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Psychiatric-Mental Health Nursing: Evidence-Based Concepts, Skills, and Practices Mohr 8th Edition Test Bank

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This is completed downloadable of Psychiatric-Mental Health Nursing: Evidence-Based Concepts, Skills, and Practices Mohr 8th Edition Test Bank

Product Details:

ISBN-10 ‏ : ‎ 1609137086
ISBN-13 ‏ : ‎ 978-1609137083
Author: R.N. Mohr, Wanda K., Ph.D.

This edition focuses on evidence-based practice and rational practice with more case-oriented content that helps students better understand how to apply key concepts to practice. Plus, new illustrations, photographs, and special features actively engage students in learning and appeal to a variety of different types of learners. Wanda Mohr aims to empower students by the down-to-earth discussion of theory and theoretical frame-work.

Table of Content:

1: Introduction to Psychiatric–Mental Health Nursing
LEARNING OBJECTIVES
KEY TERMS
MENTAL HEALTH
FIGURE 1.1
Elements of and Influences on Mental Health
FIGURE 1.2
Mental Health as a National Priority
Checkpoint Questions
MENTAL ILLNESS
The Mental Health–Illness Continuum
Incidence and Prevalence
TABLE 1.1: Mental Disorders in the United States
Etiology
Checkpoint Questions
Diagnosis
Five Axes of the DSM
DSM-IV-TR BOX 1.1: Examples of Axis IV (Psychosocial and Environmental) Problems
Case Vignette 1.1
Reflection and Critical Thinking
Limitations and Criticisms of the DSM
Prevention and Treatment
FIGURE 1.3
Problems in Treating Mental Illness
COST-RELATED ISSUES.
STIGMA.
REVOLVING DOOR TREATMENT.
FIGURE 1.4
Checkpoint Questions
Challenges Remaining
THE NEW FREEDOM COMMISSION REPORT.
LIMITED ACCESS TO SERVICES.
Goals of Care and Methods of Achievement
FIGURE 1.5
BEYOND RESPONSE TO RECOVERY.
Think About It 1.1
REINTEGRATION INTO SOCIETY.
MENTAL HEALTH PARITY.
CULTURALLY COMPETENT CARE.
FIGURE 1.6
MEDICATION ADHERENCE.
Self-Help Movements and Advocacy
NATIONAL ALLIANCE FOR THE MENTALLY ILL.
Client-Centered Education 1.1: Managing Drug Therapy
FAMILY ADVOCACY MOVEMENT.
TABLE 1.2: Family Adaptation Model
TABLE 1.3: Client Adaptation Model
PSYCHIATRIC ADVANCED DIRECTIVES.
Checkpoint Questions
PSYCHIATRIC-MENTAL HEALTH NURSING
Nursing Process and Standards of Care
Levels of Practice
FIGURE 1.7
NURSING SPOTLIGHT 1.1: Psychiatric–Mental Health Nursing’s Phenomena of Concern
Think About It 1.2
Guiding Principles
The Role of the Psychiatric Nurse as a Team Member
Development of Appropriate Client Care Skills
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
References
Web Resources
2: Neuroscience: Biology and Behavior
LEARNING OBJECTIVES
KEY TERMS
NEUROANATOMY AND NEUROPHYSIOLOGY
Neurons
FIGURE 2.1
Neurotransmitters
Checkpoint Questions
TYPES OF NEUROTRANSMITTERS.
TABLE 2.1: Some Neurotransmitters and Their Functions
BOX 2.1: Neurotransmitters in the Brain
PROCESS OF NEUROTRANSMISSION.
FIRST AND SECOND MESSENGERS.
PSYCHIATRIC NURSING IMPLICATIONS.
UNDERSTANDING BIOLOGIC FOUNDATIONS 2.1: Neurotransmission
Think About It 2.1
Plasticity
UNDERSTANDING BIOLOGIC FOUNDATIONS 2.2: Major Neurotransmitter Pathways in Mental Health
Neurogenesis
Apoptosis
Central Nervous System
Spinal Cord
Brain
FIGURE 2.2
ORGANIZATION AND STRUCTURE.
TABLE 2.2: Organization of the Brain
Cerebrum.
FIGURE 2.3
Diencephalon.
Cerebellum.
Brainstem.
Limbic System.
FIGURE 2.4
Basal Ganglia.
Checkpoint Questions
BRAIN DEVELOPMENT.
FIGURE 2.5
Client-Centered Education 2.1: Encouraging Optimal Learning in Children
Checkpoint Questions
NEUROPLASTICITY.
PSYCHIATRIC NURSING IMPLICATIONS.
Think About It 2.2
The Role of Genetics
Genetics and Psychiatric Disorders
Interaction Between Genes and Environment
FIGURE 2.6
Stress–Diathesis Model
Checkpoint Questions
OTHER TOPICS IN NEUROSCIENCE
Memory, Repetition, and Learning
FIGURE 2.7
Circadian Rhythm
FIGURE 2.8
Neuroimaging Techniques
TABLE 2.3: Neuroimaging Techniques
FIGURE 2.9
Psychoneuroimmunology
Checkpoint Questions
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
References
3: Conceptual Frameworks and Theories
LEARNING OBJECTIVES
KEY TERMS
THEORIES: WHO CARES AND SO WHAT?
FIGURE 3.1
Checkpoint Questions
THEORIES OF HUMAN BEHAVIOR
Psychoanalytic or Psychodynamic Theory
General Principles
TABLE 3.1: Defense Mechanisms
TABLE 3.2: Freud’s Model of Psychosexual Development
Critiques
Nursing Applications
Behavioral Theory
Checkpoint Questions
General Principles
CONDITIONING.
FIGURE 3.2
REINFORCEMENT.
FIGURE 3.3
PUNISHMENT.
GENERALIZATION AND DISCRIMINATION.
MODELING AND SHAPING.
Applied Behavior Analysis
TABLE 3.3: Behavior Modification Techniques
Nursing Applications
Think About It 3.1
Cognitive Theory
Rational Emotive Theory
BOX 3.1: Examples of Distorted Beliefs
Beck’s Cognitive Theory
TABLE 3.4: Types of Cognitions in Cognitive Therapy
Cognitive–Behavioral Theory
TABLE 3.5: Cognitive–Behavioral Techniques
A Brief Note on Dialectic Behavior Therapy
Nursing Applications
Humanistic Theory
Checkpoint Questions
Interpersonal Theory
General Principles
Hildegard Peplau
Biophysiologic Theory
General Principles
The Stress–Diathesis Model
FIGURE 3.4
Checkpoint Questions
Sociocultural Theory
FIGURE 3.5
Cultural Spotlight 3.1: Koro
Think About It 3.2
TOWARD A COMPREHENSIVE, MULTIDISCIPLINARY UNDERSTANDING OF PSYCHOPATHOLOGY
TABLE 3.6: Examples of Risk and Protective Factors
FIGURE 3.6
The Emergence of Mental Illness
Nursing Applications: Assessing Multiple Systems
Family Characteristics (Microsystem)
Community Characteristics (Exosystem)
FIGURE 3.7
Implications and Criticisms
Checkpoint Questions
EVIDENCE-BASED PRACTICE SPOTLIGHT 3.1: Family Functioning and Juvenile Violence
Reference
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
References
4: Evidence-Based Practice
LEARNING OBJECTIVES
KEY TERMS
FIGURE 4.1
SCIENCE
TABLE 4.1: Scientific Processes
Principles of the Scientific Method
Systematic Empiricism
FIGURE 4.2
Publicly Verifiable Knowledge
Empirically Solvable Problems and Testable Theories
Types of Scientific Evidence
EVIDENCE-BASED PRACTICE SPOTLIGHT 4.1: Typology of Studies
Checkpoint Questions
PSEUDOSCIENCE
FIGURE 4.3
EVIDENCE-BASED PRACTICE SPOTLIGHT 4.2: Exemplars of Levels of Study
Pseudoscience Versus Science
Myths
Quackery
Patterning
Facilitated Communication
The Dangers of “Junk Science”
Multiple Personality Disorder
Aspartame
Checkpoint Questions
The Dangers of Pseudoscience: Attachment Therapy
Think About It 4.1
IMPLICATIONS FOR PROFESSIONAL NURSES
Client-Centered Education 4.1: Combating Quackery and Fraudulent Claims
THE FUTURE OF MENTAL HEALTH AND PSYCHIATRIC NURSING
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
5: Legal and Ethical Aspects
LEARNING OBJECTIVES
KEY TERMS
LEGAL ISSUES IN PSYCHIATRIC-MENTAL HEALTH NURSING
Nurse Practice Acts and the Expanding Role of Nursing
Case Vignette 5.1
Reflection and Critical Thinking
Malpractice
BOX 5.1: Malpractice Suits Against Nurses
Think About It 5.1
Legal Counsel
Checkpoint Questions
Basic Rights of Clients Receiving Psychiatric Nursing Care
BOX 5.2: Federal Bill of Rights for Mental Health Clients
Informed Consent
NURSING SPOTLIGHT 5.1: Nursing Care Guidelines to Maintain Legal Rights of Clients
SPECIAL CONSIDERATIONS IN PSYCHIATRIC SETTINGS.
FIGURE 5.1
SUBSTITUTED CONSENT.
Confidentiality
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT.
RESPONSIBLE RECORD KEEPING.
FIGURE 5.2
PRIVILEGED COMMUNICATION.
Think About It 5.2
Evolving Legal Rights
Right to Treatment
Right to Treatment in the Least Restrictive Environment
Right to Refuse Treatment
FIGURE 5.3
Right to Aftercare
Checkpoint Questions
Client Status and Specific Legal Issues
Voluntary Admissions
FIGURE 5.4
Emergency Admissions
Involuntary Admissions
Legal Issues and Special Client Populations
Forensic Clients
Case Vignette 5.2
Reflection and Critical Thinking
COMPETENCY TO STAND TRIAL.
PLEAS OF INSANITY OR MENTAL ILLNESS.
Minors
Checkpoint Questions
ETHICAL ISSUES IN PSYCHIATRIC-MENTAL HEALTH NURSING
FIGURE 5.5
NURSING SPOTLIGHT 5.2: American Nurses Association Code of Ethics for Nurses
Bioethical Principles in Psychiatric Nursing Practice
Autonomy
Beneficence and Paternalism
Veracity and Fidelity
Case Vignette 5.3
Reflection and Critical Thinking
Justice
Checkpoint Questions
Nursing Ethics in Community Mental Health
FIGURE 5.6
Boundaries in Ethical Nursing Care
Case Vignette 5.4
Reflection and Critical Thinking
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
TWO: Client Care Considerations
6: Culture
LEARNING OBJECTIVES
KEY TERMS
CULTURE
Changing Demographics and Cultural Awareness
TABLE 6.1: Trends in U.S. Demographics
Assimilation
Implications for Health Care
Checkpoint Questions
Culturally Competent Health Care
BOX 6.1: National Standards for Culturally and Linguistically Appropriate Services (CLAS)
Cultural Congruence
Health Literacy
Models of Transcultural Nursing
SUNRISE MODEL.
CULTURAL COMPETENCE IN HEALTH CARE DELIVERY.
FIGURE 6.1
CULTURAL COMPETENCE.
ASSESSMENT TOOL 6.1: Fostering Cultural Self-Awareness
TRANSCULTURAL ASSESSMENT MODEL.
