Forensic Psychiatric Nursing – Describe the nurse’s role

11 Jun Forensic Psychiatric Nursing – Describe the nurse’s role

Question
1. How far back do fossils from the Burgess Shale date?

Select one:

a. 50 million years ago

b. 130 million years agoQuestion
CHAPTER 21, Forensic Psychiatric Nursing

In completing the case study, students will be addressing the following learning objectives:

Describe the nurse’s role in the forensic milieu.

Describe characteristics of psychiatric and mental health concerns specific to forensic populations, addressing implications for nursing care.

1. Two student nurses are assigned to the forensic unit for their psychiatric learning experiences. They are both slightly apprehensive but want to learn from the nursing staff the role of the nurse in forensic psychiatric nursing.

(Learning Objectives: 1, 2)

a. What will the nurse manager tell the students about the role of the nurse in forensic psychiatric nursing?

b. In addition, what do the student nurses know about the difference between the traditional mental health setting and the forensic milieu?

Case Study, Mohr

CHAPTER 22, Sleep Disorders

In completing the case study, students will be addressing the following learning objectives:

Explain normal changes in sleep across the human lifespan.

1. James, a 12-year-old middle-school student, is having problems with his schoolwork. James cannot sleep until late at night and has been unable to arrive at school until later in the morning due to excessive morning sleepiness and difficulty awakening. James is concerned and depressed over this considerable insomnia with subsequent tardiness in arriving at school. The teacher referred James to the school psychologist, who recommended psychological testing to determine if James has a learning disability. The results of the test show that James does have a learning disability and needs special placement for his English class. James continues to have insomnia. The pediatrician recommended that James have a study at a sleep clinic. After the test, James was given a sleep schedule and was able to return to his normal sleep schedule. His schoolwork improved after he was able to achieve adequate sleep.

(Learning Objectives: 1)

a. Why did James’ sleep schedule change from his normal routine? Revised Question: “What factors could have contributed to the alterations in James’ sleep pattern and subsequent insomnia?”

b. How do sleep patterns change for people over the lifespan?

Case Study, Mohr

CHAPTER 23, Anxiety Disorders

In completing the case study, students will be addressing the following learning objectives:

Explain what is meant by anxiety disorder.

Identify symptoms of anxiety disorders.

1. Amy is a 33-year-old housewife who has been saying that she is worried but cannot explain why she feels worried. Amy and her husband have two children, and the family members are healthy and financially secure and have no identified problems. Amy has resigned from her volunteer position at her children’s school, stating that she is tired. Amy always had great pride in keeping an immaculate home and preparing nutritional meals for her family. For the past month, she has neglected her housework and seldom cooks meals for her family. For the past 3 weeks, Amy has told her husband that she is afraid that “something bad is going to happen to us.” Amy is now afraid for her children to leave the home to attend school and for her husband to go to his office to work.

(Learning Objectives: 1, 2)

a. What is an anxiety disorder, and does Amy have this disorder?

b. What other differential diagnoses would you consider? OR What predisposing factors or etiologies are associated with anxiety disorders?

Case Study, Mohr

CHAPTER 24, Somatoform, Dissociative, and Sexual Disorders

In completing the case study, students will be addressing the following learning objectives:

Describe possible etiologies of somatoform disorders.

Explain the features of various somatoform disorders.

Identify the most common interdisciplinary goals and treatments for clients with somatoform disorders.

1. Roger is a 60-year-old, twice-divorced, Hispanic man who is retired. His only support system is two adult sons with whom he has a distant relationship. Roger has medical insurance from his retirement and constantly complains that he has some medical problem. He “doctor shops” by seeing different doctors for his various complaints. Roger is always asking the doctors if he needs surgery. In the past 5 years, he has undergone an exploratory laparotomy for complaints of abdominal pain, three colonoscopies for complaints of alternate diarrhea and constipation, and numerous diagnostic tests for his many physical complaints. All tests and procedures have negative findings for any physical basis. Roger remains convinced that he has multiple problems that the doctors are unable to diagnose.

