ROLES AND FUNCTIONS OF A COMMUNITY MENTAL NURSE

ROLES AND FUNCTIONS OF A COMMUNITY MENTAL NURSE

PRIMARY PREVENTION -Education by reducing the incidence of mental disorder within the population
Looking for and removing conditions that might contribute to mental illness as well as fostering those positive conditions that contribute to mental health
Providing education and support to various groups within the community
Teaching physical and psychological effects of alcohol/drugs to elementary students
Educate the public in the basis of accident prevention


SECONDARY PREVENTION - Reducing the prevalence of psychiatric illness by shortening the course of illness through early identification and prompt initiative of treatment
Focuses in detecting and treating existing internal health problems at the earliest possible stage
Nurse identifies the victim of abuse, if not the abuser
Helps to clarify the problem, explore possible solutions and provide information and reassurance
Ongoing individual assessment of individuals of high risk of illness
Provision of care for individuals in whom illness symptoms have been assessed
Referral for treatment of individuals in whom illness symptoms have been assessed

TERTIARY PREVENTION - reducing the residual effects that are associated with severe or chronic mental illness and promoting rehabilitation
Aimed at reducing the severity of a mental health problem and helping a person live at their highest functional capacity
Teaching client daily living skills and encouraging independence
Referring clients for various after care services
Making referrals for support services when required

DEFENSE MECHANISMs used in Psychiatric Nursing

Repression is an involuntary, automatic submerging of painful unpleasant thoughts and feelings into the conscious.

Suppression is an intentional exclusion of forbidden ideas and anxiety producing situations from the conscious level; a voluntary forgetting or postponing. *This is the only defense mechanism operating in the conscious level.

Sublimation is the diversion of unacceptable instinctual drives into personally and socially acceptable areas to help channel forbidden impulse into constructive activities.

Reaction Formation is assuming attitudes and behaviors that one consciously regrets

Rationalization is the attempt to justify or modify unacceptable needs and feelings to the ego, in an effort to maintain self respect and prevent guilt.

Projection is attributing ones own unacceptable feelings and thoughts to others.

Regression is the retreat to an earlier, more comfortable level of adjustment

Undoing is the actual or symbolic attempt to erase a previous consciously intolerable experience or action in an attempt to repair feeling and actions that have created guilt and anxiety.

Compensation is the attempt to make up for or offset deficiency; either real or imagined by concentrating or developing other attributes.

Displacements are feelings that are transferred, re-directed or discharged from the appropriate person or objects to less threatening person or object.

Denial is blocking out or disowning painful thoughts or feelings. Note: alcoholics may have spouses who are CO-DEPENDENT, one who denies the dependency of the spouse.

Identification is attempting to pattern or resemble the personality of an admired, idealized person.

DEFENSE MECHANISM used in Psychiatric Nursing

Four levels of Defense Mechanism

Level 1:
PSYCHOTIC MECHANISM (common in healthy individuals before age 5)
Delusional Projection
Denial
Distortion

Level 2:
IMMATURE MECHANISMS (common in ages 3-15)
Projection
Schizoid Fantasy
Hypochondriasis
Passive-aggressive behavior
Acting out

Level 3:
NEUROTIC DEFENSES (common in aged 3-90)
Intellectual
Repression
Displacement
Reaction formation
Dissociation

Level 4:
MATURE MECHANISMS
Altruism
Humor
Sublimation

GLASGOW COMA SCALE

Glasgow Coma Scale - is use to assess the neurological functioning of comatose patients.

Eye opening:
Spontaneous opening = 4
To speech = 3
To pain = 2
No response = 1

Best Motor Response:
Obeys = 6
Localizes pain = 5
Withdraws = 4
Abnormal flexion = 3
Extends = 2
No response = 1

Verbal responses:
Oriented = 5
Confused conversation = 4
Inappropriate words = 3
Incomprehensible words = 2
No response = 1

Total points: 3 - 15

FOLIC ACID, NLCEX

Folic Acid

Folic Acid =B9. B stands for brain (decreases neural tube defects); the client should begin three months prior to becoming pregnant.