Think About It 6.1
Disparities in Mental Health and Barriers to Effective Treatment
Variability and Vulnerability
Ethnopharmacology
FIGURE 6.2
Traditional Medicine
Accessibility
FIGURE 6.3
Racial Bias
BOX 6.2: Diagnosis and Race: The Case of Junius Wilson
Religious and Spiritual Influences
Checkpoint Questions
SOCIOCULTURAL VARIATIONS IN RESPONSE TO MENTAL HEALTH CARE
Hispanic and Latino(a) Clients
FIGURE 6.4
Black Americans
Case Vignette 6.1
Reflection and Critical Thinking
FIGURE 6.5
Native Americans
FIGURE 6.6
Asian and Pacific Islanders
Cultural Spotlight 6.1: Post-Traumatic Stress Disorder and Culture-Bound Syndromes Among Asian Groups
FIGURE 6.7
Middle Eastern Clients
FIGURE 6.8
Eastern Europeans
FIGURE 6.9
Checkpoint Questions
CULTURALLY COMPETENT AND CONGRUENT NURSING CARE
BOX 6.3: Treatment Strategies for Cultural Competence in Mental Health care Delivery
Essential Skills
FIGURE 6.10
Think About It 6.2
Phases of Transcultural Nursing Knowledge
Transcultural Assessment
Building Cultural Awareness
Cultural Self-Awareness
Checkpoint Questions
EVIDENCE-BASED PRACTICE
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
7: Spirituality in Psychiatric Care
LEARNING OBJECTIVES
KEY TERMS
SPIRITUALITY, RELIGION, AND MENTAL HEALTH
Definitions
FIGURE 7.1
Importance of Spirituality and Religion in North America
Health-Related Attitudes and Philosophies
Positive Effects of Spirituality and Religion
Mental Health
FIGURE 7.2
Case Vignette 7.1
Reflection and Critical Thinking
Critiques and Criticisms of Available Research
Negative Effects of Religion and Spirituality
Mental Illness
FIGURE 7.3
Checkpoint Questions
RELIGIOUS AND SPIRITUAL INTERVENTIONS IN MENTAL HEALTH CARE
Clarifying Values
FIGURE 7.4
The Role of Clergy in Mental Health Care
FIGURE 7.5
The Role of the Nurse in Mental Health Care
Think About It 7.1
Spiritual Assessment
Spiritual Coping Practices and Interventions
Therapeutic Communication 7.1: Spiritual Dialogue
Reflection and Critical Thinking
NURSING SPOTLIGHT 7.1: NANDA, NOC, and NIC Related to Spirituality
PRAYER.
FIGURE 7.6
BIBLIOTHERAPY WITH SACRED WRITINGS.
CONTEMPLATION AND MEDITATION.
FIGURE 7.7
REPENTANCE AND FORGIVENESS.
WORSHIP AND RITUALS.
FIGURE 7.8
FELLOWSHIP AND ALTRUISTIC SERVICE.
JOURNAL WRITING.
Checkpoint Questions
ETHICAL CONCERNS
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
THREE: The Nurse–Client Relationship
8: Nursing Values, Attitudes, and Self-Awareness
LEARNING OBJECTIVES
KEY TERMS
FIGURE 8.1
FEAR OF MENTAL ILLNESS: STIGMA AT WORK
BOX 8.1: Visual Hallucinations in Charles Bonnet Syndrome
MYTHS AND MENTAL ILLNESS
UNDERSTANDING MENTAL ILLNESS: CLIENTS IN THEIR OWN WORDS
Checkpoint Questions
HURTFUL LANGUAGE
FIGURE 8.2
Think About It 8.1
SITUATIONAL AND DISPOSITIONAL FACTORS IN CLINICAL SETTINGS
Checkpoint Questions
LABELING AND SOCIAL PERCEPTION
Checkpoint Questions
REALITY AND MENTAL HEALTH CARE: CHALLENGES FOR NURSING
Recommendations for Working with Clients
FIGURE 8.3
Managing Stress and Burnout
FIGURE 8.4
BOX 8.2: Managing Work-Related Stress
Checkpoint Questions
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
9: The Nursing Process in Psychiatric–Mental Health Care
LEARNING OBJECTIVES
KEY TERMS
STEPS OF THE NURSING PROCESS
FIGURE 9.1
Assessment
Interview
FIGURE 9.2
Health History
Mental Status Examination
NURSING SPOTLIGHT 9.1: Standards of Practice for Psychiatric–Mental Health Nursing
Psychosocial Assessment
Physical Examination and Laboratory and Diagnostic Testing
Checkpoint Questions
Nursing Diagnosis
The NANDA Taxonomy
FIGURE 9.3
Choosing and Formulating the Nursing Diagnosis
TABLE 9.1: Writing the Diagnostic Statement: Examples of Incorrect and Correct Diagnoses
Nursing Diagnosis and Psychiatric Diagnosis
Checkpoint Questions
Planning
Identifying Outcomes
TABLE 9.2: Examples of SMART Outcome Indicators
Selecting Interventions
FIGURE 9.4
NANDA and the NOC and NIC Taxonomies
STANDARDIZED CARE PLANS.
CLINICAL OR CRITICAL PATHWAYS.
Think About It 9.1
Implementation
FIGURE 9.5
Intervention Strategies for Beginning Practitioners
Supervision
FIGURE 9.6
Checkpoint Questions
Evaluation
FIGURE 9.7
DOCUMENTATION
TABLE 9.3: Documentation of the Nursing Process
TABLE 9.4: Comparing Documentation Notes
FIGURE 9.8
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
10: The Interview and Assessment Process
LEARNING OBJECTIVES
KEY TERMS
PREPARATION
Self-Awareness
FIGURE 10.1
BOX 10.1: Process Recording Format
Review of the Client’s History
Think About It 10.1
Setting Preparation
FIGURE 10.2
Checkpoint Questions
CONTENT OF THE ASSESSMENT
FIGURE 10.3
ASSESSMENT TOOL 10.1: PERSONS Acronym for Identifying Major Aspects of Psychiatric–Mental Health Nursing Assessment
Health History
Initial Information
BOX 10.2: Tips for Interviewing Clients With Psychiatric Disorders
Reason for Seeking Health Care
Present Illness
Medications
FIGURE 10.4
Drug Allergies
Substance Use
Checkpoint Questions
Past Illnesses
Family History
Personal and Social History
Review of Systems
Checkpoint Questions
ASSESSMENT TOOL 10.2: Brief Review of Sleep Patterns
Physical Examination
TABLE 10.1: Physical Assessment Findings That May Be Psychiatric or Medical in Origin
FIGURE 10.5
Mental Status Examination
Appearance and Behavior
FIGURE 10.6
LEVEL OF CONSCIOUSNESS.
POSTURE AND MOTOR MOVEMENTS.
FIGURE 10.7
DRESS, GROOMING, AND HYGIENE.
Mood and Affect
FIGURE 10.8
Speech and Language
Thought and Perception
THOUGHT CONTENT.
TABLE 10.2: Thought Content Disturbances
THOUGHT PROCESSES.
PERCEPTIONS.
INSIGHT.
JUDGMENT.
Cognitive Functions
ORIENTATION.
MEMORY.
ATTENTION/CONCENTRATION.
INTELLIGENCE.
ABSTRACT REASONING.
Think About It 10.2
Safety Assessments
Checkpoint Questions
Suicide Assessment
Dangerousness to Others and Homicide Assessment
Victimization Through Abuse or Neglect
Individualized Needs
Wellness
Strengths and Weaknesses
Cultural Needs
ASSESSMENT TOOL 10.3: Wellness Evaluation
Spiritual Assessment
Coping and Stress Management
Checkpoint Questions
RATING SCALES
SPECIAL CHALLENGES
Age Group
FIGURE 10.9
Communication Challenges
NURSE’S FOLLOW-UP
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
11: Therapeutic Relationships and Communication
LEARNING OBJECTIVES
KEY TERMS
THERAPEUTIC RELATIONSHIPS
EVIDENCE-BASED PRACTICE SPOTLIGHT 11.1: The Primacy of the Therapeutic Relationship in Psychiatric Treatment
Essential Elements
Trust
FIGURE 11.1
Professionalism
TABLE 11.1: Social Versus Therapeutic Relationships
Mutual Respect
FIGURE 11.2
Think About It 11.1
Caring
FIGURE 11.3
Partnership
Checkpoint Questions
Obstacles to Therapeutic Relationships
Confronting Judgmental Attitudes
Case Vignette 11.1
Reflection and Critical Thinking
Think About It 11.2
Enhancing Self-Awareness
Excessive Probing
FIGURE 11.4
Phases of the Therapeutic Relationship
Introductory Phase
FIGURE 11.5
Challenging Behaviors 11.1: The Withdrawn Client
Working (Middle) Phase
FIGURE 11.6
Termination Phase
FIGURE 11.7
Checkpoint Questions
THERAPEUTIC COMMUNICATION
TABLE 11.2: Therapeutic Communication Techniques
TABLE 11.3: Nontherapeutic Communication Techniques
Theoretical Framework and Communication Model
FIGURE 11.8
Listening
Therapeutic Communication 11.1: Encouraging Formulation of a Plan
Reflection and Critical Thinking
Assertiveness
Confrontation and Limit Setting
TABLE 11.4: Examples of Positive Reframing
Checkpoint Questions
Self-Disclosure
Therapeutic Communication in Special Situations
Clients With Anxiety
FIGURE 11.9
Clients With Psychoses
Challenging Behaviors 11.2: The Angry Client
Families
Checkpoint Questions
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
12: Working With the Multidisciplinary Team
LEARNING OBJECTIVES
KEY TERMS
PSYCHOLOGISTS
Educational Background and Training
Checkpoint Questions
The Role of School Psychologists
FIGURE 12.1
Individualized Education Programs
Multidisciplinary Service Coordination Plans in Communities
FIGURE 12.2
TEAM COMPOSITION.
TEAM FUNCTIONING.
Case Vignette 12.1
Psychologists, Nurses, and Multidisciplinary Teams
Checkpoint Questions
OCCUPATIONAL THERAPISTS
FIGURE 12.3
Educational Background and Training
The Role of Occupational Therapists
TABLE 12.1: Systems in Sensory Integration
BOX 12.1: Client Groups That Benefit from Occupational Therapy
Occupational Therapists, Nurses, and Multidisciplinary Teams
PROFESSIONAL SOCIAL WORKERS
Educational Background and Training
Case Vignette 12.2
The Role of Social Workers
FIGURE 12.4
FIGURE 12.5
Case Vignette 12.3
Social Workers, Nurses, and Multidisciplinary Teams
Checkpoint Questions
PSYCHIATRISTS
Educational Background and Training
FIGURE 12.6
The Role of Psychiatrists
Psychiatrists, Nurses, and Multidisciplinary Teams
Checkpoint Questions
REGISTERED DIETITIANS
FIGURE 12.7
Case Vignette 12.4
Educational Background and Training
The Role of Registered Dietitians
BOX 12.2: Role of the Registered Dietitian in Treatment Plans
Registered Dietitians, Nurses, and Multidisciplinary Teams
Case Vignette 12.5
ART THERAPISTS
Educational Background and Training
Role of the Art Therapist
Art Therapists, Nurses, and Multidisciplinary Teams
PROFESSIONAL CERTIFIED THERAPEUTIC RECREATION SPECIALISTS
Educational Background and Training
The Role of Recreational Therapists
Recreational Therapists, Nurses, and Multidisciplinary Teams
BENEFITS OF THE MULTIDISCIPLINARY APPROACH
FIGURE 12.8
Think About It 12.1
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
References
FOUR: Conceptual Bases of Treatment
13: Individual Therapies and Nursing Interventions
LEARNING OBJECTIVES
KEY TERMS
THERAPIES FOR INDIVIDUAL CLIENTS
FIGURE 13.1
Goals of Individual Therapy
Practitioners of Psychotherapy
Current Trends
Common Modalities
TABLE 13.1: Selected Approaches to Psychotherapy
Psychoanalysis/Psychodynamic Therapies
Checkpoint Questions
Cognitive–Behavioral Therapies
EVIDENCE-BASED PRACTICE SPOTLIGHT 13.1: Cognitive Behavioral Therapy
References
Think About It 13.1
COGNITIVE THERAPY.
Core Issues.
TABLE 13.2: Cognitive Distortions
Treatment Approach.
TABLE 13.3: Therapeutic Techniques of Cognitive Therapy
RATIONAL EMOTIVE BEHAVIOR THERAPY.
DIALECTICAL BEHAVIOR THERAPY.
FIGURE 13.2
Checkpoint Questions
Behavioral Theory
Client-Centered Therapy
FIGURE 13.3
Solution-Focused Therapy
BOX 13.1: Process of Solution-Focused Therapy
Checkpoint Questions
Integrative Approaches to Psychotherapy
Cultural Considerations in Psychotherapy
FIGURE 13.4
PSYCHIATRIC NURSING ROLES AND STRATEGIES FOR INDIVIDUAL CLIENTS
Basic-Level Psychiatric Nursing Care
Health Promotion and Health Maintenance
FIGURE 13.5
Intake Screening and Evaluation
FIGURE 13.6
Case Management
FIGURE 13.7
Milieu Therapy
Promoting Self-Care Activities
FIGURE 13.8
Implementing Psychobiologic Interventions
Health Teaching
Counseling and Crisis Intervention
Psychiatric Rehabilitation
Advanced-Level Therapeutic Nursing Interventions
FIGURE 13.9
Think About It 13.2
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
14: Groups and Group Interventions
LEARNING OBJECTIVES
KEY TERMS
GROUP PROCESS
Characteristics of Groups
Types of Groups
FIGURE 14.1
Group Norms
Group Leadership
FIGURE 14.2
Styles of Group Leadership
TABLE 14.1: Leadership Styles
Leadership Qualities for Effective Groups
BOX 14.1: Role Function Areas for Evaluation of a Group Leader
Ethical Principles in Group Counseling
AUTONOMY.