(Learning Objectives: 1, 3)

a. What are somatoform disorders, and what are the types of this disorder?

b. Based on the information given in the case study, what contributing factors do you believe Roger has? What other factors, not included, could contribute to somatoform disorders? Name the appropriate disciplines involved in the treatment of Roger and the interdisciplinary goals and interventions in treating his somatoform disorder.

Case Study, Mohr

CHAPTER 25, Personality Disorders

In completing the case study, students will be addressing the following learning objectives:

Explain what is meant by personality disorder.

Define personality disorder.

Apply the nursing process to the care of clients with personality disorders.

1. Charles, a 29-year-old white man, has been admitted to the psychiatric hospital. Charles does not seem depressed and openly discusses that he had attempted suicide after he had burned his employer’s office and truck. Charles told the student nurse that he had been mad at his boss because he was a “slave driver” and shows no remorse for destroying his employer’s office and truck. Charles has limited contact with his mother, who is his only family support. Charles is divorced and states that his ex-wife just got pregnant so that he would marry her. They have one child, and he is several months behind in child support. Other information that Charles gave the student nurse in an interview included that he was an ex-marine but had a dishonorable discharge due to stealing some extra government supplies that he said no one needed. In the treatment team, the psychiatrist stated that Charles was not suicidal and diagnoses him with antisocial personality disorder.

(Learning Objectives: 1, 3)

a. What is an antisocial personality disorder, and what are its symptoms?

b. Applying the nurse process to the treatment of Charles, what specific interventions would be most appropriate for the individual with antisocial personality disorder?

Case Study, Mohr

CHAPTER26, Eating Disorders

In completing the case study, students will be addressing the following learning objectives:

Discuss possible etiologies for eating disorders.

Differentiate anorexia nervosa, bulimia, and binge eating disorder.

1. Anna is a 20-year-old college student who is slightly overweight. Anna is neat and orderly and considered to be a perfectionist. Anna has a sister, Margie, who is 2 years younger and has always been very slim. Anna thinks that she is ugly and that her sister is pretty. Anna began a daily diet of 500 calories with a rigid exercise program to lose weight rapidly. Anna’s weight decreased below the normal amount for her height. Anna continued to diet by reducing her daily caloric intake to 250 calories and then to 100 calories and began to look emaciated. Anna’s parents asked her to increase her food intake, but Anna said that she was “still fat and ugly.” Anna’s parents intervened by taking her to a psychiatrist for treatment. Anna’s diagnosis was anorexia nervosa.

(Learning Objectives: 1)

a. What is the probable cause of Anna’s eating disorder?

b. What specific eating disorder does Anna most likely have?

Case Study, Mohr

CHAPTER 27, Depressive Disorders

In completing the case study, students will be addressing the following learning objectives:

Analyze different theories about the etiology of depressive disorders.

Discuss interdisciplinary treatment modalities for clients with depressive disorders.

1. Sarah, a 37-year-old bank employee, has developed a depressive disorder. Sarah was engaged and planned to be married next month. Her fiancé suddenly broke off their engagement and told Sarah that he had accepted a job in Europe and was moving there immediately. Sarah’s depression began shortly after this and has progressed to the point that she is now seeing a psychiatrist for treatment. Sarah’s family has a history of depressive disorders. Her father has experienced recurrent episodes of depression for 20 years. Sarah’s paternal aunt and great uncle both committed suicide.

(Learning Objectives: 1, 2)

a. Identify and discuss the major theories for the etiology of depressive disorders.

b. What different interdisciplinary treatment modalities would be appropriate to incorporate into the plan of care for Sarah?

Case Study, Mohr

CHAPTER 29,

In completing the case study, the student will be addressing the following objectives:

Identify signs and symptoms of schizophrenia.

Explain the subtypes of schizophrenia.

1. Joyce Mullins is a 31 years old client whose diagnosis is schizophrenia, disorganized type. Joyce is in the state mental hospital for a long term commitment. The student nurse is escorting Joyce and a group of patients to an art class. Suddenly, Joyce stop and look down at the sidewalk and then says “there are many brains down there on the sidewalk” later, the student is reviewing the symptoms of schizophrenia for a nursing care plan.

