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Test Bank for Psychiatric Mental Health Nursing Concepts of Care in Evidence Based Practice, 6th Edition: Townsend

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This is completed downloadable of Test Bank for Psychiatric Mental Health Nursing Concepts of Care in Evidence Based Practice, 6th Edition: Townsend

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ISBN-10 ‏ : ‎ 0803619170
ISBN-13 ‏ : ‎ 978-0803619173
Author: Mary C. Townsend

Assure that your students receive the psychiatric mental health knowledge they need with the text that’s still the most clearly written and student friendly. They’ll master an evidence-based, holistic approach to nursing practice that focuses on both biological and behavioral components. And, they’ll find all of the latest research studies, biological theories, and pharmacological data, as well as features designed to make complex concepts easier to grasp.

Table of Content:

UNIT 1 Introduction to Psychiatric/Mental Health Concepts
CHAPTER 1 Mental Health and Mental Illness
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Mental Health
FIGURE 1-1 Maslow’s hierarchy of needs.
Mental Illness
Physical and Psychological Responses to Stress
Physical Responses
BOX 1-1 Cultural Aspects of Mental Illness
Psychological Responses
CORE CONCEPT
Anxiety
FIGURE 1-2 Adaptation responses on a continuum of anxiety.
Mild Anxiety
Mild to Moderate Anxiety
Moderate to Severe Anxiety
TABLE 1-1 Ego Defense Mechanisms
Severe Anxiety
Panic Anxiety
CORE CONCEPT
Grief
Stages of Grief
Anticipatory Grief
Resolution
Maladaptive Grief Responses
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
CHAPTER 2 Concepts of Personality Development
CORE CONCEPT
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Psychoanalytic Theory
Structure of the Personality
Id
Ego
Superego
Topography of the Mind
Dynamics of the Personality
TABLE 2-1 Structure of the Personality: Behavioral Examples
Freud’s Stages of Personality Development
Oral Stage: Birth to 18 Months
Anal Stage: 18 Months to 3 Years
Phallic Stage: 3 to 6 Years
TABLE 2-2 Freud’s Stages of Psychosexual Development
Latency Stage: 6 to 12 Years
Genital Stage: 13 to 20 Years
Relevance of Psychoanalytic Theory to Nursing Practice
Interpersonal Theory
Sullivan’s Stages of Personality Development
Infancy: Birth to 18 Months
Childhood: 18 Months to 6 Years
Juvenile: 6 to 9 Years
Preadolescence: 9 to 12 Years
TABLE 2-3 Stages of Development in Sullivan’s Interpersonal Theory
Early Adolescence: 12 to 14 Years
Late Adolescence: 14 to 21 Years
Relevance of Interpersonal Theory to Nursing Practice
Theory of Psychosocial Development
TABLE 2-4 Stages of Development in Erikson’s Psychosocial Theory
Erikson’s Stages of Personality Development
Trust Versus Mistrust: Birth to 18 Months
Major Developmental Task
Autonomy Versus Shame and Doubt: 18 Months to 3 Years
Major Developmental Task
Initiative Versus Guilt: 3 to 6 Years
Major Developmental Task
Industry Versus Inferiority: 6 to 12 Years
Major Developmental Task
Identity Versus Role Confusion: 12 to 20 Years
Major Developmental Task
Intimacy Versus Isolation: 20 to 30 Years
Major Developmental Task
Generativity Versus Stagnation or Self-Absorption: 30 to 65 Years
Major Developmental Task
Ego Integrity Versus Despair: 65 Years to Death
Major Developmental Task
Relevance of Psychosocial Development Theory to Nursing Practice
Theory of Object Relations
Phase I: The Autistic Phase (Birth to 1 Month)
Phase II: The Symbiotic Phase (1 to 5 Months)
Phase III: Separation-Individuation (5 to 36 Months)
TABLE 2-5 Stages of Development in Mahler’s Theory of Object Relations
Subphase 1—Differentiation (5 to 10 Months)
Subphase 2—Practicing (10 to 16 Months)
Subphase 3—Rapprochement (16 to 24 Months)
Subphase 4—Consolidation (24 to 36 Months)
Relevance of Object Relations Theory to Nursing Practice
A Nursing Model—Hildegard E. Peplau
Peplau’s Stages of Personality Development
Learning to Count on Others
TABLE 2-6 Stages of Development in Peplau’s Interpersonal Theory
Learning to Delay Satisfaction
Identifying Oneself
Developing Skills in Participation
Relevance of Peplau’s Model to Nursing Practice
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
CHAPTER 3 Biological Implications
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
BOX 3-1 Components of the Nervous System
CORE CONCEPT
Neurophysiological Influences
The Nervous System
The Central Nervous System
The Brain
FIGURE 3-1 The human brain: cerebral lobes, cerebellum, and brainstem.
FIGURE 3-2 The human brain: midsagittal surface.
FIGURE 3-3 Structures of the limbic system.
Nerve Tissue
CORE CONCEPTS
Neurotransmitters
FIGURE 3-4 Impulse transmission at a synapse. The arrow indicates the direction of the electrical impulse.
Cholinergics
Monoamines
Amino Acids
Neuropeptides
Spinal Cord
The Peripheral Nervous System
The Afferent System
The Efferent System
FIGURE 3-5 The autonomic nervous system.
The Neuroendocrine System
The Pituitary Gland
Neurohypophysis
TABLE 3-1 Hormones of the Neuroendocrine System
Adenohypophysis
FIGURE 3-6 Hypothalamic regulation of pituitary hormones. (A) Releasing hormones of the hypothalamus circulate directly to the anterior pituitary and influence its secretions. (B) Posterior pituitary stores hormones produced in the hypothalamus.
Implications for Psychiatric Illness
Schizophrenia
Anomalies of the Brain
Neurotransmitter Hypothesis
Possible Endocrine Correlation
Mood Disorders
Neuroanatomical Considerations
Neurotransmitter Hypothesis
Possible Endocrine Correlation
Anxiety Disorders
Neuroanatomical Considerations
Neurotransmitter Hypothesis
Possible Endocrine Correlation
Anorexia Nervosa
Neuroanatomical Considerations
Neurotransmitter Hypothesis
Possible Endocrine Correlation
Alzheimer’s Disease
Neuroanatomical Considerations
Neurotransmitter Hypothesis
Possible Endocrine Correlation
Diagnostic Procedures Used to Detect Altered Brain Function
Electroencephalography
Technique
Purpose/Possible Findings
TABLE 3-2 Diagnostic Procedures Used to Detect Altered Brain Functioning
Computerized EEG Mapping
Technique
Purpose/Possible Findings
Computed Tomographic Scan
Technique
Purpose/Possible Findings
Magnetic Resonance Imaging
Technique
Purpose/Possible Findings
Positron Emission Tomography
Technique
Purpose/Possible Findings
Single-Photon Emission Computed Tomography
Technique
Purpose/Possible Findings
Psychopharmacology
CORE CONCEPT
Historical Perspectives
Role of the Nurse
Ethical and Legal Implications
Assessment
Medication Administration and Evaluation
BOX 3-2 Medication Assessment Tool
Client Education
How Do Psychotropics Work?
FIGURE 3-7 Area of synaptic transmission that is altered by drugs.
TABLE 3-3 Effects of Psychotropic Medications on Neurotransmitters
Implications for Nursing
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
CHAPTER 4 Ethical and Legal Issues
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPTS
BOX 4-1 American Nurses’ Association Code of Ethics for Nurses
Ethical Considerations
Theoretical Perspectives
Utilitarianism
Kantianism
Christian Ethics
Natural Law Theory
Ethical Egoism
Ethical Dilemmas
Ethical Principles
Autonomy
Beneficence
Nonmaleficence
Justice
Veracity
A Model for Making Ethical Decisions
Ethical Issues in Psychiatric/Mental Health Nursing
The Right to Refuse Medication
FIGURE 4-1 Ethical decision-making model.
BOX 4-2 Ethical Decision-Making: A Case Study
STEP 1. ASSESSMENT
STEP 2. PROBLEM IDENTIFICATION
STEP 3. ALTERNATIVES–BENEFITS AND CONSEQUENCES
STEP 4. CONSIDER PRINCIPLES OF ETHICAL THEORIES
STEP 5. SELECT AN ALTERNATIVE
STEP 6. TAKE ACTION AND COMMUNICATE
STEP 7. EVALUATE THE OUTCOME
The Right to the Least-Restrictive Treatment Alternative
Legal Considerations
Nurse Practice Acts
BOX 4-3 Patient Self-Determination Act—Patient Rights
Types of Law
Statutory Law
Common Law
Classifications Within Statutory and Common Law
Civil Law
Torts
Contracts
Criminal Law
Legal Issues in Psychiatric/Mental Health Nursing
Confidentiality and Right to Privacy
HIPAA
BOX 4-4 Protected Health Information (PHI): Individually Identifiable Indicators
Exception: A Duty to Warn (Protection of a Third Party)
Implications for Nursing.