FIGURE 14.3
NONMALEFICENCE.
BENEFICENCE.
CONFIDENTIALITY.
INFORMED CONSENT.
Documentation
FIGURE 14.4
Decision Making
Structuring the Group
Checkpoint Questions
Group Roles
Task Roles
FIGURE 14.5
Building and Maintenance Roles
Individual Roles
Think About It 14.1
Group Communication
TABLE 14.2: Group Communication Techniques
Latent and Manifest Communication
Content and Process Communication
Transference and Countertransference
Communication Themes
Stages of Group Development
Initial Stage
BOX 14.2: Stages of Group Development
Working Stage
Mature Stage
TABLE 14.3: Common Problems Affecting Group Therapy and Process
Termination Stage
Checkpoint Questions
GROUP THERAPY
Advantages and Disadvantages
Therapeutic Factors of Group Therapy
BOX 14.3: Yalom’s Curative (Therapeutic) Factors
Instillation of Hope
Universality
Imparting of Information
FIGURE 14.6
Group Cohesiveness
Catharsis
Existential Factors
Checkpoint Questions
Types of Therapy Groups
Psychotherapeutic Groups
INPATIENT PSYCHOTHERAPEUTIC GROUPS.
EVIDENCE-BASED PRACTICE SPOTLIGHT 14.1: Reminiscence Therapy for Dementia
References
OUTPATIENT PSYCHOTHERAPEUTIC GROUPS.
Growth Groups
ENCOUNTER GROUPS.
FIGURE 14.7
TRAINING GROUPS.
COMMUNITY SUPPORT GROUPS.
TABLE 14.4: Community Support Groups
Think About It 14.2
NURSES AND GROUP PROCESS AND THERAPY
Group Process and Therapy in Nursing Education
Group Process and Therapy in Nursing Practice
Historical Perspective
Contemporary Nursing Groups
FIGURE 14.8
EVIDENCE-BASED PRACTICE SPOTLIGHT 14.2: Group Behavior Therapy for Smoking Cessation
References
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
15: Families and Family Interventions
LEARNING OBJECTIVES
KEY TERMS
FAMILY THEORIES AND MODELS
FIGURE 15.1
Family as a System
FIGURE 15.2
Checkpoint Questions
Family Development
BOX 15.1: Family Development Stages and Tasks
Role of the Family
Family and Stress
FIGURE 15.3
Strengths Perspective With Families
Checkpoint Questions
NURSING ASSESSMENT WITH FAMILIES
Structural Assessment
FIGURE 15.4
ASSESSMENT TOOL 15.1: Components of the Calgary Family Assessment Model
FIGURE 15.5
Developmental Assessment
Functional Assessment
Cultural Considerations
NURSING INTERVENTIONS
Cognitive Interventions
Affective Interventions
Behavioral Interventions
NURSING SPOTLIGHT 15.1: NANDA, NOC, and NIC Labels in Psychiatric Family Care
FAMILIES OF CLIENTS WITH MENTAL ILLNESS
Family Burden
Objective Burden
FIGURE 15.6
Case Vignette 15.1
Reflection and Critical Thinking
Checkpoint Questions
Subjective Burden
Case Vignette 15.2
Reflection and Critical Thinking
Iatrogenic Burden
Confidentiality Issues
Involuntary Treatment Statutes
Discrimination
Burden Attributable to Professionals
Checkpoint Questions
Families as a Population at Risk
Family Consultation
Components
FIGURE 15.7
Nurses as Family Consultants
Checkpoint Questions
Family Empowerment
Therapeutic Communications 15.1: Family Consultation
Reflection and Critical Thinking
Family Education
Components
Nurses as Family Educators
Peer-Taught Family Education
Psychotherapy and Medication
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resource
16: Psychopharmacology
LEARNING OBJECTIVES
KEY TERMS
THE FOOD AND DRUG ADMINISTRATION DRUG-APPROVAL PROCESS
TABLE 16.1: The FDA Drug Testing Protocol for Humans
Clinical Trials
Special Considerations with Psychotropic Agents
PHARMACODYNAMICS
Neurons and Neurotransmission
FIGURE 16.1
Affinity
Receptor–Pharmacology Spectrum
Refractoriness
Efficacy and Potency
Rule of 5s
Effect of Medications on Neurons
TABLE 16.2: Effects of Receptor Antagonism
Effects of Medications on Synapses
Checkpoint Questions
PHARMACOKINETICS
FIGURE 16.2
Absorption
TABLE 16.3: Effects of Psychotropic Medications on Appetite, Gastrointestinal Function, Nutrient Absorption, and Metabolism
Distribution
FIGURE 16.3
Metabolism
Elimination
TABLE 16.4: Foods That Contribute to Acid or Alkaline Urine
TABLE 16.5: Effects of Food and Drug pH on Elimination
BOX 16.1: Effects of Dietary Substances on Psychotropic Medications
Checkpoint Questions
MAJOR CLASSES OF PSYCHOTROPIC DRUGS
Antidepressants
FIGURE 16.4
UNDERSTANDING PSYCHOPHARMACOLOGY 16.1: Antidepressants
Tricyclic Antidepressants (TCAs)
Think About It 16.1
Monoamine Oxidase Inhibitors (MAOIs)
FIGURE 16.5
Selective Serotonin Reuptake Inhibitors (SSRIs)
Other Selective Antidepressants
SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS).
SEROTONIN ANTAGONIST/REUPTAKE INHIBITORS (SARIS).
SELECTIVE DOPAMINE REUPTAKE INHIBITOR (SDRI).
ALPHA-2 REUPTAKE INHIBITOR (ARI).
Drugs for Refractory Depression
Checkpoint Questions
Mood Stabilizers
Lithium Carbonate
FIGURE 16.6
UNDERSTANDING PSYCHOPHARMACOLOGY 16.2: Mood Stabilizers
Anticonvulsants
Client-Centered Education 16.1: Teaching Points for Clients Taking Lithium
Medications for Refractory Mania
Anxiolytics
Buspirone
Benzodiazepines
FIGURE 16.7
UNDERSTANDING PSYCHOPHARMACOLOGY 16.3: Anxiolytics
Other Anxiolytics
Checkpoint Questions
Antipsychotic (Neuroleptic) Agents
Typical or Traditional Antipsychotics
UNDERSTANDING PSYCHOPHARMACOLOGY 16.4: Antipsychotics/Neuroleptics
TABLE 16.6: Extrapyramidal Motor Side Effects of Antipsychotic Medications
LOW-POTENCY TYPICAL ANTIPSYCHOTICS.
HIGH-POTENCY TYPICAL ANTIPSYCHOTICS.
Atypical Antipsychotics
TABLE 16.7: Comparisons of Antipsychotic Side Effects Based on Receptor Blockade
TABLE 16.8: Actions of Atypical Antipsychotic Medications by Receptor Blockade
FIGURE 16.8
Checkpoint Questions
Stimulant and Nonstimulant Cognitive Enhancers
UNDERSTANDING PSYCHOPHARMACOLOGY 16.5: Stimulants and Cognitive Enhancers
Memory and Cognition Enhancers
UNDERSTANDING PSYCHOPHARMACOLOGY 16.6: Cognitive and Memory Enhancers
Checkpoint Questions
APPLYING THE NURSING PROCESS: Clients Using Psychopharmacologic Agents
ASSESSMENT
Target Symptoms
ASSESSMENT TOOL 16.1: Brief Psychiatric Rating Scale
Caffeine Use
BOX 16.2: Assessing Caffeine Intake
Nicotine Use
Polypharmacy
FIGURE 16.9
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
NURSING SPOTLIGHT 16.1: Selected Nursing Diagnoses Pertaining to Drug Effects
Prescribed and Maximum Dose
Method of Administration
BOX 16.3: Decanoate Injections
Expected Drug Action
Side Effects
IMPLEMENTATION
Promoting Medication Adherence
ASSESSMENT TOOL 16.2: Abnormal Involuntary Movement Scale
Factors Contributing to Nonadherence
Client-Centered Education 16.2: Psychopharmacology Teaching Plan
Case Vignette 16.1
Reflection and Critical Thinking
Nursing Responses
FIGURE 16.10
Working With the Family
Lifespan Considerations
Pregnancy
Case Vignette 16.2
Reflection and Critical Thinking
Lactation
Children and Adolescents
Older Adults
Pharmacogenetics
Complementary and Alternative Modalities (CAM)
Performing Self-Clarification
Checkpoint Questions
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
17: Integrative Therapies
LEARNING OBJECTIVES
KEY TERMS
NCCAM’S CATEGORIES OF PRACTICE
BOX 17.1: Whole Systems of Medical Practice
TABLE 17.1: Illustrated Review of Common Integrative Modalities
Checkpoint Questions
PSYCHIATRIC CONDITIONS AND INTEGRATIVE THERAPIES
Anxiety Disorders
TABLE 17.2: Selected Herbs, Minerals, and Vitamins for Mental Health Use
Mood Disorders
EVIDENCE-BASED PRACTICE SPOTLIGHT 17.1: Preferred Music Listening Intervention to Lower Anxiety in Older Adults With Dementia
Reference
Light Therapy
Meditation
Cultural Spotlight 17.1: Drumming and Chanting
Herbal and Dietary Supplements
FIGURE 17.1
Client-Centered Education 17.1: Mindfulness Meditation
Other Modalities for Depression
Schizophrenia and Other Thought Disorders
Addictive Disorders
FIGURE 17.2
FIGURE 17.3
Cognitive Disorders
Think About It 17.1
INTEGRATIVE CARE: INCORPORATING CAM INTO EVIDENCE-BASED NURSING PRACTICE
Checkpoint Questions
Importance of Assessment
Ethical, Legal, and Research-Oriented Obligations
Case Vignette 17.1
Reflection and Critical Thinking
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
18: Somatic Therapies
LEARNING OBJECTIVES
KEY TERMS
ELECTROCONVULSIVE THERAPY
Pretreatment Evaluation
Procedure
FIGURE 18.1
Indications
Mechanism of Action
Side Effects
Nursing Role and Care
Checkpoint Questions
MAGNETIC SEIZURE THERAPY
PHOTOTHERAPY
Think About It 18.1
TRANSCRANIAL MAGNETIC STIMULATION
UNDERSTANDING BIOLOGIC FOUNDATIONS 18.1: Light Therapy for Seasonal Affective Disorder
Client-Centered Education 18.1: Seasonal Affective Disorder
FIGURE 18.2
VAGUS NERVE STIMULATION
TRANSCRANIAL DIRECT CURRENT STIMULATION
Checkpoint Questions
DEEP BRAIN STIMULATION AND OTHER PSYCHOSURGERIES
FIGURE 18.3
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
FIVE: Settings for Care
19: Inpatient Care Settings
LEARNING OBJECTIVES
KEY TERMS
INPATIENT CARE CRITERIA AND VARIATIONS
Levels of Care
FIGURE 19.1
Types of Settings
Psychiatric Units
Psychiatric Specialty Units
Nonpsychiatric Units
Scatter Beds
Checkpoint Questions
NURSING ROLES IN INPATIENT CARE MANAGEMENT
Admission
FIGURE 19.2
Types
BOX 19.1: Types of Involuntary Commitment
Assessment
Therapeutic Strategies
BOX 19.2: Criteria for Establishing a Therapeutic Milieu
Professional Relationships
Nurse–Client Contracts
Checkpoint Questions
Milieu Management
Think About It 19.1
INTERDISCIPLINARY MANAGEMENT.
FOSTERING SELF-CARE.
FIGURE 19.3
CLIENT EDUCATION.
LIVING SKILLS GROUPS.
MEDICATION ADMINISTRATION.
FIGURE 19.4
WORKING WITH SUPPORT SYSTEMS/FAMILIES.