Learning objectives:

a Discuss the symptoms of schizophrenia

b Compare and contrast schizophrenia, disorganized type to other types of schizophrenia.

Case Study, Mohr

CHAPTER 30, Substance Use Disorders

In completing the case study, students will be addressing the following learning objectives:

Identify the two main components of interdisciplinary treatment for clients with substance abuse disorders.

Explain the importance of recognizing co-occurring disorders.

1. John, a 23-year-old unemployed man, is addicted to cocaine. John lives with his mother and sister and has been stealing money from them to pay for his cocaine. His mother persuaded John to voluntarily commit himself to the hospital for treatment of his substance abuse. In the initial assessment interview, the nurse learns that John began smoking marijuana at age 19 and occasionally consumes alcohol. John said that he started on cocaine after his father, who had a history of alcoholism, committed suicide. John says that he began to feel anxious then and still has periods of anxiety. John is cooperative with his treatment program and stated that he wants to get completely off drugs and get a good job to help his mother and sister. John also said that if he experienced anxiety, he would take a stiff drink like his father had done when he was anxious.

(Learning Objectives: 2)

a. How can the psychiatric staff counsel with John to avoid his turning to alcohol as substance?

b. With what other co-occurring disorders could John be diagnosed?

Case Study, Mohr

CHAPTER 31, Cognitive Disorders

In completing the case study, students will be addressing the following learning objectives:

Identify clinical features or behaviors associated with cognitive disorders.

Compare possible etiologies of various cognitive disorders, especially Alzheimer’s disease.

1. Will Lunsford is a 78-year-old widower who lives with his daughter. Mr. Lunsford has been increasingly irritable and has lost many personal items during the past few weeks. Today, he returned from a trip around the neighborhood to say that he had lost his truck and could not remember where he parked it. The preceding week, Mr. Lunsford declared that the telephone was broken when he could not remember how to dial the number of his friend. He also asked his daughter when they would have breakfast one morning an hour after they had eaten breakfast. Mr. Lunsford’s daughter made an appointment for him to be seen by his doctor. The doctor diagnosed Mr. Lunsford with Alzheimer’s disease.

(Learning Objectives: 1, 2)

a. What are the clinical features or behaviors associated with cognitive disorders?

b. What possible etiologies can be applied to Mr. Lunsford’s new diagnosis of Alzheimer’s disease?

Case Study, Mohr

CHAPTER 32, Anger and Aggression

In completing the case study, students will be addressing the following learning objectives:

Discuss various interventions to manage anger and aggression.

Define broad factors that can increase risk for anger, aggression, and violence.

1. Frances, a 49-year-old African American client, is a newly admitted patient to the psychiatric hospital. Frances has the dual diagnoses of Bipolar I and Borderline Personality Disorder. Frances refuses to abide by the unit rules of being out in the day room after breakfast and is staying in her room. Her treatment level permits her to make two telephone calls daily, and Frances is demanding unlimited access to the telephone Frances is becoming increasingly frustrated and angry at the staff and has used some expletives in telling them what she thinks of the unit rules. The primary nurse attempts to defuse Frances’ anger but finally becomes frustrated and angry herself, and she commented to Frances that if she did not cooperate with unit rules, she could expect to be in the hospital longer than usual. Frances then lunged at the nurse, striking her on the head with her fist. Frances was taken to the calming room and given a medication for her aggressive behavior.

(Learning Objectives: 2)

a. What therapeutic communication techniques could the nurse have used with Frances to prevent her from becoming angry and aggressive?

b. What factors could have contributed to an increase in Frances’ level of anger?

Case Study, Mohr

Chapter 33, Violence and Abuse

In completing the case study, students will be addressing the following learning objectives:

Discuss the effects of maltreatment on child development.

Describe an organizational model for the multiple conditions that support community violence.