Informed Consent
Restraints and Seclusion
Commitment Issues
Voluntary Admissions
Involuntary Commitment
Emergency Commitments
The Mentally Ill Person in Need of Treatment
Involuntary Outpatient Commitment
The Gravely Disabled Client
Nursing Liability
Malpractice and Negligence
Types of Lawsuits That Occur in Psychiatric Nursing
Avoiding Liability
CLINICAL PEARL
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
CHAPTER 5 Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing
CORE CONCEPTS
KEY TERM
OBJECTIVES
HOMEWORK ASSIGNMENT
Cultural Concepts
CORE CONCEPTS
FIGURE 5-1 Breakdown of cultural groups in the United States.
How Do Cultures Differ?
Communication
Space
Social Organization
Time
BOX 5-1 Using an Interpreter
Environmental Control
Biological Variations
Application of the Nursing Process
Background Assessment Data
BOX 5-2 Cultural Assessment Tool
Northern European Americans
African Americans
BOX 5-3 Characteristics Common to the Culture of the United States
Native Americans
Asian/Pacific Islander Americans
Latino Americans
Western European Americans
Arab Americans*
Jewish Americans
TABLE 5-1 Comparison of Six Cultural Phenomena in Various Cultural Groups
Culture-Bound Syndromes
Diagnosis/Outcome Identification
TABLE 5-2 Examples of Culture-Bound Syndromes
Evaluation
Spiritual Concepts
CORE CONCEPT
Spiritual Needs
Meaning and Purpose in Life
Faith
Hope
Love
Forgiveness
Religion
CORE CONCEPT
Addressing Spiritual and Religious Needs Through the Nursing Process
Assessment
Diagnoses/Outcome Identification
BOX 5-4 Spiritual Assessment Tool
Planning/Implementation
Risk for Spiritual Distress
Risk Factors
Risk for Impaired Religiosity
Risk Factors
TABLE 5-3 | CARE PLAN FOR THE CLIENT WITH SPIRITUAL AND RELIGIOUS NEEDS*
Evaluation
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
UNIT 2 Psychiatric/Mental Health Nursing Interventions
CHAPTER 6 Relationship Development and Therapeutic Communication
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
The Therapeutic Nurse-Client Relationship
EXAMPLE
Therapeutic Use of Self
Conditions Essential to Development of a Therapeutic Relationship
Rapport
Trust
Respect
Genuineness
Empathy
EXAMPLE
Phases of a Therapeutic Nurse-Client Relationship
TABLE 6-1 Phases of Relationship Development and Major Nursing Goals
The Preinteraction Phase
The Orientation (Introductory) Phase
The Working Phase
Transference and Countertransference
Transference
Countertransference
The Termination Phase
Boundaries in the Nurse-Client Relationship
CORE CONCEPT
Interpersonal Communication
The Impact of Preexisting Conditions
Values, Attitudes, and Beliefs
Culture or Religion
Social Status
Gender
Age or Developmental Level
Environment in Which the Transaction Takes Place
Nonverbal Communication
Physical Appearance and Dress
Body Movement and Posture
Touch
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
Facial Expressions
Eye Behavior
TABLE 6-2 Summary of Facial Expressions
Vocal Cues or Paralanguage
CORE CONCEPT
Therapeutic Communication Techniques
TABLE 6-3 Therapeutic Communication Techniques
Nontherapeutic Communication Techniques
Active Listening
TABLE 6-4 Nontherapeutic Communication Techniques
Process Recordings
TABLE 6-5 Sample Process Recording
Feedback
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
CHAPTER 7 The Nursing Process in Psychiatric/Mental Health Nursing
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
The Nursing Process
Definition
Standards of Practice
FIGURE 7-1 The ongoing nursing process.
CORE CONCEPT
Standard 1. Assessment
BOX 7-1 Nursing History and Assessment Tool
CORE CONCEPT
Standard 2. Diagnosis
CORE CONCEPT
TABLE 7-1 Brief Mental Status Evaluation
Standard 3. Outcomes Identification
Nursing Outcomes Classification (NOC)
Standard 4. Planning
Nursing Interventions Classification (NIC)
Standard 5. Implementation
Standard 5A. Coordination of Care
Standard 5B. Health Teaching and Health Promotion
Standard 5C. Milieu Therapy
Standard 5D. Pharmacological, Biological, and Integrative Therapies
Standard 5E. Prescriptive Authority and Treatment
Standard 5F. Psychotherapy
Standard 5G. Consultation
CORE CONCEPT
Standard 6. Evaluation
Why Nursing Diagnosis?
BOX 7-2 Standards of Psychiatric/Mental Health Clinical Nursing Practice
Nursing Case Management
Critical Pathways of Care
TABLE 7-2 Sample Critical Pathway of Care for Client in Alcohol Withdrawal
Applying the Nursing Process in the Psychiatric Setting
Concept Mapping*
FIGURE 7-2 Example: Concept map care plan for client with schizophrenia.
Documentation of the Nursing Process
Problem-Oriented Recording
EXAMPLE
Focus Charting
EXAMPLE
TABLE 7-3 Validation of the Nursing Process With Problem-Oriented Recording
TABLE 7-4 Validation of the Nursing Process With Focus Charting
The PIE Method
EXAMPLE
TABLE 7-5 Validation of the Nursing Process With APIE Method
Electronic Documentation
TABLE 7-6 Advantages and Disadvantages of Paper Records and EHRs
Review Questions Self-Examination/Learning Exercise
References
CHAPTER 8 Milieu Therapy—The Therapeutic Community
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Milieu, Defined
CORE CONCEPT
Current Status of the Therapeutic Community
Basic Assumptions
Conditions That Promote a Therapeutic Community
The Program of Therapeutic Community
The Role of the Nurse in Milieu Therapy
TABLE 8-1 The Interdisciplinary Treatment Team in Psychiatry
TABLE 8-2 The Therapeutic Milieu—Topics for Client Education
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
CHAPTER 9 Intervention in Groups
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Functions of a Group
Types of Groups
Task Groups
Teaching Groups
Supportive/Therapeutic Groups
CORE CONCEPT
Self-Help Groups
Physical Conditions That Influence Group Dynamics
Seating
Size
Membership
Curative Factors
Phases of Group Development
Phase I. Initial or Orientation Phase
Group Activities
Leader Expectations
Member Behaviors
Phase II. Middle or Working Phase
Group Activities
Leader Expectations
Member Behaviors
Phase III. Final or Termination Phase
Group Activities
Leader Expectations
Member Behaviors
Leadership Styles
TABLE 9-1 Leadership Styles—Similarities and Differences
Autocratic
Democratic
Laissez-Faire
Member Roles
Psychodrama
TABLE 9-2 Member Roles Within Groups
The Family as a Group
CORE CONCEPTS
The Role of the Nurse in Group Interventions
FIGURE 9-1 Sample genogram.
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
CHAPTER 10 Intervening in Crises
CORE CONCEPT
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Characteristics of A Crisis
FIGURE 10-1 Chinese symbol for crisis.
Phases in the Development of a Crisis
FIGURE 10-2 The effects of balancing factors in a stressful event.
Types of Crises
Class 1: Dispositional Crises
EXAMPLE
Class 2: Crises of Anticipated Life Transitions
EXAMPLE
Class 3: Crises Resulting from Traumatic Stress
EXAMPLE
Class 4: Maturational/Developmental Crises
EXAMPLE
Class 5: Crises Reflecting Psychopathology
EXAMPLE
Class 6: Psychiatric Emergencies
EXAMPLE
Crisis Intervention
Phases of Crisis Intervention: The Role of the Nurse
TABLE 10-1 Roberts’ Seven-Stage Crisis Intervention Model
Phase 1. Assessment
Phase 2. Planning of Therapeutic Intervention
Phase 3. Intervention
Phase 4. Evaluation of Crisis Resolution and Anticipatory Planning
Crisis on the Inpatient Unit: Anger/Aggression Management
Assessment
Anger
Aggression
Assessing Risk Factors
Diagnosis/Outcome Identification
BOX 10-1 The Brøset Violence Checklist
Outcome Criteria
The Client:
Planning/Implementation
Evaluation
Disaster Nursing
TABLE 10-2 | CARE PLAN FOR THE INDIVIDUAL WHO EXPRESSES ANGER INAPPROPRIATELY
FIGURE 10-3 Walking a client to the seclusion room.
FIGURE 10-4 Staff restraint of a client in supine position. The client’s head is controlled to prevent biting.
FIGURE 10-5 Transporting a client to the seclusion room.