Checkpoint Questions
Documentation and Reporting
Transfers
Discharge
FIGURE 19.5
Checkpoint Questions
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
References
20: Community and Home Psychiatric Care
KEY TERMS
LEARNING OBJECTIVES
COMMUNITY MENTAL HEALTH
Evolution
Levels of Prevention
TABLE 20.1: Interventions According to Levels of Prevention
Primary Prevention
BOX 20.1: Mental Health Promotion Interventions
Secondary Prevention
Tertiary Prevention
Checkpoint Questions
COMMUNITY SUPPORT SYSTEMS
Components of a Community Support System
BOX 20.2: Essential Components of a Community Support System
Community Support Programs
Guiding Principles
Models of Community Support Programs
Assertive Community Treatment
Examples of Programs
CLUBHOUSE MODEL.
EVIDENCE-BASED PRACTICE SPOTLIGHT 20.1: Psychiatric Rehabilitation
FAIRWEATHER LODGE.
CONSUMER-RUN ALTERNATIVES.
COMMUNITY WORKER PROGRAMS.
Checkpoint Questions
Systems of Care
Public Policy and Trends
Chronicity of SPMI
FIGURE 20.1
Stalled Resources
Poverty
Reinstitutionalization
BOX 20.3: Community Alternatives to Rehospitalization for Clients With SPMI
Education
Psychopharmacology
Stigma
Checkpoint Questions
COMMUNITY PSYCHIATRIC NURSING
FIGURE 20.2
Think About It 20.1
PSYCHIATRIC HOME CARE
Services
Principles
Case Vignette 20.1
Reflection and Critical Thinking
Goals
FIGURE 20.3
Funding and Eligibility
BOX 20.4: Common Indications for and Sources of Referral in Psychiatric Home Care
Checkpoint Questions
Psychiatric Home Care Nurses
Think About It 20.2
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
21: Forensic Psychiatric Nursing
KEY TERMS
LEARNING OBJECTIVES
NURSING SPOTLIGHT 21.1: IAFN Subspecialties of Forensic Nursing
FORENSIC SETTINGS
FACTORS CONTRIBUTING TO INCARCERATION
FIGURE 21.1
ALTERNATIVES TO INCARCERATION
Checkpoint Questions
CHARACTERISTICS OF THE FORENSIC POPULATION
Offenders With Mental Illness
Cultural Spotlight 21.1: Minority Offenders
Violent Offenders
Special Populations
Juvenile Offenders
Case Vignette 21.1
Reflection and Critical Thinking
Female Offenders
FIGURE 21.2
Older Adult Offenders
Offenders With HIV/AIDS or Hepatitis
Offenders With Terminal Illness
Checkpoint Questions
EFFECTS OF INCARCERATION ON MENTAL HEALTH
BOX 21.1: Common Stressors to Mental Health in Secure Environments
CHARACTERISTICS OF FORENSIC PSYCHIATRIC NURSES
Attitudes
Skills
BOX 21.2: Levels of Prevention in Forensic Settings
NURSING SPOTLIGHT 21.2: ANA Standards for Forensic Nursing
Standards of Practice for Corrections Nursing
Standards of Corrections Nursing Professional Performance
Checkpoint Questions
APPLYING THE NURSING PROCESS: Forensic Clients
ASSESSMENT
FIGURE 21.3
Content
Risk of Suicide
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
Think About It 21.1
EVIDENCE-BASED PRACTICE SPOTLIGHT 21.1: Interventions for Suicide Prevention in Incarcerated Populations
References
IMPLEMENTATION
BOX 21.3: Boundary Maintenance Strategies
Challenging Behaviors 21.1: The Client Who Requests Personal Information
Promoting Health
Challenging Behaviors 21.2: The Client Who Gives Compliments and Makes Sexually Explicit Remarks
Maintaining an Interdisciplinary Approach
Focusing on the Family
FIGURE 21.4
Ensuring Continuity of Care
FIGURE 21.5
Acting as Advocate
FIGURE 21.6
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
SIX: Psychiatric Disorders
22: Sleep Disorders
KEY TERMS
LEARNING OBJECTIVES
SLEEP
Physiology of Sleep
Sleep Stages
TABLE 22.1: Characteristics of the Sleep Stages
NREM SLEEP.
FIGURE 22.1
REM SLEEP.
Sleep-Regulating Processes
CIRCADIAN RHYTHM.
HOMEOSTASIS.
Purposes of Sleep
UNDERSTANDING BIOLOGIC FOUNDATIONS 22.1: The Suprachiasmatic Nuclei
Influences on Sleep
Developmental Changes
NEWBORNS AND INFANTS.
FIGURE 22.2
CHILDREN AND ADOLESCENTS.
FIGURE 22.3
Sleep Disorders in Children.
YOUNG AND MIDDLE ADULTS.
OLDER ADULTS.
Sex and Gender
Race and Ethnicity
Medical Disorders and Treatments
Drugs and Chemical Substances
BOX 22.1: Drugs That Contribute to Disturbed Sleep
SLEEP DISORDERS
Signs and Symptoms/Diagnostic Criteria
Insomnia
FIGURE 22.4
TABLE 22.2: Components of Coanitive-Behavioral Theraov for Insomnia
Therapeutic Communication 22.1: Assessing Sleep Patterns
Reflection and Critical Thinking
Sleep-Related Breathing Disorders
FIGURE 22.5
DSM-IV-TR BOX 22.1: Sleep Disorders
Insomnia
Sleep-Related Breathing Disorder
Hypersomnia
Circadian Rhythm Sleep Disorder
Other Sleep Disorders
HYPERSOMNIAS.
CIRCADIAN RHYTHM SLEEP DISORDERS.
PARASOMNIAS.
SLEEP-RELATED MOVEMENT DISORDERS.
NARCOLEPSY.
Think About It 22.1
Psychiatric Comorbidity and Sleep
Mood Disorders
TABLE 22.3: Antidepressants and Sleep
Anxiety Disorders
Attention Deficit/Hyperactivity Disorder
Schizophrenia
TABLE 22.4: Antipsychotics and Sleep
Cognitive Disorders
Treatment of Sleep Disorders in Clients with Comorbid Psychiatric Disorders
Interdisciplinary Goals and Treatment
FIGURE 22.6
Checkpoint Questions
Sleep Hygiene
Hypnotic Drugs
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 22.1: Drugs Used to Treat Insomnia
Complementary and Alternative Modalities
Checkpoint Questions
APPLYING THE NURSING PROCESS: Sleep Disorders
ASSESSMENT
ASSESSMENT TOOL 22.1: Sleep Inventory
FIGURE 22.7
ASSESSMENT TOOL 22.2: The Epworth Sleepiness Scale
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
UNDERSTANDING NURSING CARE 22.1
Case in Point 22.1: Agatha’s Story
Key Assessment Findings
FIGURE A
FIGURE B
FIGURE C.
EPILOGUE
FIGURE 22.8
Client-Centered Education 22.1: Recommended Sleep Hygiene Strategies
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Review Questions
Critical Thinking Questions
References
Web Resources
23: Anxiety Disorders
KEY TERMS
LEARNING OBJECTIVES
ANXIETY
FIGURE 23.1
The Continuum of Anxiety
Effects on Sensation
Effects on Cognition
Effects on Verbal Ability
FIGURE 23.2
Normal Versus Abnormal Anxiety
BOX 23.1: Adaptive and Maladaptive Coping Mechanisms for Anxiety
Checkpoint Questions
ANXIETY DISORDERS
Incidence and Prevalence
Etiology
Neurobiologic Theories
FIGURE 23.3
Psychological Theories
Checkpoint Questions
Signs and Symptoms/Diagnostic Criteria
Generalized Anxiety Disorder
Phobic Disorders
Case Vignette 23.1
Reflection and Critical Thinking
AGORAPHOBIA.
SPECIFIC PHOBIA.
SOCIAL PHOBIA.
Panic Attacks
DSM-IV-TR BOX 23.1: Phobic Disorders
Agoraphobia
Specific Phobia
Social Phobia
Panic Disorder
Obsessive-Compulsive Disorder
DSM-IV-TR BOX 23.2: Panic Disorders
Panic Attack
Panic Disorder
FIGURE 23.4
Case Vignette 23.2
Reflection and Critical Thinking
Stress Disorders
ACUTE STRESS DISORDER.
POST-TRAUMATIC STRESS DISORDER.
Checkpoint Questions
DSM-IV-TR BOX 23.3: Stress Disorders
Acute Stress Disorder
Post-Traumatic Stress Disorder
Comorbidities and Dual Diagnoses
Differential Diagnosis
BOX 23.2: Differential Diagnoses for Anxiety Disorders
Implications and Prognoses
Think About It 23.1
Interdisciplinary Goals and Treatment
Cognitive-Behavioral Therapy
TABLE 23.1: Selected Cognitive-Behavioral Treatment Strategies for Clients With Anxiety Disorders
EVIDENCE-BASED PRACTICE SPOTLIGHT 21.1: Interventions for Anxiety Disorders
References
BASIC COGNITIVE THERAPY FOR ANXIETY.
FIGURE 23.5
Client-Centered Education 23.1: Progressive Relaxation
SYSTEMATIC DESENSITIZATION AND EXPOSURE TREATMENT.
RELAXATION TECHNIQUES AND BREATHING RETRAINING.
Psychopharmacology
SELECTIVE SEROTONIN REUPTAKE INHIBITORS.
BENZODIAZEPINES.
BUSPIRONE.
BETA BLOCKERS.
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 23.1: Guidelines for Use of Benzodiazepines
TRICYCLIC ANTIDEPRESSANTS.
Checkpoint Questions
APPLYING THE NURSING PROCESS: Clients With Anxiety Disorders
ASSESSMENT
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
ASSESSMENT TOOL 23.1: Common Findings Associated With Anxiety Disorders
Cognitive
Affective
Physiologic
Behavioral
Alleviating Anxiety
Initiating a Therapeutic Dialogue
Countering Faulty Thinking
Managing Hyperventilation
FIGURE 23.6
Case in Point 23.1: Ruth’s Story
Key Assessment Findings
FIGURE A.
FIGURE B.
FIGURE C.