1. Nita’s mother died when she was an infant. Her father married a young woman 1 year after the death of Nita’s mother. A baby girl was born to the stepmother 2 years later, followed by the birth of a baby boy 4 years later. The stepmother showed much preferential treatment to her own children, while she basically ignored Nita except to routinely ridicule her. The most difficult household chores were given to Nita, with no chores given to her own daughter. The stepmother frequently severely punished Nita without reason. Publicly, the stepmother insisted that she treated Nita and her daughter alike in every way. However, she always praised her own daughter, while continuing to verbally abuse Nita. Nita’s father put his wife in full charge and had almost no interaction with Nita. He, too, showed preferential treatment for his two children with his second wife. When Nita was 14 years old, her aunt insisted that Nita move to live with her. The aunt was very nurturing, and Nita’s life improved tremendously. Nita was very intelligent and excelled in school. Nevertheless, she was slow to make close friends and lacked confidence in social situations. Nita became a successful professional as a college professor. Nita appeared afraid to form a close relationship and was 31 years old when she married.

(Learning Objectives: 1) a. Is maltreatment of children a problem, and what are the effects on their development and functioning?

b.Discuss the Ecological Model of Violence and how it applies to the case of Nita

Case Study, Mohr

CHAPTER 34, Suicide and Suicidal Behavior

In completing the case study, students will be addressing the following learning objectives: List the warning signs of suicide.

Explain factors contributing to suicidal risk, including the relationship to culture and ethnicity, age, and gender.

1. Kate, a 35-year-old white woman, who moved to another city to take a new job. Kate has a depressive disorder and has no friends in her new city; her only family support is one brother. Kate has lost her new job and is without insurance or funds to purchase her prescribed antidepressants. Kate formerly had excellent credit but now realizes that since she has no money, she may have to declare bankruptcy. Kate became extremely depressed, purchased a gun, wrote suicide letters to her friends, and decided to commit suicide. Kate then called 911 just before pulling the trigger on the gun. However, the gun jammed and did not eject bullets. A policeman came to her apartment in response to the 911 call and took Kate to the local psychiatric hospital. After discharge, Kate went to live with her brother. Kate’s brother is concerned that she is a continued suicide risk.

(Learning Objectives: 1)

a. What are the warning signs of suicide?

b. What factors could have contributed to Kate’s desire to commit suicide?.

Case Study, Mohr

CHAPTER 35, Crisis Intervention

In completing the case study, students will be addressing the following learning objectives:

Differentiate maturational, situational, and adventitious crisis.

Apply the nursing process to a client, family, or community in crisis.

1. Frances Gordon is a 42-year-old divorced school teacher. Her 20-year-old daughter, Sarah, has developed schizophrenia and has withdrawn from college. Her youngest daughter, Glenda, is a 19-year-old unmarried mother who is living at home. Glenda has just given birth to a baby boy who has a heart defect. The baby’s father refuses to pay for any of the healthcare costs. Frances’ dire economic situation is very stressful to her. Her ex-husband refuses to help financially, and the bank has refused a second loan to Frances.

(Learning Objectives: 1) a. Can you differentiate between maturational, situational, and adventitious crises? What type of crisis is Frances experiencing?

a. Discuss how to apply the nursing process in the care of Frances.

Case Study, Mohr

CHAPTER 36, Pediatric Clients

In completing the case study, students will be addressing the following learning objectives:

Identify factors that contribute to psychiatric disorders in children and adolescents.

Discuss general interventions available for children or adolescents with psychiatric disorders.

1. Jeremy is a 9-year-old child hospitalized in the children’s unit of a psychiatric hospital. Jeremy’s biological father died 2 years ago, and the mother now has a live-in boyfriend who has repeatedly sexually abused Jeremy. Jeremy’s teacher reported this abuse to the Children’s Protective Services, and Jeremy was removed from the home. Jeremy’s biological mother has experienced a depressive disorder for several years. Since he has been living with his foster parents, Jeremy has exhibited numerous problems of angry outbursts with physical violence toward other children living in his foster home. The foster parents are seeking help from the psychiatrist to continue to care for Jeremy in their home.

(Learning Objectives: 1, 2)

a. Identify some of the factors that contribute to psychiatric disorders in children and adolescents.

b. What interventions would be most appropriate in the treatment of Jeremy?

Case Study, Mohr

CHAPTER 37, Older Adult Clients

In completing the case study, students will be addressing the following learning objectives: Differentiate communication approaches when working with older adults.

