Q1: Describe the following terms: (7 marks, each one mark)

Activities of Daily Living:

…………………………………………………………………………………………………………………………………………………………………………………………………………………………Curative Care: …………………………………………………………………………………………………………………………………………………………………………………………………………………………

Palliative Care:

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Respite Care

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Skilled Care

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Subacute Care

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Total Parenteral Nutrition

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Q2: The manual and electronic patient record has many purposes, but one goal: documentation of patient care. Regardless of the type of care provided, a health care facility’s patient records contain similar content (e.g., consent forms) and format features (e.g., all records contain patient identification information). Distinguish among patient record formats. (10 marks, each one 2 marks)

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3. Be explicit in your discussion of ED_{50 ,} LD_50, TD₅₀: what each of these are and explain in detail why it matters. Please give 2 examples of each.

Rachael Tomkins is 55 years old and is a certified practising accountant. She works part time and lives with her husband Paul, aged 64 and daughter Marie, aged 17. Her grandmother Jean aged 90, lives in a small flat at the back of their house and her mother Mary, aged 72 lives in an Over 55s housing unit nearby. In her early 20s Rachael’s father, a Vietnam Veteran, committed suicide. Rachael is described by her family as reliable and caring. She has a small group of friends from her local parish church. Rachael has regular contact with her GP to manage her Diabetes Type 2. She is prescribed metformin and has been trying to lose weight. She also sees a psychiatrist Dr Lianne Yu for management of her symptoms of schizophrenia. She is prescribed Olanzapine and Lithium. She was diagnosed with schizophrenia in her early 20’s when she was studying at university. She was hospitalised with acute psychosis several times before her symptoms were stabilised. She was able to complete her university degree and has worked part time. The last time she experienced acute psychosis was 17 years ago, just after the birth of her daughter. Her symptoms stabilised, and she has been maintained in recovery for almost 15 years. This year has been a particularly challenging year for Rachael. Both her husband’s parents passed away within months of each other, her daughter commenced Year 12 and her grandmother had an infection in her middle toe, which resulted in a series of trips to the doctor, hospitalisation and finally amputation of the affected toe. Rachael has become irritable with her family, and has developed erratic sleeping patterns, a lack of interest in grooming, and avoided social interactions with her friends or family. She complained to them that her neighbours were spying on her. In the 48 hours before she was admitted to hospital two incidents escalated Rachael’s need for professional help. In the first episode she yelled and threatened the neighbour across the fence. She accused him of spying on her with a ‘trackamanometer’. Her husband intervened and took her back into the house. In the second incident later that day, Rachael started screaming at her family to evacuate the house because they would be bombed. Rachael insisted the news reader on the TV was giving her this important information and they must all get out of the house. Rachael ran onto the road. A concerned neighbour called the police, who were able to convince her to accompany them to the hospital. She was met by her psychiatrist Dr Yu who reports the following -Rachael is dishevelled, dressed in pyjama top and tract pants, no shoes, she has an exacerbation of auditory hallucinations, with persecutory delusions and disorganised thinking. Rachael agrees to be admitted because she says ‘I’m frightened’. Rachael is admitted for inpatient psychiatric care.
In hospital, Rachael is argumentative and resistive to staff interactions and interventions, and her family are frightened and bewildered by her dramatic deterioration.

1. Identify, from the case study, the positive, negative and cognitive symptoms of schizophrenia experienced by Rachael at this presentation to the mental health service and discuss her prognosis and recovery;
2. Considering the case study, outline some common challenges and nursing interventionsassociated with the clinical presentation of a person who has been diagnosed with schizophrenia;
3. Identify the two psychotropic medicationsprescribed for the treatment of the symptoms of schizophrenia experienced by Rachael, and consider the importance of effective monitoring, consumer experiences (side effects) and safety factors;
4. Draw an ecomap to make a pictorial display of Rachael’s family relationships and medical history; Summarise key features of the ecogram for Rachael and her family and their environment (identify family and community connections, strength and quality (supportive/not supportive) of connections between individuals and community support networks/institutions( Refer to the required text Chapter 22 for more information about Genograms and Ecograms).;
5. Develop three questionsyou would ask Rachael during an interview to complete an MSE. They could be from any MSE area. Explain the reasonyou would ask these questions.
6. Complete a risk assessment(template in this tutorial outline);
7. Rachael will be admitted to the mental health inpatient unit. Write a nursing care planbased on a nursing diagnosis.