EPILOGUE
Therapeutic Communication 23.1: The Client With Generalized Anxiety Disorder
Reflection and Critical Thinking
Suggesting Lifestyle Changes
Teaching Adaptive Coping Strategies
Teaching Relaxation
Teaching Problem-Solving Skills
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
24: Somatoform, Dissociative, and Sexual Disorders
LEARNING OBJECTIVES
KEY TERMS
SOMATOFORM DISORDERS
Incidence and Prevalence
Etiology
Signs and Symptoms/Diagnostic Criteria
DSM-IV-TR BOX 24.1: Somatoform Disorders
Somatization Disorder
Undifferentiated Somatoform Disorder
Conversion Disorder
Hypochondriasis
Body Dysmorphic Disorder
Checkpoint Questions
Somatization Disorder
Undifferentiated Somatoform Disorder
Conversion Disorder
Hypochondriasis
Pain Disorder
Body Dysmorphic Disorder
FIGURE 24.1
Comorbidities and Dual Diagnoses
Implications and Prognosis
Interdisciplinary Goals and Treatment
BOX 24.1: Selected Multidiscipfinary Interventions for Clients With Somatoform Disorders
Individual and Group Psychotherapies
Psychopharmacology and Somatic Therapies
EVIDENCE-BASED PRACTICE SPOTLIGHT 24.1: Interventions for Hypochondriasis
References
APPLYING THE NURSING PROCESS: Somatoform Disorders
FIGURE 24.2
ASSESSMENT
Mental Status
Physical Examination
Social Assessment
ASSESSMENT TOOL 24.1: Common Mental Status Findings in Somatoform Disorders
Behavior
Mood and Affect
Thought Process and Content
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
Case in Point 24.1: Rose and Andrew’s Story
Key Assessment findings
EPILOGUE
Establishing a Trusting Relationship
EVIDENCE-BASED PRACTICE SPOTLIGHT 24.2: Interventions for Body Dysmorphic Disorder
References
Managing Ineffective Coping
Therapeutic Communication 24.1: Addressing Somatization Disorder
Reflection and Critical Thinking
Addressing Powerlessness and Dependency
Enhancing Self-Esteem
Reducing Anxiety
FIGURE 24.3
Reestablishing Social Activities
Reestablishing Functional Family Processes
Think About It 24.1
EVALUATION
DISSOCIATIVE DISORDERS
Cultural Spotlight 24.1: Dissociative Cultural Phenomena
FIGURE 24.4
Incidence and Prevalence
Etiology
Signs and Symptoms/Diagnostic Criteria
DSM-IV-TR BOX 24.2: Dissociative Disorders
Dissociative Fugue
Dissociative Amnesia
Depersonalization Disorder
Dissociative Identity Disorder
Comorbidities and Dual Diagnoses
Case Vignette 24.1
Reflection and Critical Thinking
Interdisciplinary Goals and Treatment
Checkpoint Questions
Individual Therapy
Group Therapy
Psychopharmacology
Art Therapy
APPLYING THE NURSING PROCESS: Dissociative Disorders
ASSESSMENT
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
ASSESSMENT TOOL 24.2: Inventory for Symptoms of Dissociation
IMPLEMENTATION
Therapeutic Communication 24.2: The Client With a Dissociative Disorder
Reflection and Critical Thinking
Milieu Management
Family Education
EVALUATION
SEXUAL DISORDERS
Sexual Dysfunction
Etiology
Signs and Symptoms/Diagnostic Criteria
BOX 24.2: Phases of Sexual Response
Desire Disorders
Arousal Disorders
Orgasmic Disorders
Case Vignette 24.2
Reflection and Critical Thinking
Pain Disorders
Checkpoint Questions
Interdisciplinary Goals and Treatments
TABLE 24.1: Psychological, Physical, and Pharmacologic Causes of Sexual Dysfunction*
Pharmacologic Therapy
Think About It 24.2
Sex Therapy
Nursing Assessment
ASSESSMENT TOOL 24.3: Sexual Health History
FIGURE 24.5
Nursing Interventions
Checkpoint Questions
Paraphilias
Therapeutic Communication 24.3: Respecting a Client’s Wishes Regarding Sexual Issues
Reflection and Critical Thinking
Client-Centered Education 24.1: Fostering Self-Esteem Related to Sexuality
Checkpoint Questions
Gender Identity Disorders
DSM-IV-TR BOX 24.3: Paraphilias
Exhibitionism
Fetishism
Frotteurism
Pedophilia
Sexual Masochism
Sexual Sadism
Transvestic Fetishism
Voyeurism
Paraphilia Not Otherwise Specified
Compulsive Sexual Behavior
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
25: Personality Disorders
LEARNING OBJECTIVES
KEY TERMS
PERSONALITY
OVERVIEW OF PERSONALITY DISORDERS
Incidence and Prevalence
Cultural Spotlight 25.1: Care in Diagnosis of Personality Disorders
Etiology
Signs and Symptoms/Diagnostic Criteria
Checkpoint Questions
Cluster A
DSM-IV-TR BOX 25.1: Cluster A Personality Disorders
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
PARANOID PERSONALITY DISORDER.
FIGURE 25.1
SCHIZOID PERSONALITY DISORDER.
SCHIZOTYPAL PERSONALITY DISORDER.
Case in Point 25.1: Margaret’s Story
Key Assessment Findings
EPILOGUE
Cluster B
ANTISOCIAL PERSONALITY DISORDER.
FIGURE 25.2
DSM-IV-TR BOX 25.2: Cluster B Personality Disorders
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
BORDERLINE PERSONALITY DISORDER.
HISTRIONIC PERSONALITY DISORDER.
FIGURE 25.3
NARCISSISTIC PERSONALITY DISORDER.
Cluster C
AVOIDANT PERSONALITY DISORDER.
DEPENDENT PERSONALITY DISORDER.
FIGURE 25.4
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER.
Checkpoint Questions
Comorbidities and Dual Diagnoses
DSM-IV-TR BOX 25.3: Cluster C Personality Disorders
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Implications and Prognosis
Interdisciplinary Goals and Treatment
FIGURE 25.5
TABLE 25.1: Goals of Treatment for Specific Personality Disorders
Psychopharmacology
Individual Psychotherapy
Dialectical Behavioral Therapy
Group Therapy
Family Education and Therapy
EVIDENCE-BASED PRACTICE SPOTLIGHT 25.1: Evidence-Based Interventions for Borderline Personality Disorder
Reference
EVIDENCE-BASED PRACTICE SPOTLIGHT 25.2: Evidence-Based Interventions for Antisocial Personality Disorder
Reference
Case Vignette 25.1
Reflection and Critical Thinking
Think About It 25.1
APPLYING THE NURSING PROCESS: Personality Disorders
ASSESSMENT
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
TABLE 25.2: Recommended Approaches to Personality Types
Promoting Participation in Treatment
FIGURE 25.6
Case in Point 25.2: Gail’s Story
Key Assessment Findings
FIGURE A.
FIGURE B.
FIGURE C.
EPILOGUE
Enlisting the Family in the Treatment Plan
Improving Coping Skills
Reducing Inappropriate Behaviors
Confronting the Client
Client-Centered Education 25.1: Helping Families When Clients Have Personality Disorders
Setting Limits
Therapeutic Communication 25.1: Antisocial Personality Disorder
Reflection and Critical Thinking
Providing for Physical Safety
EVALUATION
Checkpoint Questions
NURSE’S SELF-CARE
FIGURE 25.7
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
26: Eating Disorders
LEARNING OBJECTIVES
KEY TERMS
EATING DISORDERS: DEFINITION AND TYPES
FIGURE 26.1
Incidence and Prevalence
Etiology
FIGURE 26.2
Biologic Theories
Psychosocial Theories
Sociocultural Theories
FIGURE 26.3
Family-Based Theories
Checkpoint Questions
Signs and Symptoms/Diagnostic Criteria
Anorexia Nervosa
FIGURE 26.4
DSM-IV-TR BOX 26.1: Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Bulimia Nervosa
FIGURE 26.5
Other Eating Disorders
Comorbidities and Dual Diagnoses
Case Vignette 26.1
Reflection and Critical Thinking
Checkpoint Questions
Implications and Prognosis
Interdisciplinary Goals and Treatment
EVIDENCE-BASED PRACTICE SPOTLIGHT 26.1: Interventions for Eating Disorders
Settings for Care
Clinical and Dialectical-Pharmacologic Behavioral Therapies
Family Therapy
Psychopharmacology
EVIDENCE-BASED PRACTICE SPOTLIGHT 26.2: Interventions for Anorexia Nervosa
References
Checkpoint Questions
APPLYING THE NURSING PROCESS: Eating Disorders
ASSESSMENT
Health History
Case in Point 26.1: Jody’s Story
Key Assessment findings
FIGURE A.
FIGURE B.
FIGURE C.
FIGURE D.
FIGURE E.
EPILOGUE
ASSESSMENT TOOL 26.1: Inventory for Clients With Eating Problems
Health Perception-Health Management
Nutrition-Metabolism
Elimination
Activity-Exercise
Sleep-Rest
Self-Perception-Self-Concept
Roles Relationships
Sexuality-Reproduction
Coping-Stress Tolerance
Values-Beliefs
Nutrition
Elimination
Reproduction and Hormones
Activity and Rest
Psychosocial
TABLE 26.1: Manifestations of Cognitive Distortions in Clients With Eating Disorders
Therapeutic Communication 26.1: Moving with Resistance
Reflection and Critical Thinking
Physical Examination
FIGURE 26.6
Laboratory Testing
Electrocardiogram Studies
FIGURE 26.7
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
UNDERSTANDING NURSING CARE 26.1
Checkpoint Questions
BOX 26.1: Preventing Eating Disorders
Restoring Nutritional Balance
FIGURE 26.8
Think About It 26.1
Encouraging Realistic Thinking Processes
Client-Centered Education 26.1: Teaching Points for Clients With Eating Disorders
Improving Body Image
Fostering Self-Esteem
Exploring Feelings of Powerlessness
Encouraging Effective Coping
Challenging Behaviors 26.1: The Client With a Distorted Body Image
Restoring Family Processes
Enmeshment and Overprotectiveness
Conflict Avoidance and Rigidity
Think About It 26.2
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
27: Depressive Disorders
LEARNING OBJECTIVES
KEY TERMS
OVERVIEW OF DEPRESSIVE ILLNESS
Incidence and Prevalence
Etiology
BOX 27.1: Risk Factors for Depression
Genetic Factors
Physiologic Factors
FIGURE 27.1
BIOGENIC AMINES.
PSYCHONEUROENDOCRINE AND IMMUNE RELATIONSHIPS.
Psychological Factors
LEARNED HELPLESSNESS.
COGNITIVE FACTORS.
Checkpoint Questions
Signs and Symptoms/Diagnostic Criteria
Major Depressive Disorder
FIGURE 27.2
Dysthymic Disorder
FIGURE 27.3
DSM-IV-TR BOX 27.1: Depressive Disorders
Major Depressive Episode
Dysthymic Disorder
Postpartum Depression
Implications and Prognosis
Case Vignette 27.1
Reflection and Critical Thinking
Interdisciplinary Goals and Treatment
FIGURE 27.4
Cognitive-Behavioral Therapy
EVIDENCE-BASED PRACTICE SPOTLIGHT 27.1: Findings From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D)
FIGURE 27.5
Psychopharmacology
UNDERSTANDING BIOLOGIC FOUNDATIONS 27.1: Effects of Antidepressants on Neurotransmitters
SELECTIVE SEROTONIN REUPTAKE INHIBITORS AND RELATED DRUGS.
NOVEL (ATYPICAL) ANTIDEPRESSANTS.
CYCLIC ANTIDEPRESSANTS.
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 27.1: Symptoms of and Treatment for Serotonin Syndrome
MONOAMINE OXIDASE INHIBITORS.
Checkpoint Questions
Somatic and Integrative Interventions
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 27.2: Hypertensive Crisis Alert
APPLYING THE NURSING PROCESS: Depressive Disorders
ASSESSMENT
Safety
Suicide Risk
Case in Point 27.1: Richard’s Story
Key Assessment Findings
EPILOGUE
ASSESSMENT TOOL 27.1: Scales and Screening Instruments for Depression
Violence Risk
Mental Status Examination
Physiologic Stability
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
FIGURE 27.6
Protecting the Client From Suicide
Managing the Potential for Violence
Maintaining Physical Health and Personal Hygiene
FIGURE 27.7
Enhancing Thought Processes
Encouraging Treatment and Medication Adherence
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
28: Bipolar Disorders
LEARNING OBJECTIVES
KEY TERMS
OVERVIEW OF BIPOLAR DISORDERS
Incidence and Prevalence
Etiology
Biologic Foundations
GENETIC FACTORS.
NEUROANATOMIC FACTORS.
UNDERSTANDING BIOLOGIC FOUNDATIONS 28.1: Brain Region Alterations in Bipolar Disorder
NEUROTRANSMITTERS.
Psychological Factors
FIGURE 28.1
COGNITIVE FACTORS.
INTERPERSONAL AND SOCIAL RHYTHM MODEL.
Cognitive Functioning and Bipolar Disorder
Checkpoint Questions
Signs and Symptoms/Diagnostic Criteria
Bipolar I Disorder
FIGURE 28.2
Bipolar II Disorder
DSM-IV-TR BOX 28.1: Bipolar I Disorder
Manic Episode
Mixed Episode
FIGURE 28.3
Cyclothymic Disorder
Rapid Cycling
Implications and Prognosis
Interdisciplinary Goals and Treatment
DSM-IV-TR BOX 28.2: Bipolar II Disorder
Hypomanic Episode
Psychotherapy
DSM-IV-TR BOX 28.3: Cyclothymic Disorder
EVIDENCE-BASED PRACTICE SPOTLIGHT 28.1: Intensive Psychotherapy for Bipolar Depression
References
Checkpoint Questions
Psychopharmacologic Therapy
MOOD STABILIZERS.
BOX 28.1: Antidepressants and Bipolar Disorders
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 28.1: Lithium
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 28.2: Lithium Toxicity and Associated Serum Levels*
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 28.3: Divalproex Sodium
MEDICATIONS FOR REFRACTORY MANIA.