Discuss attitudes that many in society hold toward older people.

1. Molly Brewster is a 79-year-old white widow who is admitted to the hospital for diagnostic studies. Mrs. Brewster has been feeling fatigued with slight depression that has been increasing for the past 2 weeks prior to admission. The student nurse is assigned to care for Molly and explain some of the preparation for the diagnostic studies.

(Learning Objectives: 1)

a. What are some effective communication techniques that the student nurse should use in therapeutic communication with Mrs. Brewster?

b. Discuss different societal attitudes that individuals may have in reaction to someone in Mrs. Brewster’s position.

Case Study, Mohr

CHAPTER 38, Homeless Clients

In completing the case study, students will be addressing the following learning objectives:

Discuss factors that contribute to homelessness in people with mental illness.

Discuss barriers that prevent homeless people with mental illness from receiving care measures to promote access.

1. Kevin, a 39-year-old unemployed homeless male who has paranoid schizophrenia, was brought to the psychiatric hospital by the police. Citizens called the police because Kevin was in the street directing pedestrians and traffic in opposition to the traffic lights and verbally abusing everyone who did not follow his directions. Kevin is known to the police since he is often homeless, and states that his family does not want him. Kevin also has a history of poly substance abuse with alcohol, heroin, and crack cocaine, and he has been jailed for public intoxication several times. The nursing assessment reveals that Kevin has not been taking his prescribed psychotropic medications for 3 weeks. Kevin states that he does not have any money, and he does not remember where to go for mental health care (Learning Objectives: 2)

a. What are the major factors that contribute to Kevin’s frequent homelessness?

b. What barriers does Kevin face in the receiving treatment? How can these barriers be addressed?

Case Study, Mohr

CHAPTER 39, Clients with Medical Illnesses

In completing the case study, students will be addressing the following learning objectives:

Identify common medical conditions that can have accompanying psychiatric complications or symptoms. Describe general nursing implications for clients experiencing psychiatric disorders that are intertwined with other nonpsychiatric illnesses.

1. Carla, a 27-year-old white single mother of two preschool-age children, is in the psychiatric hospital for treatment of anxiety and depression. Carla has a cardiac condition that requires surgery. Carla is concerned over the financial cost of the surgery and caretakers for her children while she is in the hospital and undergoing rehabilitation. Carla is also worried that she may be unable to continue in her present employment as a salesperson due to the physical demands of this position. Carla’s case is representative of many patients with medical conditions who develop psychiatric symptoms.

(Learning Objectives: 1, 2)

a. What are some prevalent medical conditions that can also be accompanied by psychiatric symptoms or complications?

b.What are some nursing implications for Carla that address both the psychiatric and nonpsychiatric illnesses?

c. 320 million years ago

d. 410 million years ago

e. 540 million years ago

2. What molecules assist in the transmission of information between two neurons?

Select one:

a. Action potentials

b. Depolarization

c. Saltatory conduction

d. Integration

e. Neurotransmitters

3. Which of these associations is incorrect?

Select one:

a. Epidermal cells-protection

b. Stomata-gas exchange

c. Sclerenchyma cells-cell division

d. Sieve-tube cells-sugar transport

e. Xylem cells-water transport

4. _ (blank) _ must take place in order for gas exchange to occur during respiration.

Select one:

a. Diffusion

b. Osmosis

c. Cellular respiration

d. Fermentation

e. None of these are necessary in order for gas exchange to take place

5. _ (blank) _ occurs when air moves in and out by the same route.

Select one:

a. Inspiration ventilation

b. Intercostal ventilation

c. Expiratory ventilation

d. Tidal ventilation

e. Diaphragm ventilation

6. Which of the following areas have the highest concentration of oxygen?

Select one:

a. Atmosphere

b. Trachea

c. Alveoli

d. Tissue cells

e. Blood

7. What types of structures have the same function but do not share a common ancestry?

Select one:

a. homologous structures

b. parallel structures

c. analogous structures

d. divergent structures

e. cladistic structures

8. _ (blank) _ is a group of similar cells performing a specific function.

Select one:

a. An organ

b. An organism

c. A tissue

d. An organ system

e. A cell