Application of the Nursing Process to Disaster Nursing
Background Assessment Data
Nursing Diagnoses/Outcome Identification
The Client:
Planning/Implementation
Evaluation
TABLE 10-3 | CARE PLAN FOR THE CLIENT WHO HAS EXPERIENCED A TRAUMATIC EVENT
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
CHAPTER 11 The Recovery Model
CORE CONCEPT
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
What Is Recovery?
Guiding Principles of Recovery
Models of Recovery
The Tidal Model
The Wellness Recovery Action Plan (WRAP)
The Psychological Recovery Model
Nursing Interventions That Assist With Recovery
TABLE 11-1 Nurse-Client Collaboration in the Mental Health Recovery Process
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
CHAPTER 12 Complementary and Psychosocial Therapies
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Complementary Therapies
CORE CONCEPT
CORE CONCEPT
TABLE 12-1 Classification of Complementary and Alternative Medicine Practices
FIGURE 12-1 Ten most common CAM therapies among adults.
Commonalities and Contrasts
Types of Complementary Therapies
Herbal Medicine
TABLE 12-2 Commonalities and Contrasts Between Conventional and Complementary or Alternative Therapies
Acupressure and Acupuncture
TABLE 12-3 Herbal Remedies
Diet and Nutrition
Balancing Calories to Manage Weight
Foods and Food Components to Reduce
Foods and Nutrients to Increase
Building Healthy Eating Patterns
Chiropractic Medicine
TABLE 12-4 Sample USDA Food Guide at the 2,000-Calorie Level
TABLE 12-5 Essential Vitamins and Minerals
FIGURE 12-2 Chiropractic adjustments.
Therapeutic Touch and Massage
Therapeutic Touch
Massage
Yoga
Pet Therapy
FIGURE 12-3 Achieving relaxation through the practice of yoga.
FIGURE 12-4 Healthy aging with a pet.
Psychosocial Therapies
Individual Psychotherapies
Psychoanalysis
Free Association
Dream Analysis
Hypnosis
Catharsis
Interpersonal Psychotherapy
Reality Therapy
Relaxation Therapy
Deep-Breathing Exercises
Progressive Relaxation
Meditation
Mental Imagery
Biofeedback
Assertiveness Training
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
EXAMPLE
Cognitive Therapy
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
UNIT 3 Care of Clients With Psychiatric Disorders
CHAPTER 13 Neurocognitive Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Delirium
Clinical Findings and Course
Predisposing Factors
Delirium
Other Etiological Implications
Substance Intoxication Delirium
Substance Withdrawal Delirium Withdrawal from certain substances can precipitate symptoms of delirium that are sufficiently severe to warrant clinical attention. These substances include alcohol; opioids; sedative, hypnotics, and anxiolytics; and others.
Medication-Induced Delirium
Delirium Due to Another Medical Condition or to Multiple Etiologies
CORE CONCEPT
Neurocognitive Disorder
Clinical Findings, Epidemiology, and Course
BOX 13-1 A Comparison of Diagnostic Criteria
Predisposing Factors
NCD Due to Alzheimer’s Disease
Etiology
FIGURE 13-1 Changes in the Alzheimer’s brain. A. Metabolic activity in a normal brain. B. Diminished metabolic activity in the Alzheimer’s diseased brain. C. Late stage Alzheimer’s disease with generalized atrophy and enlargement of the ventricles and sulci.
FIGURE 13-2 Neurobiology of Alzheimer’s disease.
Neurotransmitters
Areas of the Brain Affected
Medications and Their Effects on the Brain
Vascular NCD
Etiology
Frontotemporal NCD
NCD Due to Traumatic Brain Injury
NCD Due to Lewy Body Dementia
NCD Due to Parkinson’s Disease
NCD Due to HIV Infection
Substance/Medication-Induced NCD
NCD Due to Huntington’s Disease
NCD Due to Prion Disease
NCD Due to Another Medical Condition
BOX 13-2 Etiological Factors Implicated in the Development of Delirium and/or Mild or Major Neurocognitive Disorder (NCD)
Application of the Nursing Process
Assessment
Client History
Physical Assessment
Diagnostic Laboratory Evaluations
BOX 13-3 Mental Status Examination for Neurocognitive Disorder (NCD)
TABLE 13-1 A Comparison of Neurocognitive Disorder (NCD) and Pseudodementia (Depression)
Nursing Diagnosis/Outcome Identification
Outcome Criteria
The Client:
Planning/Implementation
Concept Care Mapping
Client/Family Education
Evaluation
TABLE 13-2 Assigning Nursing Diagnoses to Behaviors Commonly Associated with Neurocognitive Disorders (NCDs)
TABLE 13-3 CARE PLAN FOR THE CLIENT WITH A NEUROCOGNITIVE DISORDER (NCD)
BOX 13-4 Validation Therapy
Quality and Safety Education for Nurses (QSEN)
FIGURE 13-3 Concept map care plan for client with major NCD.
BOX 13-5 Topics for Client/Family Education Related to Neurocognitive Disorders (NCDs)
Medical Treatment Modalities
Delirium
BOX 13-6 QSEN TEACHING STRATEGY
Neurocognitive Disorder (NCD)
Cognitive Impairment
TABLE 13-4 Selected Medications Used in the Treatment of Clients With Neurocognitive Disorder (NCD)
Agitation, Aggression, Hallucinations, Thought Disturbances, and Wandering
Anticholinergic Effects
Depression
Anxiety
Sleep Disturbances
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
IMPLICATIONS OF RESEARCH FOR EVIDENCE BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE BASED PRACTICE
Communication Exercises
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 14 Substance-Related and Addictive Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Substance Use Disorder, Defined
CORE CONCEPT
Substance Addiction
Substance-Induced Disorders, Defined
CORE CONCEPT
Substance Intoxication
CORE CONCEPT
Substance Withdrawal
Classes of Psychoactive Substances
Predisposing Factors to Substance-Related Disorders
Biological Factors
Genetics
Biochemical
Psychological Factors
Developmental Influences
Personality Factors
Sociocultural Factors
Social Learning
Conditioning
Cultural and Ethnic Influences
The Dynamics of Substance-Related Disorders
Alcohol Use Disorder
A Profile of the Substance
Historical Aspects
Patterns of Use
Phase I. The Prealcoholic Phase
Phase II. The Early Alcoholic Phase
Phase III. The Crucial Phase
Phase IV. The Chronic Phase
Effects on the Body
Peripheral Neuropathy
Alcoholic Myopathy
Wernicke’s Encephalopathy
Korsakoff’s Psychosis
Alcoholic Cardiomyopathy
Esophagitis
Gastritis
Pancreatitis
Alcoholic Hepatitis
Cirrhosis of the Liver
Leukopenia
Thrombocytopenia
Sexual Dysfunction
Use During Pregnancy
Fetal Alcohol Syndrome
FIGURE 14-1 Facial features of FAS.
Alcohol Intoxication
Alcohol Withdrawal
Sedative, Hypnotic, or Anxiolytic Use Disorder
A Profile of the Substance
TABLE 14-1 Sedative, Hypnotic, and Anxiolytic Drugs
Historical Aspects
Patterns of Use
Effects on the Body
The Effects on Sleep and Dreaming
Respiratory Depression
Cardiovascular Effects
Renal Function
Hepatic Effects
Body Temperature
Sexual Functioning
Sedative, Hypnotic, or Anxiolytic Intoxication
FIGURE 14-2 Continuum of behavioral depression with increasing doses of sedative-hypnotic drugs.
Sedative, Hypnotic, or Anxiolytic Withdrawal
Stimulant Use Disorder
A Profile of the Substance
TABLE 14-2 Central Nervous System (CNS) Stimulants
Historical Aspects
Patterns of Use
Effects on the Body
TABLE 14-3 Common Sources of Caffeine
CNS Effects
Cardiovascular/Pulmonary Effects
Gastrointestinal and Renal Effects
Sexual Functioning
Stimulant Intoxication
Stimulant Withdrawal
Inhalant Use Disorder
A Profile of the Substance
Patterns of Use
Effects on the Body
CNS Effects
Respiratory Effects
GI Effects
Renal System Effects
Inhalant Intoxication
Opioid Use Disorder
A Profile of the Substance
TABLE 14-4 Opioids and Related Substances
Historical Aspects
Patterns of Use
Effects on the Body
CNS Effects
GI Effects
Cardiovascular Effects
Sexual Functioning
Opioid Intoxication
Opioid Withdrawal
Hallucinogen Use Disorder
A Profile of the Substance
Historical Aspects
TABLE 14-5 Hallucinogens
Patterns of Use
Effects on the Body
Psychological Effects
Hallucinogen Intoxication
Cannabis Use Disorder
A Profile of the Substance
Historical Aspects
TABLE 14-6 Cannabinoids
Patterns of Use
Effects on the Body
Cardiovascular Effects
Respiratory Effects
Reproductive Effects
CNS Effects
Sexual Functioning
Cannabis Intoxication
Cannabis Withdrawal
Application of the Nursing Process
Assessment
TABLE 14-7 Psychoactive Substances: A Profile Summary
TABLE 14-8 Summary of Symptoms Associated With the Syndromes of Intoxication and Withdrawal
Assessment Tools
BOX 14-1 Drug History and Assessment*
BOX 14-2 Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
Dual Diagnosis
BOX 14-3 Michigan Alcoholism Screening Test (MAST)
BOX 14-4 The CAGE Questionnaire
Diagnosis/Outcome Identification
Outcome Criteria
TABLE 14-9 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Substance-Related Disorders
Planning/Implementation
TABLE 14-10 | CARE PLAN FOR THE CLIENT WITH A SUBSTANCE-RELATED DISORDER
Detoxification
Intermediate Care
Rehabilitation
Client/Family Education
Evaluation
FIGURE 14-3 Concept map care plan for client with alcoholism.