FIGURE 28.4
Checkpoint Questions
Somatic Nonpharmacologic Interventions
BOX 28.2: Somatic Therapies for Bipolar Illnesses
Sleep Deprivation
Transcranial Magnetic Stimulation
Vagal Nerve Stimulation
APPLYING THE NURSING PROCESS: Bipolar Mania
ASSESSMENT
Safety
Mental Status Examination
Physiologic Stability
Family Issues
FIGURE 28.5
EVIDENCE-BASED PRACTICE SPOTLIGHT 28.2: Client Education in Lithium Therapy
References
UNDERSTANDING NURSING CARE 28.1
ASSESSMENT TOOL 28.1: Components and Findings of the MSE in Mania
Appearance and General Behavior
Mood and Affect
Thought Content and Process
Perceptual Disturbances
Judgment and Insight
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
Managing the Potential for Violence
Case in Point 28.1: Danielle’s Story
Key Assessment Findings
FIGURE A
FIGURE B
FIGURE C
EPILOGUE
Maintaining Physical Health and Personal Hygiene
FIGURE 28.6
Enhancing Thought Processes
Self-Esteem Issues
Anxiety and Agitation
Encouraging Treatment and Medication Adherence
Think About It 28.1
EVALUATION
Client-Centered Education 28.1: Helping a Loved One Who Has Bipolar Disorder
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
29: Thought Disorders
LEARNING OBJECTIVES
KEY TERMS
SCHIZOPHRENIA AND OTHER THOUGHT DISORDERS
FIGURE 29.1
Incidence and Prevalence
Etiology
Biologic Theories
GENETIC INFLUENCES.
NEUROCHEMICAL AND NEUROANATOMIC CHANGES.
FIGURE 29.2
UNDERSTANDING BIOLOGIC FOUNDATIONS 29.1: The Dopamine Hypothesis of Schizophrenia
Psychosocial Theories
Checkpoint Questions
Signs and Symptoms/Diagnostic Criteria
DSM-IV-TR BOX 29.1: Thought Disorders
Schizophrenia
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Shared Psychotic Disorder (Formerly Called Folie à Deux)
BOX 29.1: Positive and Negative Symptoms of Schizophrenia
Positive Symptoms
Negative Symptoms
The Disorganization Dimension
DISORGANIZED SPEECH.
BOX 29.2: Illustrations of Bizarre and Disorganized Speech
Loose Associations
Clanging
Neologisms
Word Salad
DISORGANIZED BEHAVIOR.
FIGURE 29.3
INCONGRUOUS AFFECT.
The Psychotic Dimension
DELUSIONS.
Cultural Spotlight 29.1: Delusions, Hallucinations, and Contextual Experience
HALLUCINATIONS.
Challenging Behaviors 29.1: Hallucinations
The Negative Dimension
FIGURE 29.4
Other Symptoms
Subtypes of Schizophrenia
Water Intoxication
Checkpoint Questions
Comorbidities and Dual Diagnoses
Differential Diagnosis
BOX 29.3: Differential Diagnoses of Thought Disorders
Implications and Prognosis
Interdisciplinary Goals and Treatment
TABLE 29.1: Clinical Pathway: Schizophrenic Disorder (295.1x, catatonic 295.2x, delusional 297.10, brief reactive psychosis 298.80)
EVIDENCE-BASED PRACTICE SPOTLIGHT 29.1: Interventions for Schizophrenia
References
Checkpoint Questions
Psychopharmacologic Interventions
TRADITIONAL (CONVENTIONAL) ANTIPSYCHOTICS.
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 29.1: Traditional and Atypical Antipsychotic Medications
FIGURE 29.5
UNDERSTANDING PSYCHOPHARMACOLOGY BOX 29.2: Medications Used for Side Effects of Antipsychotics
ATYPICAL (NOVEL) ANTIPSYCHOTICS.
EVIDENCE-BASED PRACTICE SPOTLIGHT 29.2: Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)
References
Psychosocial Interventions
MILIEU MANAGEMENT.
INDIVIDUAL AND GROUP THERAPY.
COGNITIVE–BEHAVIORAL THERAPY.
SOCIAL SKILLS TRAINING.
VOCATIONAL REHABILITATION.
FIGURE 29.6
Checkpoint Questions
Continuum of Care
DISCHARGE PLANNING.
CARE IN THE COMMUNITY.
Think About It 29.1
APPLYING THE NURSING PROCESS: Schizophrenia and Thought Disorders
ASSESSMENT
Mood and Cognitive State
FIGURE 29.7
Potential for Violence
Assessing Social Support
Challenging Behaviors 29.2: Threatened Aggression
Knowledge of Illness
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
Case in Point 29.1: James’s Story
Key Assessment Findings
FIGURE A
FIGURE B
FIGURE C
FIGURE D
FIGURE E
EPILOGUE
IMPLEMENTATION
UNDERSTANDING NURSING CARE 29.1
Addressing Disturbed Thought Processes and Sensory Perceptions
Reinforcing Reality
Challenging Behaviors 29.3: The Client Who Is Hostile
Understanding Language Content
Intervening in Hallucinations
Managing Violent Behavior
Enhancing Social Interaction
Developing Trust
Initiating Interaction
FIGURE 29.8
Modeling Affect
Promoting Medication Adherence
Therapeutic Communication 29.1: Disorganized Speech in Schizophrenia
Reflection and Critical Thinking Questions
Promoting Improved Coping
Checkpoint Questions
Strengthening Family Processes
FIGURE 29.9
Educating Clients and Families
Teaching Symptom Management
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
30: Substance Use Disorders
KEY TERMS
LEARNING OBJECTIVES
SUBSTANCE ABUSE AND DEPENDENCE
Incidence and Prevalence
FIGURE 30.1
BOX 30.1: Key Facts from the 2009 National Household Survey on Drug Abuse
Alcohol-Related Statistics
Drug-Related Statistics
Cultural and Ethnic Variations
Checkpoint Questions
Etiology
Biologic Foundations
Psychosocial and Behavioral Factors
Signs and Symptoms/Diagnostic Criteria
Alcohol-Related Disorders
FIGURE 30.2
UNDERSTANDING BIOLOGIC FOUNDATIONS 30.1: Effects of Cocaine on Neurotransmission
DSM-IV-TR BOX 30.1: Substance-Related Disorders
Categories
Criteria
FIGURE 30.3
ALCOHOL CONCENTRATION IN THE BODY.
INTOXICATION.
BLACKOUTS.
TOLERANCE.
WITHDRAWAL.
COMPLICATIONS.
FIGURE 30.4
FIGURE 30.5
FIGURE 30.6
Think About It 30.1
Controlled Substance Disorders
TABLE 30.1: Commonly Abused Controlled Substances
STIMULANTS.
FIGURE 30.7
CANNABIS.
HALLUCINOGENS AND PHENCYCLIDINE.
OPIOIDS.
FIGURE 30.8
SEDATIVES, HYPNOTICS, AND ANXIOLYTICS.
Checkpoint Questions
Comorbidities and Co-occurring Disorders
FIGURE 30.9
Implications and Prognosis
Perinatal Statistics and Risks
FIGURE 30.10
Preventive and Public Health Strategies
BOX 30.2: Consequences of Cocaine Use During Pregnancy
Increased Risks to Pregnancy
Maternal Risks
Effects on Fetus
Effects on the Newborn
Checkpoint Questions
Interdisciplinary Goals and Treatment
Detoxification
BOX 30.3: Principles of Addiction Treatment
EVIDENCE-BASED PRACTICE SPOTLIGHT 30.1: Evidence-Based Practice Guideline for Detoxification and Substance Abuse Treatment: An Overview of the Psychosocial and Biomedical Issues During Detoxification
References
UNDERSTANDING PSYCHOPHARMACOLOGY 30.1: Medications Used for Detoxification
ALCOHOL.
ASSESSMENT TOOL 30.1: Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
OPIOIDS AND OTHER DRUGS.
Checkpoint Questions
Rehabilitation
TABLE 30.2: Selected Interdisciplinary Interventions in Rehabilitation
SELF-HELP GROUPS.
BOX 30.4: The 12 Steps of Alcoholics Anonymous
BRIEF INTERVENTION.
Client-Centered, Culturally Competent Care
APPLYING THE NURSING PROCESS: Substance Use Disorders
ASSESSMENT
UNDERSTANDING NURSING CARE 30.1
Screening
Case in Point 30.1: Erica and Paul’s Story
Key Assessment Findings
FIGURE A
FIGURE B
FIGURE C
FIGURE D
EPILOGUE
Physical Examination
Psychosocial Assessment
ASSESSMENT TOOL 30.2: Substance Use Inventory
Health History Questions
Physical Examination
NURSING DIAGNOSIS
ASSESSMENT TOOL 30.3: The CAGE Questionnaire for Substance Abuse Screening
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
Managing Withdrawal
FIGURE 30.11
Breaking Through Denial
TABLE 30.3: Forms of Denial
Managing Anxiety
Teaching Effective Coping Strategies
Therapeutic Communication 30.1: A Cocaine Abuser in Denial
Reflection and Critical Thinking
Improving Relationships
Improving Self-Image
Case Vignette 30.1
Reflection and Critical Thinking
Promoting Healthy Activities
EVALUATION
Checkpoint Questions
IMPAIRED NURSES
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
31: Cognitive Disorders
KEY TERMS
LEARNING OBJECTIVES
ETIOLOGIC AND DIAGNOSTIC CHALLENGES OF COGNITIVE DISORDERS
TABLE 31.1: Delirium Versus Dementia
DELIRIUM
Incidence and Prevalence
Etiology
BOX 31.1: Specific Causes of Delirium
FIGURE 31.1
Checkpoint Questions
Signs and Symptoms/Diagnostic Criteria
DSM-IV-TR BOX 31.1: Delirium
Delirium Due to a General Medical Condition
Substance-Withdrawal Delirium
Substance-Intoxication Delirium
Delirium Due to Multiple Etiologies
Delirium Not Otherwise Specified
Case Vignette 31.1
Reflection and Critical Thinking
Implications and Prognosis
Interdisciplinary Goals and Treatment
Medical Interventions
Environmental Interventions
FIGURE 31.2
Cognitive and Psychosocial Interventions
Checkpoint Questions
APPLYING THE NURSING PROCESS: Delirium
ASSESSMENT
ASSESSMENT TOOL 31.1: Sample Mini-Mental Status Examination Questions
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
Think About It 31.1
IMPLEMENTATION
Managing Symptoms of Delirium
FIGURE 31.3
Challenging Behaviors 31.1: The Client Who Has Acute Confusion
Providing a Safe Environment
Assisting With Personal Care
FIGURE 31.4
Providing Client and Family Education
EVALUATION
Checkpoint Questions
DEMENTIA
Incidence and Prevalence
Signs and Symptoms/Diagnostic Criteria
DSM-IV-TR BOX 31.2: Dementia
Dementia of the Alzheimer’s Type
Vascular Dementia
Dementia Due to Other General Medical Conditions
Impaired Learning
Compromised Ability for Complex Tasks
Impaired Reasoning
Compromised Spatial Ability and Orientation
Language Deficits
FIGURE 31.5
Behavioral Problems
Checkpoint Questions
Types of Dementia
TABLE 31.2: Comparative Assessment for Cognitive Disorders
Alzheimer’s Disease
ETIOLOGIC FACTORS.
UNDERSTANDING BIOLOGIC FOUNDATIONS 31.1: Neurologic Alterations in Alzheimer’s Disease
BOX 31.2: Stages of Alzheimer’s Disease
Genetics.
Oxidative Stress.
Immunology.
Hormones.
Inflammation.
Diet.
PREVENTIVE FACTORS.
FIGURE 31.6
Vascular Dementia
Lewy Body Disease
Parkinson’s Disease
UNDERSTANDING BIOLOGIC FOUNDATIONS 31.2: The Pathophysiology of Parkinson’s Disease
Huntington’s Disease
Human Immunodeficiency Virus Dementia
Frontotemporal Lobar Degeneration
Creutzfeldt-Jakob Disease
Implications and Prognosis
Interdisciplinary Goals and Management
EVIDENCE-BASED PRACTICE SPOTLIGHT 31.1: Nonpharmacologic Treatment of Dementia-Related Agitation
References
Medical and Supportive Interventions
Psychopharmacologic Interventions
Think About It 31.2
Psychosocial Interventions
EVIDENCE-BASED PRACTICE SPOTLIGHT 31.2: Interventions for Cognitive Disorders
Checkpoint Questions
APPLYING THE NURSING PROCESS: Dementia
ASSESSMENT
BOX 31.3: Differential Diagnosis for Dementia
ASSESSMENT TOOL 31.2: Screening Tests for Dementia
Behavior
ASSESSMENT TOOL 31.3: Questionnaire for Dementia
Subjective Data
Behavioral Changes (Often Asked of the Family)
Emotional Changes
Social Changes
Intellectual Behavior
Functional Capacity
Objective Data
Level of Consciousness
Appearance
Attention
Language
Memory
Constructional Ability
Cortical Function
Mental Status
ASSESSMENT TOOL 31.4: Testing for Cognitive Deficits
FIGURE 31.7
Perceptual Problems
Orientation
Memory
Family
Education
NURSING DIAGNOSES
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
Case in Point 31.1: Betty’s Story
Key Assessment Findings
FIGURE A.
