness (SMI)
Serious mental illness (SMI) effects multiple areas such as:
ADL’s, poverty, social interaction, employment, relationships, and ability to maintain home
Have a severe mental illness and a substance abuse problem
Dual Diagnosis
Legislation that resulted in the mass movement of severely mentally ill persons from state hospitals to outpatient care.
deinstitutionalization
What two groups can SMIs be seperated into
- ) Those old enough to have experienced long-term institutionalization
- ) those young enough to have been hospitalized only for acute care during exacerbations of their disorder
Focuses on managing patients deficits and helping them learn to live with their illnesses, dominated psychiatric care.
Rehabilitation
Focuses on achieving goals of patients’ choosing, and leading a increasingly productive and meaningful life.
Recovery
What is the recovery model supported by? It is the leading mental health consumer advocacy organization. Helps people become more aware of disease and also helps educates families on disease.
National Alliance on Mental Illness (NAMI)
Issue Confronting those with SMI?
It is difficult for the person to establish goals and find meaning in life
People with SMIs commonly have what comorbid conditions?
Substance abuse (60%) Physical disorders (HTN, CVD, DM, Obesity) Depression/Suicide
View of a certain group of persons, assigning them with negative traits.
Stigma
Common stigma with people with SMIs is?
All persons with mental health issues are violent (usually the opposite MH person is victim)
Most common coping mechanism with SMIs is….
Denial
The inability to recognize one’s deficits due to one’s illness.
Anosognosia
Those that do not improve completely or consistently with treatment.
Residual symptoms
Residual symptoms will eventually lead to….
hopelessness and helplessness, pt may discontinue treatment in response, worsening the illness
Coordinate services and help with accessing them. Goal is to make sure the patients needs are met.
Case management
Multidisciplinary team provides comprehensive services to the patient in their own home environments.
Assertive Community Treatment (ACT)
Focus on helping patient gain ability to cope during overwhelming stressful situations
Crisis Intervention Services
Includes couseling and therapy based on a variety of models, usually provided by independently licensed mental health professional.
Group and individual psychotherapy
Include supervised or unsupervised group homes, “board and care” homes.
Housing services
Goals of SMI patients
stabilization and independence
The appointment of a person to make decisions for the consumer during times when judgement is impaired
Guardianship
Focused on homeless persons to help them get needed services (hot meals, clothing, transportation)
Community outreach programs
Includes medical and psychosocial assessment, detox, medication such as methadone (synthetic narcotic) if applicable. Family tx.
Substance abuse treatment
Principle that compromised neurological functions can be assumed by healthier areas of the brain
cognitive enhancement therapy
What is one of the strongest predictors of recovery
Family support and partnership
Focuses on teaching a wide variety of social and ADL skills. work on this in group home.
Social skills training
Instead of focusing on change, it stresses coping and anxiety reduction at their present stage of illness.
Supportive psychotherapy
Can include vocational training, financial support for attaining employment, or supported-employment services.
vocation rehab and related services
Consumers run their own business, such as a coffee shop or housekeeping service, they teach all members to perform a job in order to run the business.
clubhouse model
Mandated by the court when the patient leaves the hospital or prison for persons unlikely to continue treatment and then become a danger to self or society
Mandatory outpatient treatment
Shifting a person from one kind of institution to another (state hospital to jails, prisons, nursing homes or shelters)
Trans-institutionalization
The focus of the clubhouse model of treatment is….
providing socialization and building independence
One of the roles of a case manager working with severely and persistently mentally ill clients who are homeless is to
coordinate needed services and provide outreach.
The mother of a client with severe, persistent schizophrenia tells the nurse, “My son has slipped so far away from me over the past few years. We really don’t have a relationship anymore. I miss him.” The nursing diagnosis that best describes the mother’s feelings is
Grieving
After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires persistent direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of……..
dependency caused by institutionalization
An adult diagnosed with a serious mental illness says, “I do not need help with money management. I have excellent ideas about investments.” This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating:
anosognosia
Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with serious mental illness?
Assertive Community Therapy
A family discusses the impact of a seriously mental ill member. Insurance partially covered treatment expenses, but the family spent much of their savings for care. The patient’s sibling says, “My parents have no time for me.” The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful?
a. Acknowledge their concerns and consult with the treatment team about ways to bring the patient’s symptoms under better control.
b. Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one.
c. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families.
d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.
D. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.
The sibling of a patient who was diagnosed with a serious mental illness asks why a case manager has been assigned. The nurse’s reply should cite the major advantage of the use of case management as:
Case managers coordinate services and help with accessing them, making sure the patient’s needs are met
Which nursing diagnosis is likely to apply to an individual diagnosed with a serious mental illness who is homeless?
a. Insomnia
b. Substance abuse
c. Chronic low self-esteem
d. Impaired environmental interpretation syndrome
C. Chronic low self esteem
A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, “You cause too much trouble.” What problem is the patient experiencing?
Stigma
Select all that apply.
The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal?
a. Maintain stable and consistent staff.
b. Increase the length of medication education groups.
c. Stress that without treatment, illnesses will worsen.
d. Prescribe drugs in smaller but more frequent dosages.
e. Make it easier to access prescribers and pay for drugs.
f. Require adherence in order to participate in programming.
A, E
Select all that apply.
A person diagnosed with serious mental illness has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse?
a. Discourage potentially stressful activities such as groups or volunteer work.
b. Develop written plans that will help the patient remember what to do in a crisis.
c. Help the patient identify and anticipate events that are likely to be overwhelming.
d. Encourage health-promoting activities such as exercise and getting adequate rest.
e. Accompany the patient to a National Alliance on Mental Illness support group.
B,C,D,E
Select all that apply. An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Where should the nurse refer the patient? a. Psychoeducational classes b. Vocational rehabilitation c. Social skills training d. A homeless shelter e. Crisis intervention
A, B, C
Select all that apply.
Which statements most clearly indicate the speaker views mental illness with stigma?
a. “We are all a little bit crazy.”
b. “If people with mental illness would go to church, their problems would be solved.”
c. “Many mental illnesses are genetically transmitted. It’s no one’s fault that the illness occurs.”
d. “Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people.”
e. “People with mental illness are lazy. They get government disability checks instead of working.”
A, B, E
A repeated and persistent pattern of having an angry and irritable mood in conjunction with demonstrating defiant and vindictive behavior. Primarily a child disorder
oppositional defiant disorder