BOX 14-5 Topics for Client/Family Education Related to Substance-Use Disorders
The Chemically Impaired Nurse
Codependency
The Codependent Nurse
Treating Codependency
Treatment Modalities for Substance-Related Disorders
Alcoholics Anonymous
Pharmacotherapy
Disulfiram (Antabuse)
BOX 14-6 Alcoholics Anonymous (AA)
TABLE 14-11 Addiction Self-Help Groups
Other Medications for Treatment of Alcoholism
Counseling
Group Therapy
Psychopharmacology for Substance Intoxication and Substance Withdrawal
Alcohol
Opioids
Depressants
Stimulants
Hallucinogens and Cannabinols
Non-Substance Addictions
Gambling Disorder
Predisposing Factors to Gambling Disorder
Biological Influences
Genetic.
Physiological.
Psychosocial Influences
BOX 14-7 Diagnostic Criteria for Gambling Disorder
Treatment Modalities for Gambling Disorder
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
Communication Exercises
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 15 Schizophrenia Spectrum and Other Psychotic Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Nature of the Disorder
CORE CONCEPT
Phase I: The Premorbid Phase
Phase II: The Prodromal Phase
Phase III: Schizophrenia
Phase IV: Residual Phase
Prognosis
Predisposing Factors
Biological Influences
Genetics
Twin Studies
Adoption Studies
Biochemical Influences
The Dopamine Hypothesis
Other Biochemical Hypotheses
Physiological Influences
Viral Infection
FIGURE 15-1 Neurobiology of schizophrenia.
Neurotransmitters
Areas of the Brain Affected
ANTIPSYCHOTIC MEDICATIONS
Anatomical Abnormalities
Histological Changes
Physical Conditions
Psychological Influences
Environmental Influences
Sociocultural Factors
Stressful Life Events
Theoretical Integration
Types of Schizophrenia and Other Psychotic Disorders
BOX 15-1 Diagnostic Criteria for Catatonia Specifier
Delusional Disorder
Erotomanic Type
Grandiose Type
Jealous Type
Persecutory Type
Somatic Type
Mixed Type
Brief Psychotic Disorder
Substance/Medication-Induced Psychotic Disorder
Psychotic Disorder Due to Another Medical Condition
TABLE 15-1 Substances That May Cause Psychotic Disorders
TABLE 15-2 General Medical Conditions That May Cause Psychotic Symptoms
Catatonic Disorder Due to Another Medical Condition
Schizophreniform Disorder
Schizoaffective Disorder
Application of the Nursing Process
Schizophrenia—Background Assessment Data
BOX 15-2 Positive and Negative Symptoms of Schizophrenia
Positive Symptoms
Content of Thought
Delusions.
Religiosity.
Paranoia.
Magical Thinking.
Form of Thought
Associative Looseness.
Neologisms.
Concrete Thinking.
Clang Associations.
Word Salad.
Circumstantiality.
Tangentiality.
Mutism.
Perception
Illusions.
Sense of Self
Echolalia.
Echopraxia.
Identification and Imitation.
Depersonalization.
Negative Symptoms
Affect
Inappropriate Affect.
Bland or Flat Affect.
Apathy.
Volition
Emotional Ambivalence.
Deteriorated Appearance.
Interpersonal Functioning and Relationship to the External World
Impaired Social Interaction.
Social Isolation.
Psychomotor Behavior
Anergia.
Waxy Flexibility.
Posturing.
Pacing and Rocking.
Associated Features
Anhedonia.
Regression.
Diagnosis/Outcome Identification
TABLE 15-3 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Psychotic Disorders
Outcome Criteria
Planning/Implementation
Concept Care Mapping
Client/Family Education
Evaluation
TABLE 15-4 I CARE PLAN FOR THE CLIENT WITH SCHIZOPHRENIA
Quality and Safety Education for Nurses (QSEN)
FIGURE 15-2 Concept map care plan for client with schizophrenia.
BOX 15-3 Topics for Client/Family Education Related to Schizophrenia
Treatment Modalities for Schizophrenia and Other Psychotic Disorders
Psychological Treatments
Individual Psychotherapy
BOX 15-4 QSEN TEACHING STRATEGY
Group Therapy
Behavior Therapy
Social Skills Training
Social Treatments
Milieu Therapy
Family Therapy
Program of Assertive Community Treatment (PACT)
The Recovery Model
Organic Treatment
Psychopharmacology
TABLE 15-5 Antipsychotic Agents
Indications
Action
Contraindications/Precautions
Interactions
Side Effects
TABLE 15-6 Comparison of Side Effects Among Antipsychotic Agents
TABLE 15-7 Antiparkinsonian Agents Used to Treat Extrapyramidal Side Effects (EPS) of Antipsychotic Drugs
BOX 15-5 Abnormal Involuntary Movement Scale (AIMS)
Client/Family Education Related to Antipsychotics The Client Should:
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
DISTURBED SENSORY PERCEPTION: AUDITORY
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
Communication Exercises
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 16 Depressive Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
CORE CONCEPT
Historical Perspective
Epidemiology
Age and Gender
Social Class
Race and Culture
Marital Status
Seasonality
Types of Depressive Disorders
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
BOX 16-1 Diagnostic Criteria for Major Depressive Disorder
BOX 16-2 Diagnostic Criteria for Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Disorder
BOX 16-3 Diagnostic Criteria for Premenstrual Dysphoric Disorder
Depressive Disorder Due to Another Medical Condition
Predisposing Factors
Biological Theories
Genetics
Twin Studies
Family Studies
Adoption Studies
Biochemical Influences
Biogenic Amines
Neuroendocrine Disturbances
Hypothalamic-Pituitary-Adrenocortical Axis
Hypothalamic-Pituitary-Thyroid Axis
Physiological Influences
Medication Side Effects
Neurological Disorders
FIGURE 16-1 Neurobiology of depression.
Neurotransmitters
Areas of the Brain Affected
Medications and Their Effects on the Brain
Electrolyte Disturbances
Hormonal Disturbances
Nutritional Deficiencies
Other Physiological Conditions
Psychosocial Theories
Psychoanalytical Theory
Learning Theory
Object Loss Theory
Cognitive Theory
Developmental Implications
Childhood
BOX 16-4 Diagnostic Criteria for Disruptive Mood Dysregulation Disorder
Adolescence
Senescence
Postpartum Depression
Application of the Nursing Process
Background Assessment Data
FIGURE 16-2 A continuum of depression.
BOX 16-5 Hamilton Depression Rating Scale (HDRS)
Transient Depression
Mild Depression
Moderate Depression
Severe Depression
Diagnosis/Outcome Identification
TABLE 16-1 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Depression
Outcome Criteria
Planning/Implementation
Concept Care Mapping
TABLE 16-2 | CARE PLAN FOR THE DEPRESSED CLIENT
FIGURE 16-3 Concept map care plan for a client with depression.