FIGURE B.
FIGURE C.
FIGURE D.
FIGURES E AND F.
FIGURE G.
Epilogue
Managing the Client’s Health
Enhancing Sensory Capabilities
Meeting the Client’s Physical Needs
Encouraging Appropriate Behaviors
Modifying the Environment
FIGURE 31.8
Challenging Behaviors 31.2: The Client Who Is Disruptive
FIGURE 31.9
Therapeutic Communication 31.1
A Client with Dementia
Reflection and Critical Thinking
Performing Pharmacologic Interventions
Preserving the Family Unit
FIGURE 31.10
EVALUATION
AMNESTIC DISORDERS
DSM-IV-TR BOX 31.3: Amnestic Disorders
Amnestic Disorder Due to a General Medical Condition
Substance-Induced Persisting Amnestic Disorder
Checkpoint Questions
NURSE’S SELF-CARE
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
SEVEN: Psychiatric Emergencies
32: Anger and Aggression
LEARNING OBJECTIVES
KEY TERMS
DEFINITIONS
POTENTIAL CONTRIBUTORS TO ANGRY, AGGRESSIVE, OR VIOLENT BEHAVIORS
Psychiatric Illness
BOX 32.1: Psychiatric Diagnoses and Patterns of Aggression or Violence
Medical Conditions
BOX 32.2: Selected Medical Conditions Associated With Aggression and Violence
Traumatic Life Events
Biologic Factors and Temperament
FIGURE 32.1
Social–Environmental Factors
Checkpoint Questions
HEALTH CARE ENVIRONMENTS AND ANGRY AND AGGRESSIVE CLIENT BEHAVIOR
Challenging Behaviors 32.1: The Client Who Is Hostile and Profane
Considerations for Inpatient Settings
FIGURE 32.2
Outpatient Factors
LEGAL ISSUES RELATED TO DANGEROUSNESS AND INTENT
Checkpoint Questions
INTERDISCIPLINARY MANAGEMENT OF AGGRESSION AND VIOLENCE
Verbal Interventions
FIGURE 32.3
Limit Setting
FIGURE 32.4
Cognitive–Behavioral Interventions
Guided Discovery
Anger Management
Behavior Therapy: Token Economy
Case Vignette 32.1
Reflection and Critical Thinking
Group and Family Therapy
Prevention of Vapor Lock and Meltdown
Pharmacologic Intervention
UNDERSTANDING PSYCHOPHARMACOLOGY 32.1: Typical Medications Used to Treat Aggressive Behavior
Checkpoint Questions
Restraint and Seclusion
Related Controversies
Think About It 32.1
Standards in Behavioral Health Care
BOX 32.3: Summary of Standards for Restraint and Seclusion (R/S)
Outpatient Management
A Note on Other Settings
Checkpoint Questions
APPLYING THE NURSING PROCESS: Angry, Aggressive, or Violent Behavior
ASSESSMENT
BOX 32.4: Risk Factor Profiles for Violent Behavior
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
ASSESSMENT TOOL 32.1: Assessment of Violence and Homicidal Ideation
Violence Assessment
Assessment of Homicidal Ideation
Maintaining the Safety of Clients and Staff
Defusing Anger and Aggression Through Verbal Interventions
BOX 32.5: Situation-Specific Interventions to Prevent Escalation of Client Aggression
Setting Limits to Prevent Violent Behavior
Teaching Anger Management and Coping Skills
FIGURE 32.5
Checkpoint Questions
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
33: Violence and Abuse
KEY TERMS
LEARNING OBJECTIVES
THE ECOLOGICAL MODEL OF VIOLENCE
Societal Influences and Macrosystem
FIGURE 33.1
Microsystem
Individual Factors
PUBLIC HEALTH APPROACH TO VIOLENCE PREVENTION
Checkpoint Questions
YOUTH VIOLENCE
FIGURE 33.2
Risk and Protective Factors for Youth Violence
Individual Risk Factors
Family Risk Factors
Peer Risk Factors
Neighborhood Risk Factors
Protective Factors
FIGURE 33.3
Public Health Approach to Youth Violence
Nurses’ Role in Youth Violence Prevention Efforts
Checkpoint Questions
FAMILY VIOLENCE
Intimate Partner Violence
Defining the Scope of Intimate Partner Violence
FIGURE 33.4
Cost to Children
Addressing Intimate Partner Violence
PROBLEMS WITH DETECTION AND SCREENING.
IMPORTANCE OF SCREENING.
Nurses’ Role
ASSESSMENT TOOL 33.1: Intimate Partner Violence Documentation Form
Checkpoint Questions
Child Maltreatment
Effects on Child Functioning
SOCIAL FUNCTIONING.
BEHAVIORAL FUNCTIONING.
EMOTIONAL AND INTELLECTUAL FUNCTIONING.
BOX 33.1: Child Maltreatment and Post-Traumatic Stress Disorder
Case Vignette 33.1
HEALTH AND PHYSICAL FUNCTIONING.
Nurses’ Role
FIGURE 33.5
Checkpoint Questions
Elder Abuse
TABLE 33.1: Types of Elder Abuse
Causes
Nurses’ Role
Checkpoint Questions
RAPE AND SEXUAL ASSAULT
ASSESSMENT TOOL 33.2: Elder Assessment Instrument (EAI)
Types of Rape
Rape by a Stranger
Date Rape and Acquaintance Rape
Marital Rape
Rape Trauma Syndrome
FIGURE 33.6
Additional Ramifications of Rape
Treatment for Survivors of Rape or Sexual Assault
Case Vignette 33.2
Reflection and Critical Thinking
Psychopharmacologic Interventions
Psychological Interventions
Checkpoint Questions
APPLYING THE NURSING PROCESS: Survivors of Rape Trauma
ASSESSMENT
Case Vignette 33.3
Reflection and Critical Thinking
NURSING DIAGNOSIS, OUTCOME IDENTIFICATION, AND PLANNING
Think About It 33.1
IMPLEMENTATION
EVALUATION
Case in Point 33.1: Alicia’s Story
Key Assessment Findings
EPILOGUE
Client-Centered Education 33.1: Coping with Rape Trauma Syndrome
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
34: Suicide and Suicidal Behavior
KEY TERMS
LEARNING OBJECTIVES
SUICIDE
Incidence and Prevalence
Suicide Prevention Efforts
Checkpoint Questions
Etiology
Genetic Factors
Psychological Factors
Physical Factors
Case Vignette 34.1
Reflection and Critical Thinking
Other Factors
Checkpoint Questions
Protective Factors
APPLYING THE NURSING PROCESS: Suicidal Clients
ASSESSMENT
BOX 34.1: Warning Signs of Suicide
ASSESSMENT TOOL 34.1: Questions to Review Stressors for Suicidal Clients
Eating
Sleeping
Mood
Health
Activities
Coping
Prior Suicidal Behavior
BOX 34.2: Is Path Warm?
Current Suicide Plan
Lethality Assessment
Current Resources
TABLE 34.1: Lethality of Suicide Attempts by Method
Checkpoint Questions
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
Think About It 34.1
General Overall Guidelines
Therapeutic Communication 34.1
The Suicidal Client
Reflection and Critical Thinking
Additional Guidelines for Hospitalized Clients
EVALUATION
SUICIDE AS A PUBLIC HEALTH PROBLEM
THOSE LEFT BEHIND
BOX 34.3: Blueprint for a National Suicide Prevention Strategy
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
35: Crisis Intervention
KEY TERMS
LEARNING OBJECTIVES
CRISIS
FIGURE 35.1
Phases of a Crisis
FIGURE 35.2
Types of Crises
Maturational Crisis
FIGURE 35.3
Situational Crisis
FIGURE 35.4
Adventitious Crisis
CRISIS RESPONSES TO TERRORISM.
FIGURE 35.5
EVIDENCE-BASED PRACTICE SPOTLIGHT 35.1: Crisis Intervention for People With Severe Mental Illnesses Living in the Community
Reference
CRITICAL INCIDENT STRESS DEBRIEFING.
SELF-CARE FOR PROVIDERS RESPONDING TO ADVENTITIOUS CRISES.
CRISIS PREVENTION
FIGURE 35.6
Checkpoint Questions
CRISIS INTERVENTION AND STABILIZATION
Crisis Intervention Versus Traditional Therapies
Crisis Intervention Across Contexts
Characteristics and Skills of the Crisis Intervener
Case Vignette 35.1
Reflection and Critical Thinking
Checkpoint Questions
Team Approach
Challenging Behaviors 35.1: The Client Who Pits Staff Members Against One Another
Crisis Groups
Families in Crisis
FIGURE 35.7
Telephone Counseling
FIGURE 35.8
Checkpoint Questions
APPLYING THE NURSING PROCESS: Clients in Crisis
ASSESSMENT
FIGURE 35.9
Evaluating Feelings
NURSING SPOTLIGHT 35.1: Ten Tips for Crisis Prevention
Determining Perception of the Event
Assessing Support Systems
Assessing Coping Skills
Determining Potential for Self-Harm
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
FIGURE 35.10
IMPLEMENTATION
Realizing the Potential for Growth
Think About It 35.1
Learning to Ask for Help
Using Adaptive Coping
Focusing on Problem Resolution
Using Information Technology
EVALUATION
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
EIGHT: Special Populations
36: Pediatric Clients
KEY TERMS
LEARNING OBJECTIVES
THEORIES OF CHILD DEVELOPMENT
TABLE 36.1: Overview of Traditional Developmental Theories
Temperament Theory
BOX 36.1: Temperaments
Moral Development Theory
Cognitive Development Theory
TABLE 36.2: Piaget’s Theory of Cognitive Development
Attachment Theory
FIGURE 36.1
Contemporary Views of Child Development
FIGURE 36.2
MENTAL HEALTH: PROTECTIVE INFLUENCES FOR RESILIENCE
OVERVIEW OF PEDIATRIC MENTAL ILLNESS
FIGURE 36.3
Infrastructure and Availability of Care to Pediatric Populations
Cultural Barriers to Mental Health Care for Children
Risk Factors and Etiology
Biologic Influences
FIGURE 36.4
Familial and Societal Influences
Stressors
DIVORCE.
FIGURE 36.5
CHILD ABUSE.
Checkpoint Questions
Evidence-Based Interventions
EVIDENCE-BASED PRACTICE SPOTLIGHT 36.1: Interventions for Child and Adolescent Disorders
Prevention and Early Identification
FIGURE 36.6
Psychosocial Modalities
INDIVIDUAL THERAPY.
Cultural Spotlight 36.1: Considerations for Mental Health Services
BRIEF PSYCHOTHERAPY.
PLAY THERAPY.
FAMILY THERAPY.
TRAUMA-INFORMED CARE.
TABLE 36.3: Behaviors and Cognitions Associated With Traumatized Children
PARENT MANAGEMENT TRAINING AND MULTISYSTEMIC THERAPY.
GROUP THERAPY.
FIGURE 36.7
MILIEU THERAPY.
Pharmacologic Therapy
Interdisciplinary Coordination
TREATMENT SETTINGS AND CONTINUUM OF CARE.
WRAP-AROUND SERVICES AND SYSTEMS OF CARE.
Client-Centered Education 36.1: Warnings for Families Considering a Child’s Residential Placement
COMMUNITY-RELATED FOCI.
SPECIAL EDUCATION.
FIGURE 36.8
General Nursing Care for Pediatric Clients With Psychiatric Disorders
Assessment
FAMILY FUNCTIONING.
FIGURE 36.9
CURRENT PROBLEM.
HISTORY.
MENTAL STATUS EXAMINATION.
FIGURE 36.10
PHYSICAL EXAMINATION.
Interventions
PROVIDING MEDICATION EDUCATION.
MEETING FAMILIES’ NEEDS.
PROMOTING THE RIGHTS OF CHILDREN IN TREATMENT SETTINGS.
NURSING SPOTLIGHT 36.1: Rights of Pediatric Clients in Health Care Settings
AVOIDING SECLUSION AND RESTRAINT.
PROVIDING ADVOCACY.