RULE OF NINES FOR BURNS, NCLEX

Rule of nines for burns:

Head = 9%
Arms = 18% (9% each arm)
Back = 18%
Legs = 36% (18% each leg)
Genitalia = 1%

ANTICOAGULANT THERAPY, NCLEX

Anticoagulant Therapy

-Coumadin (sodium warfarin) PT: 10 -12 sec. (control),Antidote: The antidote for coumadin toxicity is Vit. K.

-Heparin/Lovenox/Dalteparin PTT: 30 - 45 sec. (control), Antidote: The antidote for heparin toxicity is Protamine Sulfate

-Therapeutic Level: It is important to maintain the bleeding time slightly prolonged so that clotting will not occur; therefore the bleeding time with medicine Should be 1 ½ - 2 times the control. The control is the pre-medication bleeding time.

TYPE 2 DIABETES

Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes, accounting for 90% of cases. An estimated 19 million Americans have type 2 diabetes and half are unaware they have it. The disease mechanisms in type 2 diabetes are not wholly known, but some experts suggest that it may involve the following three stages in most patients:

The first stage in type 2 diabetes is the condition called insulin resistance. Although insulin can attach normally to receptors on liver and muscle cells, certain mechanisms prevent insulin from moving glucose (blood sugar) into these cells where it can be used. Most patients with type 2 diabetes produce variable, even normal or high, amounts of insulin, and in the beginning this amount is usually sufficient to overcome such resistance.
Over time, the pancreas becomes unable to produce enough insulin to overcome resistance. In type 2 diabetes, the initial effect of this stage is usually an abnormal rise in blood sugar right after a meal (called postprandial hyperglycemia). This effect is now believed to be particularly damaging to the body.
Eventually, the cycle of elevated glucose further impairs and possibly destroys beta cells, thereby stopping insulin production completely and causing full-blown diabetes. This is made evident by fasting hyperglycemia, in which elevated glucose levels are present most of the time.

TYPE 1 DIABETES

Type 1 Diabetes
In type 1 diabetes, the disease process is more severe than with type 2, and onset is usually in childhood:

-Beta cells in the pancreas that produce insulin are gradually destroyed. Eventually insulin deficiency is absolute.
-Without insulin to move glucose into cells, blood glucose levels become excessively high, a condition known as hyperglycemia.
-Because the body cannot utilize the sugar, it spills over into the urine and is lost.
-Weakness, weight loss, and excessive hunger and thirst are among the consequences of this "starvation in the midst of plenty."
-Patients become dependent on administered insulin for survival.

SIGNS OF TRUE LABOR, NCLEX

TRUE CONTACTIONS
- regular strong contractions
- progressive in frequence and intensity
- short intervals between contractions
- continuous
- discomfort starts at the back and radiates
- progressive thinning and dilatation of cervix
- bloody show
- incrases contractions while walking

THERAPEUTIC DRUG LEVEL , NCLEX

THERAPEUTIC DRUG LEVEL
Digoxin = 0.5 –2.0
Lithium = 0.8 –1.5
Dilantin = 10 –20
Theophylline = 10 –20

CHEMISTRY VALUES , NCLEX

CHEMISTRY VALUES
Glucose = 70 –100/dL
Specific Gravity = 1.010 – 1.030
BUN = 7 – 22 mg/dL
Creatinine = 0.6 – 1.35 mg/dL (<2 older adults)
LDH = 100- 190 U/I
CPK = 21 – 233 mg/dL
Uric Acid = 3.5 – 7.5 mg/dL
Triglyceride = 40 –50 mg/dL
Total Cholesterol = 130 – 200 mg/dL
Bilirubin = <1.0 mg/dL
Protein = 6.2 – 8.1 g/dL
Albumin = 3.4 –5.0 g/dL

ABG NORMAL Values, NCLEX

ABG NORMAL Values
HCO₃ = 24 – 26 mEq/L
CO₂ = 35 –45 mEq/L
PaO₂ = 80 –100%
SaO₂ = >95%