Client/Family Education
Evaluation of Care for the Depressed Client
BOX 16-6 Topics for Client/Family Education Related to Depression
Quality and Safety Education for Nurses (QSEN)
BOX 16-7 QSEN TEACHING STRATEGY
Treatment Modalities for Depression
Individual Psychotherapy
Phase I
Phase II
Phase III
Group Therapy
Family Therapy
Cognitive Therapy
Electroconvulsive Therapy
Mechanism of Action
Side Effects
Risks Associated With ECT
Mortality
Permanent Memory Loss
Brain Damage
Medications Used With ECT
Transcranial Magnetic Stimulation
Light Therapy
Psychopharmacology
Historical Aspects
Indications
Action
Contraindications/Precautions
TABLE 16-3 Medications Used in the Treatment of Depression
Interactions
TCAs
MAOIs
SSRIs
Others (Heterocyclics and SNRIs)
TABLE 16-4 Diet and Drug Restrictions for Clients on MAOI Therapy
Side Effects
May Occur With All Chemical Classes
Most Commonly Occur With Tricyclics and Heterocyclics
Most Commonly Occur With MAOIs
Miscellaneous Side Effects
Client/Family Education Related to Antidepressants
The Suicidal Client
Epidemiological Factors
Application of the Nursing Process With the Suicidal Client
Assessment
Demographics
TABLE 16-5 Facts and Fables About Suicide
TABLE 16-6 Suicide Risk Factors and Protective Factors
Presenting Symptoms/Medical-Psychiatric Diagnosis
Suicidal Ideas or Acts
Interpersonal Support System
Analysis of the Suicidal Crisis
Psychiatric/Medical/Family History
Coping Strategies
Diagnosis/Outcome Identification
Outcome Criteria
Planning/Implementation
Intervention With the Suicidal Client Following Discharge (or Outpatient Suicidal Client)
Information for Family and Friends of the Suicidal Client
Intervention With Families and Friends of Suicide Victims
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
Communication Exercises
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 17 Bipolar and Related Disorders
CORE CONCEPT
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Historical Perspective
Epidemiology
Types of Bipolar Disorders
BOX 17-1 Diagnostic Criteria for Manic Episode
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
BOX 17-2 Diagnostic Criteria for Hypomanic Episode
Substance/Medication-Induced Bipolar Disorder
Bipolar Disorder Due to Another Medical Condition
BOX 17-3 Diagnostic Criteria for Cyclothymic Disorder
Predisposing Factors
Biological Theories
Genetics
Twin Studies
Family Studies
Other Genetic Studies
Biochemical Influences
Biogenic Amines
Physiological Influences
Neuroanatomical Factors
Medication Side Effects
Psychosocial Theories
Developmental Implications
Childhood and Adolescence
Treatment Strategies
Psychopharmacology
Family Interventions
Application of The Nursing Process to Bipolar Disorder (Mania)
Background Assessment Data
Stage I: Hypomania
Mood
Cognition and Perception
Activity and Behavior
Stage II: Acute Mania
Mood
Cognition and Perception
Activity and Behavior
Stage III: Delirious Mania
Mood
Cognition and Perception
Activity and Behavior
Diagnosis/Outcome Identification
TABLE 17-1 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Bipolar Mania
Planning/Implementation
Concept Care Mapping
TABLE 17-2 | CARE PLAN FOR THE CLIENT EXPERIENCING A MANIC EPISODE
FIGURE 17-1 Concept map care plan for a client with bipolar mania.
Client/Family Education
Evaluation of Care for the Client With Bipolar Mania
TABLE 17-3 Topics for Client/Family Education Related to Bipolar Disorder
Treatment Modalities for Bipolar Disorder (Mania)
Individual Psychotherapy
Group Therapy
Family Therapy
Cognitive Therapy
The Recovery Model
Electroconvulsive Therapy
Psychopharmacology With Mood-Stabilizing Agents
TABLE 17-4 Mood Stabilizing Agents
TABLE 17-5 Interactions of Mood Stabilizing Agents
Side Effects
Lithium Toxicity
TABLE 17-6 Side Effects and Nursing Implications of Mood Stabilizing Agents
Client/Family Education for Lithium
Client/Family Education for Anticonvulsants
Client/Family Education for Calcium Channel Blocker
Client/Family Education for Antipsychotics
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
INTERNET REFERENCES
MOVIE CONNECTIONS
CHAPTER 18 Anxiety, Obsessive-Compulsive, and Related Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Historical Aspects
FIGURE 18-1 Neurobiology of anxiety disorders.
Neurotransmitters
Areas of the Brain Affected
Epidemiological Statistics
How Much is Too Much?
EXAMPLE
EXAMPLE
Application of the Nursing Process—Assessment
CORE CONCEPT
Panic Disorder
Background Assessment Data
Generalized Anxiety Disorder
Background Assessment Data
Predisposing Factors to Panic and Generalized Anxiety Disorders
Psychodynamic Theory
Cognitive Theory
Biological Aspects
Genetics.
Neuroanatomical.
Biochemical.
Neurochemical.
CORE CONCEPT
Phobias
Agoraphobia
Background Assessment Data
Social Anxiety Disorder (Social Phobia)
Background Assessment Data
Specific Phobia
Background Assessment Data
BOX 18-1 Diagnostic Criteria for Agoraphobia
BOX 18-2 Diagnostic Criteria for Social Anxiety Disorder (Social Phobia)
Predisposing Factors to Phobias
Psychoanalytic Theory
TABLE 18-1 Classifications of Specific Phobias
Learning Theory
Cognitive Theory
Biological Aspects
Temperament.
FIGURE 18-2 Locus of control as a variable in the etiology of phobias.
Life Experiences
Anxiety Disorder Due to Another Medical Condition and Substance/Medication-Induced Anxiety Disorder
Background Assessment Data
CORE CONCEPT
CORE CONCEPT
Obsessive-Compulsive Disorder
Background Assessment Data
Body Dysmorphic Disorder
Background Assessment Data
BOX 18-3 Diagnostic Criteria for Obsessive-Compulsive Disorder
Trichotillomania (Hair-Pulling Disorder)
BOX 18-4 Diagnostic Criteria for Body Dysmorphic Disorder
Predisposing Factors to Obsessive-Compulsive and Related Disorders
Psychoanalytic Theory
Learning Theory
Psychosocial Influences
Biological Aspects
Genetics.
Neuroanatomy.
Physiology.
Biochemical Factors.
Assessment Scales
Diagnosis/Outcome Identification
BOX 18-5 Hamilton Anxiety Rating Scale (HAM-A)
Outcome Criteria
TABLE 18-2 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Anxiety, Obsessive-Compulsive, and Related Disorders
Planning/Implementation
TABLE 18-3 | CARE PLAN FOR THE CLIENT WITH ANXIETY, OBSESSIVE-COMPULSIVE, AND RELATED DISORDERS
Concept Care Mapping
Client/Family Education
FIGURE 18-3 Concept map care plan for client with agoraphobia.
BOX 18-6 Topics for Client/Family Education Related to Anxiety, OCD, and Related Disorders
Evaluation
Treatment Modalities
Individual Psychotherapy
Cognitive Therapy
Behavior Therapy
Systematic Desensitization
Implosion Therapy (Flooding)
CASE STUDY: SYSTEMATIC DESENSITIZATION
Psychopharmacology
Antianxiety Agents
Indications
Action
TABLE 18-4 Antianxiety Agents
Contraindications/Precautions
Interactions
Medications for Specific Disorders
For Panic and Generalized Anxiety Disorders
Anxiolytics.
Antidepressants.
Antihypertensive Agents.
For Phobic Disorders
Anxiolytics.
Antidepressants.
Antihypertensive Agents.
For Obsessive-Compulsive Disorder
Antidepressants.
For Body Dysmorphic Disorder
Antidepressants.
For Trichotillomania (Hair-Pulling Disorder)
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 19 Trauma- and Stressor-Related Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Historical and Epidemiological Data
Application of the Nursing Process—Trauma-Related Disorders
CORE CONCEPT
Posttraumatic Stress Disorder and Acute Stress Disorder
Background Assessment Data
BOX 19-1 Diagnostic Criteria for Posttraumatic Stress Disorder
Predisposing Factors to Trauma-Related Disorders
Psychosocial Theory
The Traumatic Experience
BOX 19-2 Diagnostic Criteria for Acute Stress Disorder
The Individual
The Recovery Environment
Learning Theory
Cognitive Theory
Biological Aspects
Diagnosis/Outcome Identification
Planning/Implementation
Concept Care Mapping
TABLE 19-1 | CARE PLAN FOR THE CLIENT WITH A TRAUMA-RELATED DISORDER
Evaluation
FIGURE 19-1 Concept map care plan for a client with post-traumatic stress disorder.
Application of the Nursing Process—Stressor-Related Disorders
Adjustment Disorders—Background Assessment Data
CORE CONCEPT
Adjustment Disorder With Depressed Mood
Adjustment Disorder With Anxiety
BOX 19-3 Diagnostic Criteria for Adjustment Disorders
Adjustment Disorder With Mixed Anxiety and Depressed Mood
Adjustment Disorder With Disturbance of Conduct
Adjustment Disorder With Mixed Disturbance of Emotions and Conduct
Adjustment Disorder Unspecified
Predisposing Factors to Adjustment Disorders
Biological Theory
Psychosocial Theories
Transactional Model of Stress/Adaptation
Diagnosis/Outcome Identification
Outcome Criteria
Planning/Implementation
Concept Care Mapping
Evaluation
TABLE 19-2 | CARE PLAN FOR THE CLIENT WITH AN ADJUSTMENT DISORDER
Treatment Modalities
Trauma-Related Disorders
Cognitive Therapy
FIGURE 19-2 Concept map care plan for a client with an adjustment disorder.