Checkpoint Questions
COMMON PSYCHIATRIC DISORDERS OF CHILDREN AND ADOLESCENTS
DISRUPTIVE BEHAVIOR DISORDERS
Attention Deficit/Hyperactivity Disorder
Etiology
Signs and Symptoms/Diagnostic Criteria
DSM-IV-TR BOX 36.1: Attention Deficit/Hyperactivity Disorder
Comorbidities
Interdisciplinary Goals and Treatment
Behavioral Treatment and Other Psychosocial Interventions
Pharmacologic Therapy
UNDERSTANDING PSYCHOPHARMACOLOGY 36.1: Methylphenidate (Ritalin, Concerta)
APPLYING THE NURSING PROCESS: ADHD
ASSESSMENT
Case in Point 36.1: Michael’s Story
Key Assessment Findings
FIGURE A
FIGURE B AND C.
FIGURE D.
FIGURE E.
FIGURE F.
FIGURE G.
FIGURE H.
EPILOGUE
FIGURE I.
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
Teaching Social Skills
FIGURE 36.11
Educating the Family
FIGURE 36.12
Helping Families Cope
Managing Developmental and Academic Issues
Improving Self-Esteem
FIGURE 36.13
EVALUATION
Checkpoint Questions
Oppositional-Defiant Disorder
DSM-IV-TR BOX 36.2: Oppositional-Defiant Disorder
Conduct Disorder
DSM-IV-TR BOX 36.3: Conduct Disorder
EVIDENCE-BASED PRACTICE SPOTLIGHT 36.2: Parent Management Training and Conduct Disorder
References
ADJUSTMENT DISORDERS
FIGURE 36.14
ANXIETY DISORDERS
Obsessive–Compulsive Disorder
Separation Anxiety Disorder
FIGURE 36.15
Phobias
Social Anxiety Disorder (Social Phobia)
Generalized Anxiety Disorder
Post-Traumatic Stress Disorder
Checkpoint Questions
MOOD DISORDERS
Case Vignette 36.1
Reflection and Critical Thinking
Depression
Signs and Symptoms
BOX 36.2: What Does a Child Have to Be Depressed About?
Think About It 36.1
Comorbidities
Prevention
Interdisciplinary Goals and Treatment
Cognitive–Behavioral Therapy and Family Consultation
FIGURE 36.16
Pharmacologic Therapy
Bipolar Disorder
Signs and Symptoms
Interdisciplinary Goals and Treatment
Importance of Early Identification and Treatment
Pharmacologic Therapy
AUTISM SPECTRUM DISORDERS
Signs and Symptoms/Diagnostic Criteria
DSM-IV-TR BOX 36.4: Autism Spectrum Disorders
Autistic Disorder
Asperger’s Disorder
Autism
Asperger’s Syndrome
Interdisciplinary Goals and Treatment
Checkpoint Questions
EATING DISORDERS
SUBSTANCE ABUSE
BOX 36.3: Signs and Symptoms of Substance Abuse in Adolescents
Prevention of Drug and Alcohol Abuse
Interdisciplinary Goals and Treatment
Therapeutic Communication 36.1: Discussing Peer Pressure and Substance Use With Adolescents
Reflection and Critical Thinking
TIC DISORDERS
TRICHOTILLOMANIA
FIGURE 36.17
Checkpoint Questions
SUICIDE
Signs
Prevention
Interdisciplinary Goals and Treatment
CHILDREN WITH MEDICAL ILLNESS OR DISABILITY
FIGURE 36.18
MENTAL RETARDATION
FIGURE 36.19
Checkpoint Questions
NURSES’ SELF-CARE
FIGURE 36.20
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
37: Older Adult Clients
LEARNING OBJECTIVES
KEY TERMS
DEMOGRAPHICS OF AGING AND FUTURE TRENDS
FIGURE 37.1
BIOPSYCHOSOCIAL COMPONENTS OF AGING
FIGURE 37.2
Biologic Changes
BOX 37.1: Ten Tips for Healthy Aging
Risk Factors Affecting Health and Functional Status
Chronic Illness
Medications
UNDERSTANDING BIOLOGIC FOUNDATIONS 37.1: Acetylcholine and Aging
Checkpoint Questions
Psychosocial Issues and Influences of Aging
Retirement
Client-Centered Education 37.1: Preretirement Planning
Relocation
FIGURE 37.3
Bereavement
Case Vignette 37.1
Reflection and Critical Thinking
Responses to Life Transitions
Sociopolitical Issues and Influences
Ageism, Myths, and Prejudices
Fragmentation of Health Care
Checkpoint Questions
OLDER ADULTS WITH PSYCHIATRIC DISORDERS
TABLE 37.1: Common Psychiatric Conditions in Older Adults
Sleep Disorders
Anxiety Disorders
Somatoform Disorders
Mood Disorders
FIGURE 37.4
Major Depression
Suicide
Nursing and Health Care Responses
Thought Disorders
Substance Use Disorders
FIGURE 37.5
Cognitive Disorders
Checkpoint Questions
COMMUNICATING EFFECTIVELY WITH OLDER ADULTS
BOX 37.2: Useful Communication Skills With Older Adults
TABLE 37.2: Age-Sensitive Terminology
CARE OF OLDER ADULTS
Comprehensive Geriatric Mental Health Assessment
Think About It 37.1
Case Vignette 37.2
Intervention and Treatment
General Medication Management
Psychotropic Medication Management
Electroconvulsive Therapy
Psychosocial Interventions
FIGURE 37.6
Role of Nurses
Checkpoint Questions
PROMOTING MENTAL HEALTH AND WELLNESS IN OLDER ADULTS
Nutrition and Fluids
Client-Centered Education 37.2: Suggestions About Mental Wellness
EVIDENCE-BASED PRACTICE SPOTLIGHT 37.1: Interventions to Increase Health Promotion Activities in Older Adults
References
Mental and Physical Activities
FIGURE 37.7
Support Systems
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
38: Homeless Clients
LEARNING OBJECTIVES
KEY TERMS
DEMOGRAPHICS
FIGURE 38.1
HOMELESSNESS AND MENTAL ILLNESS
Checkpoint Questions
Contributing Factors
Deficient Mental Health Care System
DSM-IV-TR BOX 38.1: Common Diagnoses in Homeless People with Mental Illness
Functional Abilities and Deficits
Substance Abuse
FIGURE 38.2
Poverty
FIGURE 38.3
Inadequate Housing
High Mobility
FIGURE 38.4
Critical Issues Affecting the Homeless Population with Mental Illness
A Changing Mental Health System
Barriers to Care
BOX 38.1: Barriers to Health Care for the Homeless Population
FIGURE 38.5
The Shelter System
FIGURE 38.6
Health Concerns
Case Vignette 38.1
Reflection and Critical Thinking
FIGURE 38.7
Criminal Justice System
Checkpoint Questions
APPLYING THE NURSING PROCESS: Homelessness
ASSESSMENT
BOX 38.2: Stressors of Homelessness That Influence Mental Health
Think About It 38.1
BOX 38.3: Communication Suggestions With Homeless Clients Who Have a Mental Illness
NURSING DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
IMPLEMENTATION
EVIDENCE-BASED PRACTICE SPOTLIGHT 38.1: Meeting the Needs of Homeless People
Reference
Forming a Therapeutic Alliance
Challenging Behaviors 38.1: The Client Lost in the System
Managing Medications
Teaching Clients
Providing Case Management
Becoming Politically Involved
EVALUATION
UNDERSTANDING PSYCHOPHARMACOLOGY 38.1: Medication Management Suggestions for the Homeless Person
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
39: Clients With Medical Illnesses
LEARNING OBJECTIVES
KEY TERMS
FIGURE 39.1
MENTAL DISORDER DUE TO A GENERAL MEDICAL CONDITION
BOX 39.1: Common Medical Disorders Associated With Psychiatric Symptoms
General Features
Example: Seizure Disorder (Epilepsy)
DSM-IV-TR BOX 39.1: Mental Disorders Due to a Medical Condition
Diagnostic Criteria
Categories
Treatment
Nursing Implications
Checkpoint Questions
ADJUSTMENT DISORDERS
General Features
DSM-IV-TR BOX 39.2
Adjustment Disorder
Reactions to Physical Illness
BOX 39.2: Factors That Influence Reactions to Illness
Treatment
Nursing Implications
Checkpoint Questions
MENTAL DISORDER NOT OTHERWISE SPECIFIED DUE TO A GENERAL MEDICAL CONDITION
FIGURE 39.2
Cardiovascular Illness
FIGURE 39.3
Client Reactions
Treatment and Nursing Implications
Pulmonary Illness
Client Reactions
Treatment and Nursing Implications
FIGURE 39.4
Think About It 38.1
Reproductive Challenges
Client Reactions
FIGURE 39.5
Treatment and Nursing Implications
Checkpoint Questions
Neoplastic Diseases (Cancer)
Client Reactions
Treatment and Nursing Implications
FIGURE 39.6
NURSING STRATEGIES FOR PSYCHOSOCIAL CARE IN MEDICAL ILLNESS
Reviewing and Applying Your Knowledge
Chapter Summary
Study Questions
Critical Thinking Questions
References
Web Resources
Back Matter
APPENDIX A: Global Assessment of Functioning (GAF) Scale
APPENDIX B: DSM-IV-TR Classification: Axes I and II Categories and Codes
DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE
Mental Retardation
Learning Disorders
Motor Skills Disorder
Communication Disorders
Pervasive Developmental Disorders
Attention-Deficit and Disruptive Behavior Disorders
Feeding and Eating Disorders of Infancy or Early Childhood
Tic Disorders
Elimination Disorders
Other Disorders of Infancy, Childhood, or Adolescence
DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS
Delirium
Dementia
Amnestic Disorders
Other Cognitive Disorders
MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION NOT ELSEWHERE CLASSIFIED
SUBSTANCE-RELATED DISORDERS
Alcohol-Related Disorders
Alcohol Use Disorders
Alcohol-Induced Disorders
Amphetamine (or Amphetamine-Like)-Related Disorders
Amphetamine Use Disorders
Amphetamine-Induced Disorders
Caffeine-Related Disorders
Caffeine-Induced Disorders
Cannabis-Related Disorders
Cannabis Use Disorders
Cannabis-Induced Disorders
Cocaine-Related Disorders
Cocaine Use Disorders
Cocaine-Induced Disorders
Hallucinogen-Related Disorders
Hallucinogen-Use Disorders
Hallucinogen-Induced Disorders
Inhalant-Related Disorders
Inhalant Use Disorders
Inhalant-Induced Disorders
Nicotine-Related Disorders
Nicotine Use Disorder
Nicotine-Induced Disorder
Opioid-Related Disorders
Opioid Use Disorders
Opioid-Induced Disorders
Phencyclidine (or Phencyclidine-Like)-Related Disorders
Phencyclidine Use Disorders
Phencyclidine-Induced Disorders
Sedative-Hypnotic- or Anxiolytic-Related Disorders
Sedative-Hypnotic- or Anxiolytic Use Disorders
Sedative, Hypnotic, or Anxiolytic-Induced Disorders
Polysubstance-Related Disorder
Other (or Unknown) Substance-Related Disorders
Other (or Unknown) Substance Use Disorders
Other (or Unknown) Substance-Induced Disorders
SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
MOOD DISORDERS
Depressive Disorders
Bipolar Disorders
ANXIETY DISORDERS
SOMATOFORM DISORDERS
FACTITIOUS DISORDERS
DISSOCIATIVE DISORDERS
SEXUAL AND GENDER IDENTITY DISORDERS
Sexual Dysfunctions
Sexual Desire Disorders
Sexual Arousal Disorders
Orgasmic Disorders
Sexual Pain Disorders
Sexual Dysfunction Due to a General Medical Condition
Paraphilias
Gender Identity Disorders
EATING DISORDERS
SLEEP DISORDERS
Primary Sleep Disorders
Dyssomnias
Parasomnias
Sleep Disorders Related to Another Mental Disorder
Other Sleep Disorders
IMPULSE-CONTROL DISORDERS NOT ELSEWHERE CLASSIFIED
ADJUSTMENT DISORDERS
PERSONALITY DISORDERS
OTHER CONDITIONS THAT MAY BE A FOCUS OF CLINICAL ATTENTION
Psychological Factors Affecting Medical Condition
Medication-Induced Movement Disorders
Other Medical-Induced Disorder
Relational Problems
Problems Related to Abuse or Neglect
Additional Conditions That May be Focus of Clinical Attention
ADDITIONAL CODES
Glossary

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