Case Study:

You are a nurse caring for a 26-year-old mother of three who presents at your physician’s office with tachypnea, productive cough, hyperthermia, malaise, and insufficient fluid intake. On auscultation, you note coarse rhonchi in bilateral lung fields.

• Outline the rationale for performing a comprehensive physical assessment.
• Prioritize the symptoms to be assessed.
• Explain which system would have the highest priority for this assessment why
• Describe the etiology of this patient’s adventitious lung sounds?
• List appropriate health history questions that could identify this patient’s risk factors for altered pulmonary health.

51. Which of the following would be the best example of an environment(s) that would contribute to a client’s increased confusion: a) Poor lighting, and excessive noise b) Unfamiliar surroundings such as furniture and pictures c) Quiet music playing d) Both a and b

a) Poor lighting, and excessive noise

b) Unfamiliar surroundings such as furniture and pictures

c) Quiet music playing

d) Both a and b

52. Persons with acute confusion should be:

a) Restrained or confined

b) Given complex tasks

c) Distracted

d) Politely reminded of the correct information

53. Your client is exhibiting blurred vision, slurred speech, headache and confusion, what could be happening?

a) Myocardial Infarction

b) Gallbladder attack

c) CVA

d)seizure

54. The GPA or Gentle Persuasive Approach program was designed to teach health care workers how to understand responsive behaviors and how to react to them in a respectful and safe manner:

a)true

b)false

55. People with a mental illness often suffer from:

a) Conceit

b) An affectation

c)stigma

D) Distinction

The ABC organization relies on personal health information provided to their home care nurses from the patients as well as their primary care physicians, specialists or case managers. Briefly explain PHIPA (Personal Health Information Protection Act) outlines regarding the use of patient information. What could and What couldn't they use, share, disclose etc?

_Discuss the techniques and assessment of an adult female external genital and include one usual abnormal finding

_Discuss the techniques and assessment of an adult female external genital and include one usual abnormal finding

Employees of XYZ hospital are divided by the area of the hospital and there is a little cross over- the staff of the ICU tend to socialize with their team, the staff of Emergency department don't converse with other departments. It has now gotten to the point that those nurses who work the night shift don't really have anything to do with those work with day shift and nurse managers are noticing that it is affecting the patient reports at shift change. The lack of communication outside of work is now transferring to a lack of communication for work-related tasks as a result, patient safety is at risk. This issue is not only communication but employees also do not seem motivated to improve upon the feedback given on their lack of communication. Suppose you are a unit manager and have been tasked with putting in place to help improve their communication and lack of motivation. List and clearly describe 3 strategies you might use as a manager in this situation. Please make sure to specifically mention the scenario in your strategies.

35. Your client is disoriented, has limited thinking ability and has difficulty making decisions. The best way to care for her is to:

a) Offer her a variety of choices

b) Give her simple directions

c) Increase her recreational activities and activation

d) Provide variety in her daily routine

36. Moving to a long-term care facility can improve a person’s mental health by:

a) Forcing compliance

b) Lowering self-esteem

c) Diminishing independence

d) Increasing socialization

37. Conditions that start with physical symptoms but will progress to dementia are:

a) Parkinson’s disease

b) Huntington’s disease

c) Acquired immunodeficiency syndrome

d) All of the above

38. All persons, when moved from a personal residence into a nursing home, will experience:

a) Loss and separation

b) Guilt

c) Gains and further independence

d) Anger and hostility

39. A false belief of being persecuted or of being superior to everyone else is a:

a) Hallucination

b) Obsession

c) Delusion

d) Defense mechanism

40. Mr. Baer, a normally independent and cooperative resident, has become hostile and aggressive lately. In dealing with Mr. Baer’s aggressive episodes, the PSW should:

a) Try to physically restrain him

b) Punish him by withholding his dinner

c) Isolate him in a room by himself

d) Encourage him to tell you why he is angry

16. A sudden onset of confusion and disorientation is often associated with:

a) Dementia

b) A developmental disability

c) Aging

d) Delirium

17. Alzheimer’s disease support groups do all the following EXCEPT:

a) Provide care

b) Offer encouragement and care ideas

c) Provide support for the family

d) Promote the sharing of feelings and frustrations

18. Identified risk factors of Alzheimer’s disease include:

a) Age and family history of Alzheimer’s disease

b) A family history of Down syndrome

c) Race and gender

d) Both a and c

19. Cognitive impairment is an effect of the normal aging process on the brain:

a)true

b)false

20. Acute confusion is usually reversible:

a)true

b)false

6. An eating disorder, in which the person has a fear of weight gain and obesity, despite a body weight far below what is normal is:

a) Anorexia Nervosa

B) Anorexia Bulimia

C) Pica

D) Obesity

7. Seeing, hearing, feeling or smelling something that is not real is called:

a) Defence mechanism

b) A hallucination

c) Paranoia

d) Phobia

8. The resident believes he is being harassed and mistreated daily. This belief is called:

a) Fantasy

B) Grieving

C) Oppositional defiant disorder

D)Delusion of persecution

9. Mr. Jones has fatigue, a general lack of interest, an inability to experience pleasure, a feeling of uselessness, anxiety and a slow, unreliable memory. These are symptoms of:

a) Depression

B) Mania and elation

C) Paranoia

D) Agoraphobia

10. The individual set of attitudes, values, beliefs and behaviours that are deeply ingrained in the psyche refers to a person’s:

a) Physiology

b) Anatomy

c) Hormones

d) Personality

1. The ability to cope with and adjust to the stresses of everyday living in a manner that is acceptable to society is called:

a) mental illness

B) mental disorders

C) psychiatric

D) mental health

2. Which one of the following represents the highest level of anxiety?

a) manis

B) stressor

C) panic

D) conversion disorder

3. Psychosis, delusions, hallucinations, and paranoia are symptoms of:

a) Unipolar dipressive disorder

b) clinical depression

c) Antisocial behavioours

d)Schizophrenia

4. Unconscious reactions that block unpleasant or threatening feelings are:

a) Hyperactive

B) Hyperactive responsive

C) Defense mechanism

D) Phobic disorders

5. A person who lacks regard for moral standards and demonstrates a noticeable inability to get along with others or abide by societal rules is displaying which personality disorder?

a) Abusive

B) Paranoid

C) c) Antisocial

D) Co-dependent

11. Refusing to accept something that is true, in an attempt to block it out is called:

a) Regression

b) Projection

c) Denial

d) Rationalizatio

12. Assigning your own feelings to someone or something else refers to which defense mechanism? Rationalization

a) Regression

b) Projection

c) Denial

d) Rationalization

13. Rationalization is a defense mechanism where the individual:

a) Refuses to be aware of some aspect of reality

b) Finds a logical reason for his behaviour while ignoring the real reason

c) Transfers emotion from its original source to an acceptable source

d) Sees in other people unacceptable traits about himself he cannot admit to having

14. Dementia is best described as:

a) A false belief

b) A loss of cognitive function caused by changes in the brain

c) Increased self-esteem

d) A developmental disability

15. Which of the following is a reason for some persons in the elderly population to consider suicide?

a) Multiple losses as they

b) Poor health

c) Concern over becoming a burden to their family

d) All of the above

Tony Rossi is 73 years old man living in regional NSW. His is part of a large Italian community that established itself in the area mid last century. His family are farmers and Tony as always worked in the family business, planting and harvesting crops. These days he keeps himself busy helping his cousins maintain the farm machinery. Tony never married and now he lives on his own following the death of his mother, six months ago. His cottage is fifteen kilometers out of town, located near the home of his older sister and her husband.