Prolonged Exposure Therapy
Group/Family Therapy
Eye Movement Desensitization and Reprocessing
Psychopharmacology
Antidepressants.
Anxiolytics.
Antihypertensives.
Other Medications.
Adjustment Disorders
Individual Psychotherapy
Family Therapy
Behavior Therapy
Self-Help Groups
Crisis Intervention
Psychopharmacology
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
CHAPTER 20 Somatic Symptom and Dissociative Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Historical Aspects
CORE CONCEPT
CORE CONCEPT
Epidemiological Statistics
Application of the Nursing Process
Background Assessment Data: Types of Somatic Symptom Disorders
Somatic Symptom Disorder
Illness Anxiety Disorder
BOX 20-1 Diagnostic Criteria for Somatic Symptom Disorder
Conversion Disorder (Functional Neurological Symptom Disorder)
BOX 20-2 Diagnostic Criteria for Illness Anxiety Disorder
Psychological Factors Affecting Other Medical Conditions
BOX 20-3 Diagnostic Criteria for Conversion Disorder (Functional Neurological Symptom Disorder)
Factitious Disorder
BOX 20-4 Diagnostic Criteria for Psychological Factors Affecting Other Medical Conditions
BOX 20-5 Diagnostic Criteria for Factitious Disorder
Predisposing Factors Associated With Somatic Symptom Disorders
Genetic
Biochemical
Neuroanatomical
Psychodynamic
Family Dynamics
Learning Theory
Background Assessment Data: Types of Dissociative Disorders
Dissociative Amnesia
CORE CONCEPT
Dissociative Identity Disorder
BOX 20-6 Diagnostic Criteria for Dissociative Amnesia
Depersonalization-Derealization Disorder
BOX 20-7 Diagnostic Criteria for Dissociative Identity Disorder
BOX 20-8 Diagnostic Criteria for
Predisposing Factors Associated With Dissociative Disorders
Genetics
Neurobiological
Psychodynamic Theory
Psychological Trauma
Diagnosis/Outcome Identification
Outcome Criteria
TABLE 20-1 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Somatic Symptom and Dissociative Disorders
Planning/Implementation
Concept Care Mapping
TABLE 20-2 | CARE PLAN FOR THE CLIENT WITH A SOMATIC SYMPTOM DISORDER
TABLE 20-3 | CARE PLAN FOR THE CLIENT WITH A DISSOCIATIVE DISORDER
FIGURE 20-1 Concept map care plan for a client with somatic symptom disorder.
FIGURE 20-2 Concept map care plan for a client with dissociative identity disorder.
Evaluation
Treatment Modalities
Somatic Symptom Disorders
Individual Psychotherapy
Group Psychotherapy
Behavior Therapy
Psychopharmacology
Dissociative Amnesia
Dissociative Identity Disorder
Depersonalization-Derealization Disorder
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 21 Issues Related to Human Sexuality and Gender Dysphoria
CORE CONCEPTS
KEY TERM
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Development of Human Sexuality
Birth Through Age 12
Adolescence
Adulthood
Marital Sex
Extramarital Sex
Sex and the Single Person
The “Middle” Years—40 to 65
Sexual Disorders
Paraphilic Disorders
Historical Aspects
Epidemiological Statistics
Types of Paraphilic Disorders
Exhibitionistic Disorder
Fetishistic Disorder
Frotteuristic Disorder
Pedophilic Disorder
Sexual Masochism Disorder
Sexual Sadism Disorder
Transvestic Disorder
Voyeuristic Disorder
Predisposing Factors to Paraphilic Disorders
Biological Factors
Psychoanalytic Theory
Behavioral Theory
Treatment Modalities for Paraphilic Disorders
Biological Treatment
Psychoanalytic Therapy
Behavioral Therapy
Role of the Nurse
Sexual Dysfunctions
The Sexual Response Cycle
Historical and Epidemiological Aspects Related to Sexual Dysfunction
Types of Sexual Dysfunction
Erectile Disorder
TABLE 21-1 Prevalence of Sexual Problems in Sexually-Active Men and Women in the United States
Female Orgasmic Disorder
Delayed Ejaculation
Premature (Early) Ejaculation
Female Sexual Interest/Arousal Disorder
Male Hypoactive Sexual Desire Disorder
Genito-Pelvic Pain/Penetration Disorder
Substance/Medication-Induced Sexual Dysfunction
Predisposing Factors to Sexual Dysfunction
Biological Factors
Sexual Desire Disorders.
Sexual Arousal Disorders.
Orgasmic Disorders.
Sexual Pain Disorders.
Psychosocial Factors
Sexual Desire Disorders.
Sexual Arousal Disorders.
Orgasmic Disorders.
Sexual Pain Disorders.
Application of the Nursing Process to Sexual Disorders
Assessment
BOX 21-1 Sexual History: Content Outline
Diagnosis/Outcome Identification
Outcome Criteria
Planning/Implementation
Concept Care Mapping
TABLE 21-2 | CARE PLAN FOR THE CLIENT WITH A SEXUAL DISORDER
Client/Family Education
Evaluation
FIGURE 21-1 Concept map care plan for clients with sexual disorders.
BOX 21-2 Topics for Client/Family Education Related to Sexual Disorders
Quality and Safety Education for Nurses (QSEN)
BOX 21-3 QSEN TEACHING STRATEGY
Treatment Modalities for Sexual Dysfunctions
Sexual Desire Disorders
Hypoactive Sexual Desire Disorder
Sexual Arousal Disorders
Female Sexual Interest/Arousal Disorder
Erectile Disorder
Orgasmic Disorders
Female Orgasmic Disorder
Delayed Ejaculation
Early Ejaculation
Genito-Pelvic Pain/Penetration Disorder
Gender Dysphoria
CORE CONCEPT
Course and Epidemiology
Predisposing Factors
Biological Influences
Family Dynamics
Psychoanalytic Theory
Application of the Nursing Process to Gender Dysphoria in Children
Background Assessment Data (Symptomatology)
Diagnosis/Outcome Identification
BOX 21-4 Diagnostic Criteria for Gender Dysphoria in Children
Planning/Implementation
TABLE 21-3 | CARE PLAN FOR THE CHILD WITH GENDER DYSPHORIA
Evaluation
Treatment Issues
Gender Dysphoria in Adolescents or Adults
Treatment Issues
Variations in Sexual Orientation
Homosexuality
Predisposing Factors
Biological Theories
Psychosocial Theories
Special Concerns
Bisexuality
Predisposing Factors
Sexually Transmitted Diseases
TABLE 21-4 Sexually Transmitted Diseases
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSIS/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 22 Eating Disorders
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Epidemiological Factors
Application of the Nursing Process
Background Assessment Data (Anorexia Nervosa)
CORE CONCEPT
CORE CONCEPT
Background Assessment Data (Bulimia Nervosa)
CORE CONCEPT
BOX 22-1 Diagnostic Criteria for Anorexia Nervosa
Predisposing Factors Associated With Anorexia Nervosa and Bulimia Nervosa
Biological Influences
Genetics.
BOX 22-2 Diagnostic Criteria for Bulimia Nervosa
Neuroendocrine Abnormalities.
Neurochemical Influences.
Psychodynamic Influences
Family Influences
Conflict Avoidance.
Elements of Power and Control.
Background Assessment Data (Obesity)
BOX 22-3 Diagnostic Criteria for Binge-Eating Disorder
Predisposing Factors Associated with Obesity
Biological Influences
Genetics.
Physiological Factors.
TABLE 22-1 Body Mass Index (BMI) Chart
Lifestyle Factors.
Psychosocial Influences
Diagnosis/Outcome Identification
Outcome Criteria
TABLE 22-2 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Eating Disorders
Planning/Implementation
TABLE 22-3 | CARE PLAN FOR CLIENT WITH EATING DISORDERS: ANOREXIA NERVOSA AND BULIMIA NERVOSA
TABLE 22-4 | CARE PLAN FOR THE CLIENT WITH AN EATING DISORDER: OBESITY
Concept Care Mapping
FIGURE 22-1 Concept map care plan for a client with anorexia nervosa.
FIGURE 22-2 Concept map care plan for a client with obesity.
