Describe the family as a system adapting to change.

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CHAPTER 15, Families and Family Interventions
In completing the case study, students will be addressing the following learning objective:
Describe the family as a system adapting to change.
1. Wanda, a 17-year-old high school senior, has been rejected by a boy in her chemistry class whom she wanted to date for the senior prom.  Wanda became severely depressed and attempted suicide with an overdose of barbiturates.  Wanda’s mother found her unconscious and called an emergency ambulance to take her to the emergency department at the local hospital.  After Wanda’s recovery, she was in individual counseling, and the psychiatrist referred all family members for counseling.   Naomi, her younger sister, refused to go, saying that she did not have a problem and that Wanda was the one who had tried to commit suicide.  Her older brother, Matthew, had a similar response and added that Wanda had embarrassed the family.  Wanda’s parents stated that they would attend and urged both Naomi and Matthew to attend family counseling.
(Learning Objective: 1)

  • Wanda’s family must reorganize to survive the disturbance created by the suicide attempt. Describe the family as a system adapting to change.

Case Study, Mohr
CHAPTER 16, Psychopharmacology
In completing the case study, students will be addressing the following learning objective:
Discuss the therapeutic indication, mechanism of action, recommended dosage, routes of administration, side effects, potential adverse effects, contraindications, and nursing implications for major psychotropic medications.
1. The student was reviewing the medication record for a client diagnosed with major depressive disorder with psychotic features. The client has been on medications for the past 12 years, has exhibited many side effects, and experienced multiple medication changes. On this admission, the client has developed abnormal movements of the tongue, a masklike face, shuffling gait, and constipation. The client is taking a selective serotonin reuptake inhibitor (SSRI) and an antipsychotic.
(Learning Objective: 6)
a. Identify the medication classification that may be responsible for the side effects and explain your choice.
b. Discuss the most important nursing implication related to the side effects the client is experiencing.
c. Explain why psychiatric clients experience multiple side effects and often need medication changes.

How can the psychiatric nurse best facilitate a community support group?

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CHAPTER 13, Individual Therapies and Nursing Interventions
In completing the case study, students will be addressing the following learning objective:
Discuss the goals of therapeutic modalities used with individual clients.
1. Frank, a 16-year-old adolescent, is a high school sophomore.  Frank is on the verge of failing his Spanish class.  After his grade fell to a “D” grade, Frank procrastinated about doing his Spanish homework, postponing it until last.  Then, saying he was tired, Frank played video games until bedtime and rationalized that he would get up early in the morning and do his homework. Frank often sleeps late and does not have time to complete his Spanish homework.  Frank is now very distressed over his grade in the Spanish class. His mother brought Frank to the counselor to help with his problem.  The counselor suggested a parent-teacher conference to explore any learning difficulties and the possibility of a tutor to help Frank.  The counselor also said that perhaps Frank’s mother could supervise the completion of his Spanish homework as the first step.  Frank appeared relieved at these suggestions, and said, “That sounds great! Maybe I can improve my Spanish grade and pass the class. Then I won’t be a loser!”
(Learning Objective: 2)
a. Using a cognitive-behavioral approach, write three goals for Frank’s individual counseling sessions.
b. Explain why cognitive-behavioral therapy (CBT) can be successful for Frank.
Case Study, Mohr
CHAPTER 14, Groups and Group Interventions
In completing the case study, students will be addressing the following learning objectives:
Discuss the advantages of group therapy.
Discuss the nurse’s role in working with groups.
1. Mary, a student nurse, is studying for an upcoming examination in her psychiatric–mental health nursing class.  Mary is reviewing group psychiatric therapy and made some practice test questions on this topic.  Help Mary study by answering the following questions.
(Learning Objectives: 7, 10)
a. Why does group therapy benefit clients with a psychiatric diagnosis?

  • How can the psychiatric nurse best facilitate a community support group?

Discuss the role of multidisciplinary teams in the care of clients.