SERUM ELECTROLYTES (Normal Values), NCLEX

SERUM ELECTROLYTES (Normal Values)
Na = 135 – 145 mEq/L
K = 3.5 –4.5 mEq/L
Ca = 9.3 – 10.9 mEq/L
Cl = 95 – 105 mEq/L
Mg = 1.5 – 2.5 mEq/L (toxic level 4.8 – 9.6)
P = 2.5 4.5 mEq/L

HEMATOLOGY (Normal Values) , NCLEX

HEMATOLOGY (Normal Values)

RBC = 4.5 – 5.0 million
WBC = 5,000 – 10,000
Platelet = 200, 000 – 400,000
Hgb
For women = 40 – 48%
For men = 42 – 50%

NURSING REVIEW ON Normal VaLues for Pulse Pressure

PULSE
· Wave of blood created by left ventricular contraction
· Normal adult rate = 60 – 100 beats/min. Tachycardia is above 100 while bradycaardia is less than 60
· Cardiac Output is the product of stroke volume (amount if blood ejected per contraction) and the cardiac rate. Urine output is the most reliable indicator of cardiac output.
· Cardiac output is affected by the preload (venous return); after load (peripheral resistance) and cardiac contractility inotropic.

Pulses: temporal, femoral, brachial, radial, carotid, popliteal, dorsal pedis

Pulse Deficit is the difference between the apical and the peripheral pulse. Two nurses take this!
Pulse Pressure is the difference between the systolic and diastolic pressure in blood pressure.

NURSING REVIEW ON Kinds of fever

Intermittent fever – temperature fluctuates and normal on fluctuation

Constant fever – temperature that fluctuates minimally

Relapsing fever – short febrile periods of a few days

Remittent fever – temperature fluctuates and is non-normal between fluctuations

NURSING REVIEW ON VITAL SIGNS / Normal Values for temperature.

TEMPERATURE:
· 37°C (98.6°F), normal. Hypothalamus is the regulatory center for heat.
· Pyrexia (hyperthermia) is temperature 38 – 41°C. Hyperprexia is very high temperature as 41°C
· Rectal most accurate and is 1°F higher than oral
· Rectal 2-3 minutes; oral 3-5 minutes; axillary 6-9 minutes

Oral – wait until 20 minutes before taking after cold or hot food or smoking
Rectal – very accurate, contraindicated in MI patient, rectal condition or surgery, 1 ½ inches in adult.
Axillary – safe and non-invasive, place long enough for accurate measurement

NURSING REVIEW ON Kinds of exercises for bed ridden and ambulatory patients.

Exercises

-Type if physical activity defined as planned, structured and repetitive bodily movement to improve or maintain physical fitness.
-Strengthens muscles, increases endurance, promotes joint mobility, improves lung capacity and cardiovascular health, prevents constipation, improves sleep quality, reduces the risk of arteriosclerosis, decreases blood pressure, enhances appetite.

Isotonic exercise (dynamic)- Those that shorten muscle to produce contraction and active movement.
Isometric exercise (Static or Setting)- There is change in muscle tension but no change in muscle length and no muscle or joint movement.

Isokinetic exercise (Resistive) - Muscle contraction or tension against a resistance , either isotonic or isometric.

NURSING REVIEW ON Three levels of prevention

PREVENTION

Primary Prevention:
CONCERNED WITH THE PREVENTION OR DELAY OF THE ACTUAL OCCURRENCE OF A SPECIFIC ILLNESS OR DISAESE.
Example: maintenance of diet, body weight; safe sex; cessation of smoking; limiting alcohol intake

Secondary Prevention:
PROMOTE EARLY DETECTION (case finding and screening) AND EARLY TREATMENT OF DISEASE
Example: breast self-exam; TB screening; newborn screening; genetic counseling

Tertiary Prevention:
DIRECTED TOWARD PREVENTION OF COMPLICATION AND REHABILITATION AFTER THE DISEASE
Goal: support adaptation to risk; optimal reconstitution; ad Establishment of wellness.