Client/Family Education
Evaluation
BOX 22-4 Topics for Client/Family Education Related to Eating Disorders
Quality and Safety Education for Nurses (QSEN)
Treatment Modalities
Behavior Modification
BOX 22-5 QSEN TEACHING STRATEGY
Individual Therapy
Family Therapy
Psychopharmacology
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 23 Personality Disorders
CORE CONCEPT
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
TABLE 23-1 Comparison of Personality Development—Sullivan, Erikson, and Mahler
Historical Aspects
Types of Personality Disorders
Paranoid Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
Predisposing Factors
BOX 23-1 Diagnostic Criteria for Paranoid Personality Disorder
Schizoid Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
Predisposing Factors
BOX 23-2 Diagnostic criteria for Schizoid Personality Disorder
Schizotypal Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
Predisposing Factors
BOX 23-3 Diagnostic Criteria for Schizotypal Personality Disorder
Antisocial Personality Disorder
Definition and Epidemiological Statistics
Borderline Personality Disorder
Definition and Epidemiological Statistics
Histrionic Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
Predisposing Factors
Narcissistic Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
BOX 23-4 Diagnostic Criteria for Histrionic Personality Disorder
Predisposing Factors
BOX 23-5 Diagnostic Criteria for Narcissistic Personality Disorder
Avoidant Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
Predisposing Factors
BOX 23-6 Diagnostic Criteria for Avoidant Personality Disorder
Dependent Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
Predisposing Factors
BOX 23-7 Diagnostic Criteria for Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Definition and Epidemiological Statistics
Clinical Picture
BOX 23-8 Diagnostic Criteria for Obsessive-Compulsive Personality Disorder
Predisposing Factors
Application of the Nursing Process
Borderline Personality Disorder (Background Assessment Data)
Clinical Picture
Chronic Depression
BOX 23-9 Diagnostic Criteria for Borderline Personality Disorder
Inability to Be Alone
Patterns of Interaction
Clinging and Distancing
Splitting
Manipulation
Self-Destructive Behaviors
Impulsivity
Predisposing Factors to Borderline Personality Disorder
Biological Influences
Biochemical.
Genetic.
Psychosocial Influences
Childhood Trauma.
Developmental Factors
Theory of Object Relations.
Diagnosis/Outcome Identification
Outcome Criteria
Planning/Implementation
TABLE 23-2 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Borderline Personality Disorder
TABLE 23-3 | CARE PLAN FOR THE CLIENT WITH BORDERLINE PERSONALITY DISORDER
Concept Care Mapping
Evaluation
FIGURE 23-1 Concept map care plan for a client with borderline personality disorder.
Antisocial Personality Disorder (Background Assessment Data)
Clinical Picture
BOX 23-10 Diagnostic Criteria for Antisocial Personality Disorder
Predisposing Factors to Antisocial Personality Disorder
Biological Influences
Family Dynamics
Diagnosis/Outcome Identification
Outcome Criteria
Planning/Implementation
Concept Care Mapping
TABLE 23-4 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Antisocial Personality Disorder
TABLE 23-5 | CARE PLAN FOR THE CLIENT WITH ANTISOCIAL PERSONALITY DISORDER
Evaluation
FIGURE 23-2 Concept map care plan for a client with antisocial personality disorder.
Treatment Modalities
Interpersonal Psychotherapy
Psychoanalytical Psychotherapy
Milieu or Group Therapy
Cognitive/Behavioral Therapy
Dialectical Behavior Therapy
Psychopharmacology
CASE STUDY AND SAMPLE CARE PLAN
NURSING HISTORY AND ASSESSMENT
NURSING DIAGNOSES/OUTCOME IDENTIFICATION
PLANNING/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
Communication Exercises
MOVIE CONNECTIONS
INTERNET REFERENCES
UNIT 4 Psychiatric Mental Health Nursing of Special Populations
CHAPTER 24 Children and Adolescents
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Neurodevelopmental Disorders
Intellectual Disability (Intellectual Developmental Disorder)
Predisposing Factors
Genetic Factors
BOX 24-1 Diagnostic Criteria for Intellectual Disability (Intellectual Developmental Disorder)
Disruptions in Embryonic Development
Pregnancy and Perinatal Factors
General Medical Conditions Acquired in Infancy or Childhood
Sociocultural Factors and Other Mental Disorders
Application of the Nursing Process to Intellectual Disability
Background Assessment Data (Symptomatology)
Nursing Diagnosis
TABLE 24-1 Developmental Characteristics of Intellectual Disability by Degree of Severity
Outcome Identification
Planning/Implementation
TABLE 24-2 CARE PLAN FOR THE CHILD WITH INTELLECTUAL DISABILITY
Evaluation
CORE CONCEPT
Autism Spectrum Disorder
Clinical Findings
Epidemiology and Course
Predisposing Factors
Neurological Implications
Physiological Implications
Genetics
Perinatal Influences
Application of the Nursing Process to Autism Spectrum Disorder
Background Assessment Data (Symptomatology)
Impairment in Social Interaction.
Impairment in Communication and Imaginative Activity.
Restricted Activities and Interests.
Nursing Diagnosis
BOX 24-2 Diagnostic Criteria for Autism Spectrum Disorder
Outcome Identification
Planning/Implementation
Evaluation
TABLE 24-3 ## CARE PLAN FOR THE CHILD WITH AUTISM SPECTRUM DISORDER
Psychopharmacological Intervention for ASD
CORE CONCEPT
Attention-Deficit/Hyperactivity Disorder
Clinical Findings, Epidemiology, and Course
CORE CONCEPT
Predisposing Factors
Biological Influences
Genetics.
Biochemical Theory.
Anatomical Influences.
Prenatal, Perinatal, and Postnatal Factors.
FIGURE 24-1 Neurobiology of attention-deficit/hyperactivity disorder.
Environmental Influences
Environmental Lead.
Diet Factors.
Psychosocial Influences
Application of the Nursing Process to ADHD
Background Assessment Data (Symptomatology)
Comorbidity.
BOX 24-3 Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder
Nursing Diagnosis
TABLE 24-4 Type and Frequency of Comorbidity With Attention-Deficit/Hyperactivity Disorder
Outcome Identification
Planning/Implementation
Concept Care Mapping
TABLE 24-5 CARE PLAN FOR THE CHILD WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Evaluation
Psychopharmacological Intervention for ADHD
Indications
Action
Contraindications/Precautions
FIGURE 24-2 Concept map care plan for a client with attention-deficit/hyperactivity disorder.
TABLE 24-6 Medications for Attention-Deficit/Hyperactivity Disorder
Interactions
CNS Stimulants (Amphetamines).
Dexmethylphenidate and Methylphenidate.
Atomoxetine.
Bupropion.
Alpha Agonists.
Side Effects
Tourette’s Disorder
Clinical Findings, Epidemiology, and Course
Predisposing Factors
Biological Factors
Genetics.
Biochemical Factors.
Structural Factors.
Environmental Factors
Application of the Nursing Process to Tourette’s Disorder
Background Assessment Data (Symptomatology)
Nursing Diagnosis
BOX 24-4 Diagnostic Criteria for Tourette’s Disorder
Outcome Identification
Planning/Implementation
Evaluation
TABLE 24-7 CARE PLAN FOR THE CHILD OR ADOLESCENT WITH TOURETTE’S DISORDER
Psychopharmacological Intervention for Tourette’s Disorder
Antipsychotics
Alpha Agonists
Disruptive Behavior Disorders
Oppositional Defiant Disorder
Clinical Findings, Epidemiology, and Course
Predisposing Factors
Biological Influences
Family Influences
Application of the Nursing Process to ODD
Background Assessment Data (Symptomatology)
Nursing Diagnosis
BOX 24-5 DIAGNOSTIC CRITERIA FOR OPPOSITIONAL DEFIANT DISORDER
Outcome Identification
Planning/Implementation
Evaluation
TABLE 24-8 ## CARE PLAN FOR THE CHILD/ADOLESCENT WITH OPPOSITIONAL DEFIANT DISORDER
Conduct Disorder
Clinical Findings, Epidemiology, and Course
CORE CONCEPT
Predisposing Factors
Biological Influences
Genetics.
Temperament.
Biochemical Factors.
Psychosocial Influences
Peer Relationships.
Family Influences
Application of the Nursing Process to Conduct Disorder
Background Assessment Data (Symptomatology)
BOX 24-6 Diagnostic Criteria for Conduct Disorder
Nursing Diagnosis
Outcome Identification
Planning/Implementation
Evaluation
TABLE 24-9 ## CARE PLAN FOR CHILD/ADOLESCENT WITH CONDUCT DISORDER
Anxiety Disorders
Separation Anxiety Disorder
Clinical Findings, Epidemiology, and Course
Predisposing Factors
Biological Influences
Genetics.
Temperament.
Environmental Influences
Stressful Life Events.
Family Influences
Application of the Nursing Process to Separation Anxiety Disorder
Background Assessment Data (Symptomatology)
BOX 24-7 Diagnostic Criteria for Separation Anxiety Disorder
Nursing Diagnosis
Outcome Identification
Planning/Implementation
TABLE 24-10 CARE PLAN FOR THE CLIENT WITH SEPARATION ANXIETY DISORDER
Evaluation
Quality and Safety Education for Nurses (QSEN)
General Therapeutic Approaches
Behavior Therapy
BOX 24-8 QSEN TEACHING STRATEGY
Family Therapy
BOX 24-9 Behavior Therapy—A Case Study
Group Therapy
Psychopharmacology
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 25 Survivors of Abuse or Neglect
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
Predisposing Factors
Biological Theories
Neurophysiological Influences
Biochemical Influences
Genetic Influences
Disorders of the Brain
Psychological Theories
Psychodynamic Theory
FIGURE 25-1 Neurobiology of violence.