Tony was diagnosed with schizophrenia when he was 19 years old. He has always been supported by his family, and he has not had an admission to for almost fifteen years. Over the years he has been case managed by community mental health nurses at the community health Centre. Now he sees his GP once a month for a depot injection. He has been offered his medications as oral tablets, but he has always preferred the depot injection. He fears becoming unwell, and then made an involuntary patient under the State Mental Health Act and spending time in seclusion. After his first admission to a large regional psychiatric hospital in 1968 he experienced periods of long inpatient stays until a community mental health team was set up at the new community health center in the early 1980's. For many years Tony could not talk about his experiences in the hospital where his treatment included long periods of seclusion and physical restraint, and several treatments of Electroconvulsive Therapy. However, later in his 60's he shared his story of hope and recovery from the trauma of his time in the hospital, to a local group supporting young people who were known to the juvenile justice system.

Tony sees his GP every month and is currently being managed for schizophrenia, diabetes type 2, hyperlipidemia, chronic obstructive airways disease and arthritis in his left hip. He is reluctant to agree to a hip replacement because he does not want to be admitted to hospital. He does not drink but does report smoking ten cigarettes a day.

Medications: paliperidone palmitate 100mg monthly; Atorvastatin 10mg bd; Metformin ER 1500mg daily, Panadol Osteo 665mg TDS.

Today Tony arrives at the Community Health Centre to see Jenna, the mental health nurse. Jenna had been his case manager several years ago, before he was transferred to GP care. He had asked for an appointment because since his mother passed away six months ago, he finds he feels sad all the time, and does not want to join his cousins in the machinery shed. He is worried he will end up in hospital again. On arrival he noticed how noisy the waiting room was with people crowding around the reception desk, people yelling and phones ringing. When it came to his turn to speak, he was told that he had missed his appointment and his doctor couldn’t see him. The person at reception said they were booked out and if he couldn’t be on time, that was too bad, and he would have to wait till the next available time. But he said was sure he had the right time and he said so, using a profanity in Italian. He fumbled in his pockets for the card with the appointment date, but she crossed her arms, raised her voice, and told him to ‘go away and learn to speak English and if he didn't move away from the desk, she would call security'. Tony could feel himself starting to shake, his face feeling hotter and hotter, and clenched and unclenched his fists. He was trying so hard to keep control and he knew if he didn’t move, he might do something he'd regret and end up in seclusion again. Just then Jenna, the practice nurse came through the door. She made eye contact and smiled and said ‘Hi Tony, I’m glad you made it. Come inside and let's have a chat.'

1. Tony is worried about being made ‘involuntary’. What is the difference between ‘voluntary’ and ‘involuntary’ treatmentin the context of mental health legislation in your state or territory?
2. Identify incidents in Tony’s life that are known to cause traumafor people when they are admitted to an inpatient mental health unit and describe how these have impacted his life.
3. Identify the psychotropic medicationprescribed for Tony, for the treatment of the symptoms of schizophrenia and consider the importance of effective monitoring, consumer experiences (side effects) and safety factors; Include nursing responsibilities when administering a LAI medicationand include specific knowledge about increased risk factorsfor a person diagnosed with schizophrenia.
4. What does the nurse need to be aware of about MetSynwhen caring for Tony, who is prescribed an atypical antipsychotic? Outline the actions the prescribed medications- Metformin ER, Panadol Osteo and Atorvastatin.
5. What is the difference between grief and depression? What factors and signs indicate Tony may be depressed and not experiencing an acute exacerbation of schizophrenia? Week 1 Introduction to unit Mental state examination
6. He may be commenced on antidepressant medication. What drug classification does Sertralinebelong to, and what are the common side effects associated with this drug?

