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.

Erin is a 19-year-old university student in her second year at university. Erin is bright and has always been a high achiever at school, and her parents have been keen to prompt her to follow her dreams and encourage her pursuits. Erin loves cooking for her family, particularly her older brother Josh. In order to achieve the best possible Year 12 score, Erin’s parents decided to move her to a private school for girls that had a good reputation for university acceptance. Erin’s mother took on extra work to pay for the school fees. While Erin was sad to leave her old school and friends, she agreed that this was the best choice for her academically. Things did not go as well as planned, however, and Erin was subjected to distressing bullying from the beginning of Year 12 until she finished the school year. Erin has always been conscious of her health and weight but was targeted because she had ‘fat legs’

and the bullies sent her text messages of ‘fat people’ and memes with derogatory messages about her. Because her parents had made sacrifices for her to attend this school, Erin didn’t want to tell them that she was being bullied, so she kept it to herself. This bullying had a devastating impact on Erin’s self-esteem, and she began dieting. People would comment on how great she looked, so she continued dieting. She felt she had some control over what she ate, and this made her feel better. When her local gym had a special rate for new members, Erin joined. When she wasn’t at the gym, she was studying. Because she was working out so much, and restricting her diet, Erin became seriously constipated. So, she went to her local pharmacy and began buying laxatives. Erin noticed that they helped with her constipation, but they also reduced her weight (Erin would weigh herself daily), so she began taking them all the time. It got to the point where her local pharmacy would not sell them to her anymore, so she began buying them from multiple pharmacies and online. Despite the turmoil at school, Erin did well academically and achieved exceptionally high marks in her final exams. She got her first preference for courses and enrolled in a Bachelor of Dietetics at a well-regarded university. Recently, however, wearing baggy clothing and restricting her food intake has been causing suspicions. Her mother has told her she is too thin, and her brother and father have expressed concern about her –but Erin doesn’t see it this way. When Erin looks in the mirror, she sees the fat girl who was bullied in Year 12. Erin has collapsed at her gym several times, and staff have expressed concern about her weight. Erin worried that as with the pharmacy, she will need to find another gym. At 1.62 cm tall and weighing 41 kg, Erin’s BMI is 15.6.

1. What are some of the physical risksassociated with Erin’s behaviours?
2. Erin is exhibiting many different behaviours consistent with ED. Describe what these are;
3. EDs can be upsetting for family and friends of the consumer, and family members who are concerned about their loved one are almost always correct in their ED concerns. What are the impacts on the familyare common when a member has an ED;
4. Investigate longer term issues that may impact recoveryfrom an Eating Disorder.
5. Develop three questionsyou would ask Erin during an interview to complete an MSE. They could be from any MSE area.
6. Complete a risk assessment;
7. Develop a nursing care plan.

Your CIO asks you develop a governance plan for enhancing information access that is necessary for the success of an expanded population health program. Part of your plan is the introduction of new KPI’s.

List five (5) KPI’s associated with the new governance plan. For each KPI, include metric, definition, and goal.

Jerry is a 35-year-old man who is studying horticulture part-time at his local TAFE and working part-time for the government in a forestry role. Jerry has had bipolar disorder since his late teens but was only officially diagnosed three years ago. Recently, Jerry has started staying up longer during the night working on his assignments, and for the past five days he has not slept at all. For the past month, Jerry has only been sporadically taking his prescribed medication. Last week Jerry’s neighbours made a complaint to the body corporate in the unit where Jerry lives after he did some gardening in his courtyard at 3 am, followed by mowing the communal areas at 4.30 am. Jerry thinks his neighbours need to ‘chill’ and that he was actually in the middle of a breakthrough that could result in reversing global warming. Jerry believes that his neighbours should mind their own business and stop interfering with his creativity, and he cannot understand why they are confused by his ideas. Jerry believes he is on the ‘verge’ of a major discovery. While he was writing his latest assignment, his research helped him unearth a discovery that will reverse global warming, resulting in him making millions of dollars. When the morning came, Jerry quit his job. Jerry’s major concern now is what will happen if he accidentally reverses global warming too much and the temperature becomes too cool. While he is worried about this, he believes everything will probably be okay, because it all comes down to the word ‘land’ and it will ‘even out’, but he does want to seek clarification on this. Jerry is reassured because people live in Iceland, Greenland, Ireland and Poland and these are all cold climates. It will all balance out because there are equal numbers of countries in warmer climates that have the word ‘land’ in them, too, such as Swaziland, Thailand, New Zealand and the Falklands. Outcomes being ‘even’ is of great importance to Jerry. Jerry’s father Paul visited him a few days ago for dinner and is worried about him. Despite Paul making dinner, Jerry couldn’t sit still long enough to eat it. Jerry doesn’t want to talk about the possibility that he may be unwell again, because, he says, ‘It’s not like last time, Dad.’ Yesterday, Jerry attended the Polish embassy requesting they work with him on his project. He demanded to see the ‘most senior person here’ because they would be the only one who could understand his discovery. Both the Thai and Irish embassies had refused to return his calls. Jerry became upset when a representative from the Polish embassy exports department would not meet with him. Jerry was talking rapidly and loudly, and staff could not follow the topic of his conversation. Jerry became irritated when staff didn’t provide the information he wanted and eventually security was called. Jerry was taken to his local hospital for assessment and later admitted.

1. You have been asked to formulate a risk assessmentfor Jerry. Based on the information in the case study, what risks would you identify? Use the form attached to this tutorial guide.
2. Describe these features of the presentation of mania: pressured speech, disinhibition, punning, grandiose delusions, and second person auditory hallucinations. Provide examples from the video, or from Jerry’s case study.
3. Jerry became irritated and security were called, and he was taken to his local hospital for assessment. What is the difference between ‘voluntary’ and ‘involuntary’ treatmentin the context of mental health act legislation in your state or territory?
4. Treatment for Bipolar Disorder includes antipsychotics, anxiolytics, antidepressants and most commonly mood stabilizers. Investigate the following psychotropic medications known as Mood Stabiliser- Lithium Carbonate, Sodium Valproate, Lamotrigine and Carbamazepine. Consider the importance of effective monitoring, consumer experiences(side effects) and safety factors(e.g. Lithium Toxicity). Discover the other therapeutic use for the last three medications.
5. The mental state examination (MSE) is a formal assessment used in both diagnostics and ongoing assessment. How can the principles of a therapeutic relationshipfacilitate the processof obtaining information through an MSE?
6. Australia’s legal system requires health care clinicians to operate within a ‘least restrictive’ framework. Discuss where this approach is evident in the mental health act legislation in your state.
7. What does the mental health legislation act in your state or territory stipulate about ‘recovery’?
8. How can the mental health nurse apply Bandura’s concept of self-efficacyto support consumers in medication self-management?