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CHAPTER 11, Therapeutic Relationships and Communication
In completing the case study, students will be addressing the following learning objectives:
List the key ingredients of therapeutic relationships. Contrast effective and ineffective communication techniques with clients.
1. Two student nurses are preparing for psychiatric–mental health clinical learning experiences.  They decided to review the assigned reading and lecture notes from their class on therapeutic communication. After discussion, the students decided that the elements of respect, genuineness, and caring in talking to clients could lead to a trusting relationship. Both students voiced concern over their ability to develop and maintain a professional and not a social relationship.
(Learning Objectives: 1, 6)
a. How can the student nurses convey the essential elements of a therapeutic relationship in talking to clients?
b. How can the student nurses maintain a professional relationship and avoid a social one for clients in psychiatric settings?
Case Study, Mohr
CHAPTER 12, Working with the Multidisciplinary Team
In completing the case study, students will be addressing the following learning objective:
Discuss the role of multidisciplinary teams in the care of clients.
1.   A multidisciplinary team meeting is in progress for Cindy, a 21-year-old college student who has recently been diagnosed with schizophrenia.  Cindy had been an excellent student on the dean’s list until 2 weeks ago, when she stopped attending classes, stayed in her room with the blinds drawn, and refused to eat because “they have poisoned the food.” The team includes Cindy’s psychiatrist, primary nurse, unit psychologist, social worker, occupational therapist, and a registered dietician.  Cindy and her parents attend the team meeting. The team members introduced themselves and stated that they would monitor and coordinate the treatment plan for Cindy, evaluate her progress in treatment, and plan for her discharge.
(Learning Objective: 1)

  • How will the multidisciplinary team help Cindy and her family in the treatment of her schizophrenia?

Case Study, Mohr

Describe skills essential to the implementation of culturally competent care

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Case Study, Mohr
CHAPTER 5, Legal and Ethical Aspects: In completing the case study, students will be addressing the following learning objectives:  Identify the basic rights of people with mental illness. Describe the different types of commitments and states of competency.
1. Gerald, a 22-year-old black man, has a diagnosis of schizoaffective disorder.  Gerald has been living at home, but this afternoon he had a physical fight with the neighbors and set a fire in their garage to burn their house.  His father took him to the local psychiatric hospital and said that he wants an involuntary commitment for Gerald since he will not agree to the hospitalization.  The father expressed concern over Gerald’s legal rights.  The psychiatric nurse practitioner recommends to the father that he commit Gerald on involuntarily for emergency care for a period of 72 hours since he is clearly a danger to others. The nurse explains that Gerald will be evaluated to determine if he needs involuntary detention for observation and treatment for a longer period of time.  The nurse explains that Gerald will be periodically evaluated, and that when it is determined that he is no longer a danger to others or himself, Gerald will be released from the hospital.
(Learning Objectives: 4, 5)
a. What basic legal rights does Gerald have at the time of this illness?
b. Why can Gerald not make the decision for himself about being an involuntary emergency commitment to the hospital?
Case Study, Mohr
CHAPTER 6, Culture
In completing the case study, students will be addressing the following learning objective:
Describe skills essential to the implementation of culturally competent care.
1. Mrs. Maria Gonzalez is a Mexican National, age 58, who was brought to a health clinic by her adult son. She is complaining that she has had aches and pains all over her body for 2 days. Mrs. Gonzalez states that her neighbor is a witch who gave her the mal do ojo (evil eye) and cast a spell on her to cause her death. The clinic nurse takes an oral temperature and it is 101º F.  The clinic nurse refers Mrs. Gonzales to the clinic physician because she believes that the client has influenza.  Mrs. Gonzales is reluctant to see the doctor and states that the doctor cannot prevent her death.
(Learning Objective: 8)
a. How can the nurse provide culturally competent care to Mrs. Gonzalez and convince her to see the clinic doctor?
b. Can Mrs. Gonzalez be convinced that there is no spell cast on her to cause her death? Explain your answer.
Case Study, Mohr