Emma is a 12-year-old girl enrolled in year 7 at a local state high school. Since commencing high school this year, Emma’s academic results have dropped significantly over the past 9 months from an A to a C level student. She has lost interest in completing schoolwork and participates little in class. She regularly misses days from school and when she is there, frequently isolates herself at break times and asks to go home as she is feeling ill. Teachers have spoken to you as the School Based Youth Health Nurse regarding Emma’s wellbeing. They are concerned as to whether there may be any physical or mental health issues impacting Emma’s presentation at school. After speaking with Emma’s mother to obtain the background case history information detailed below, you consult the School Guidance Officer who refers Emma to the local Child and Youth Mental Health Service (CYMHS), requesting COPMI support and investigation of potential anxiety disorder.

Demographic information
Emma lives with her mother Julie, aged 29 and younger sister Ariella, aged 9. Julie’s husband Paul is aged 32 and works as a Fly in Fly out (FIFO) miner who spends 2 weeks away then 2 weeks back in town. Paul lives separately, about 15 minutes’ drive away, after acrimoniously separating from Julie for a second time, 9 months ago. Despite Paul being in town for 2 full weeks at a time, he has been unpredictable in his contact with both Emma and Ariella. Julie reports that Paul will often turn up to her house at odd hours before school or in the evening, demanding to see the girls. He will yell and argue loudly with Julie about child support payments and contact with the girls whilst his daughters remain inside the house. To cope with this stressful contact, lack of nearby family support and financial worries caused by unemployment, Julie self-medicates with a combination of alcohol and medications. On one occasion after school, Emma found her mother unconscious as a result of overdose. Emma later overheard paramedics say that if she hadn’t called 000 when she did, her mother would have died.

In your discussion with Julie, she describes spending her childhood in a regional town however she left home at 15 years of age as a result of her own parent’s separation and divorce following paternal alcohol problems. Julie has had limited contact with her parents and younger sister since that time. She described feeling highly anxious during her teenage years whilst living on the streets. To cope with her anxiety, she engaged in substance misuse for 18 months before falling pregnant with Emma. Whilst pregnant with Emma, she met Paul and soon married him. For a short time, Julie and Paul lived with Paul’s parents in the regional town however Paul’s father was frequently verbally and physically aggressive towards them so they moved to the city in the hope that Paul could have improved employment opportunities. Two years later, Julie fell pregnant with Ariella who is Paul’s only biological child. Paul has made it clear to Emma from a young age that she is not his child and that he prefers to spend time with Ariella. Emma has never met her biological father as Julie has had no contact with him since informing him of her pregnancy with Emma. Emma is described by her mother as mature for her age, with a shy, sensitive and caring nature. She has a small group of close friends who she has maintained regular contact with up until the last 6 months. Since then, Emma has preferred to come home and spend time in her room despite regular invitations to visit friends after school and stay for sleepovers. From the age of 8 years onwards, Emma has had a love of netball, regularly attending all weekly practice sessions and weekend games. However, at the start of this netball season Emma has only attended sporadic practices and games, preferring to stay at home with her mother and sister. Julie reported that Emma has more recently complained of feelingsick before school and frequently asks to stay home. Julie explains that she has allowed this to occur on several occasions, particularly when she is stressed knowing Paul is home from his FIFO work.

1. Emma is aged 12. Identify the developmental (biological and psychological) issuesto be considered by the nurse when caring for Emma;
2. Relate information in Emma’s history to known factors associated with risk of mental illness in adolescents;
3. List the potential impacts for Emma related to her schooling and social interactionsif she and her mother are not engaged with mental health services? Summarise strategies mental health nurses can implement to engage with the family;
4. Outline methods the mental health nurse, aware of the potential for re-traumatisationand the reality that ongoing trauma may still be present in their life experience, will use to build trustwith Emma and her mother;
5. Review the HEEADSSS assessment tooland the MSE for children: Write two questionsyou would pose to Emma about school and netball(education, activities: alone and with peers)– to engage Emma in conversation(speech, concept of self/others, positive attributes).
6. Complete a risk assessment(see table on the last page of this document);
7. Emma has a provisional diagnosis of anxiety. In the context of child and youth mental health services, outline the aim of early intervention.  Summarise the pharmacologic and non-pharmacologic approachesto care and identify referral and support pathways to other health care professionals and services.