Learning Theory
Sociocultural Theories
Societal Influences
Application of the Nursing Process
Background Assessment Data
Intimate Partner Violence
CORE CONCEPT
Profile of the Victim
Profile of the Victimizer
The Cycle of Battering
Phase I. The Tension-Building Phase.
FIGURE 25-2 The cycle of battering.
Phase II. The Acute Battering Incident.
Phase III. Calm, Loving, Respite (“Honeymoon”) Phase.
Why Does She Stay?
Child Abuse
Physical Abuse
Signs of Physical Abuse.
Emotional Abuse
Physical and Emotional Neglect
CORE CONCEPT
Indicators of Neglect.
Sexual Abuse of a Child
CORE CONCEPT
Indicators of Sexual Abuse.
Characteristics of the Abuser
The Incestuous Relationship
The Adult Survivor of Incest
BOX 25-1 Factors and Characteristics That Place a Child at Risk for Maltreatment
Sexual Assault
CORE CONCEPT
Profile of the Victimizer
The Victim
Diagnosis/Outcome Identification
Outcome Criteria
The Client Who Has Been Sexually Assaulted:
The Client Who Has Been Physically Battered:
The Child Who Has Been Abused:
Planning/Implementation
Concept Care Mapping
TABLE 25-1 CARE PLAN FOR SURVIVORS OF ABUSE
Evaluation
FIGURE 25-3 Concept map care plan for clients who are victims of abuse.
Treatment Modalities
Crisis Intervention
The Safe House or Shelter
Family Therapy
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
Communication Exercises
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 26 The Aging Individual
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
How Old is Old?
Epidemiological Statistics
The Population
Marital Status
Living Arrangements
Economic Status
FIGURE 26-1 Living arrangements of noninstitutionalized persons age 65 or older
Employment
Health Status
Theories of Aging*
Biological Theories
Genetic Theory
Wear-and-Tear Theory
Environmental Theory
Immunity Theory
Neuroendocrine Theory
Psychosocial Theories
Personality Theory
Developmental Task Theory
Disengagement Theory
Activity Theory
Continuity Theory
The Normal Aging Process
Biological Aspects of Aging
Skin
Cardiovascular System
Respiratory System
Musculoskeletal System
Gastrointestinal System
Endocrine System
Genitourinary System
Immune System
Nervous System
Sensory Systems
Vision
Hearing
Taste and Smell
Touch and Pain
Psychological Aspects of Aging
Memory Functioning
Intellectual Functioning
Learning Ability
Adaptation to the Tasks of Aging
Loss and Grief
Attachment to Others
Maintenance of Self-Identity
Dealing With Death
Psychiatric Disorders in Later Life
Neurocognitive Disorder
Delirium
Depression
Schizophrenia
Anxiety Disorders
Personality Disorders
Sleep Disorders
Sociocultural Aspects of Aging
Sexual Aspects of Aging
Physical Changes Associated With Sexuality
Changes in Women
Changes in Men
Sexual Behavior in the Elderly
Special Concerns of the Elderly Population
Retirement
TABLE 26-1 Sexuality at Midlife and Beyond
Social Implications
Economic Implications
Long-Term Care
Risk Factors for Institutionalization
Age
Health
Mental Health Status
Socioeconomic and Demographic Factors
Marital Status, Living Arrangement, and the Informal Support Network
Attitudinal Factors
Elder Abuse
BOX 26-1 Examples of Elder Abuse
Factors That Contribute to Abuse
Longer Life
Dependency
Stress
Learned Violence
Identifying Elder Abuse
Suicide
Application of the Nursing Process
Assessment
Diagnosis/Outcome Identification
Physiologically Related Diagnoses
Psychosocially Related Diagnoses
Outcome Criteria
Planning/Implementation
TABLE 26-2 | CARE PLAN FOR THE ELDERLY CLIENT
BOX 26-2 Reminiscence Therapy and Life Review With the Elderly
Evaluation
Summary and Key Points
What Do You See, Nurse?
Review Questions Self-Examination/Learning Exercise
TEST YOUR CRITICAL THINKING SKILLS
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
MOVIE CONNECTIONS
INTERNET REFERENCES
CHAPTER 27 Community Mental Health Nursing
CORE CONCEPT
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
The Changing Focus of Care
The Public Health Model
CORE CONCEPT
CORE CONCEPT
CORE CONCEPT
The Community as Client
Primary Prevention
CORE CONCEPT
Populations at Risk
Maturational Crises
Adolescence.
Marriage.
Parenthood.
Midlife.
Retirement.
Situational Crises
Poverty.
High Rate of Life Change Events.
Environmental Conditions.
Trauma.
Secondary Prevention
Populations at Risk
Maturational Crises
Adolescence.
TABLE 27-1 Client Education for Primary Prevention: Drugs of Abuse
Marriage.
Parenthood.
Midlife.
Retirement.
Situational Crises
Tertiary Prevention
Individuals With Severe and Persistent Mental Illness
Historical and Epidemiological Aspects
BOX 27-1 Secondary Prevention Case Study: Parenthood
Treatment Alternatives
Community Mental Health Centers.
Program of Assertive Community Treatment (PACT).
BOX 27-2 Nursing Case Management in the Community Mental Health Center: A Case Study
Day-Evening Treatment/Partial Hospitalization Programs.
Community Residential Facilities.
Psychiatric Home Health Care.
BOX 27-3 CMS Guidelines for Psychiatric Home Nursing Care
BOX 27-4 Psychiatric Home Health Care and the Nursing Process: A Case Study
TABLE 27-2 | CARE PLAN FOR PSYCHIATRIC HOME HEALTH CARE OF DEPRESSED ELDERLY (MRS. C.)
Care for the Caregivers.
The Homeless Population
Historical and Epidemiological Aspects
TABLE 27-3 | CARE PLAN FOR PRIMARY CAREGIVER OF CLIENT WITH SEVERE AND PERSISTENT MENTAL ILLNESS
Who Are the Homeless?
Age.
Gender.
Families.
Ethnicity.
Mental Illness and Homelessness
Types of Mental Illness Among the Homeless.
Contributing Factors to Homelessness Among Individuals With Mental Illness
Deinstitutionalization.
Poverty.
A Scarcity of Affordable Housing.
Other Factors.
Community Resources for the Homeless
Interfering Factors.
Health Issues.
Types of Resources Available
Homeless Shelters.
Health-Care Centers and Storefront Clinics.
Mobile Outreach Units.
The Homeless Client and the Nursing Process
BOX 27-5 CASE STUDY: NURSING PROCESS WITH A HOMELESS CLIENT
ASSESSMENT
DIAGNOSIS/OUTCOME IDENTIFICATION
PLAN/IMPLEMENTATION
EVALUATION
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
CHAPTER 28 The Bereaved Individual
CORE CONCEPTS
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
CORE CONCEPT
CORE CONCEPT
Theoretical Perspectives on Loss and Bereavement
Stages of Grief
Elisabeth Kübler-Ross
TABLE 28-1 Stages and Tasks of the Normal Grief Response: A Comparison of Models by Elisabeth Kübler-Ross, John Bowlby, George Engel, and William Worden
John Bowlby
George Engel
J. William Worden
Length of the Grief Process
Anticipatory Grief
Maladaptive Responses to Loss
Delayed or Inhibited Grief
Distorted (Exaggerated) Grief Response
Chronic or Prolonged Grieving
Normal versus Maladaptive Grieving
TABLE 28-2 Normal Grief Reactions versus Symptoms of Clinical Depression
Application of the Nursing Process
Background Assessment Data: Concepts of Death—Developmental Issues
Children
Birth to Age 2
Ages 3 to 5
Ages 6 to 9
Ages 10 to 12
Adolescents
Adults
Older Adults
Background Assessment Data: Concepts of Death—Cultural Issues
BOX 28-1 Guidelines for Assessing Culturally Specific Death Rituals
African Americans
Asian Americans
Chinese Americans
Japanese Americans
Vietnamese Americans
Filipino Americans
Jewish Americans
Mexican Americans
Native Americans
Nursing Diagnosis/Outcome Identification
Planning/Implementation
Evaluation
TABLE 28-3 | CARE PLAN FOR THE GRIEVING PERSON
Additional Assistance
Hospice
BOX 28-2 Principles of Care—National Hospice and Palliative Care Organization
Interdisciplinary Team
Nurses
Attendants
Physicians
Social Workers
Trained Volunteers
Rehabilitation Therapists
Dietitian
Counseling Services
Pain and Symptom Management
Emotional Support
Pastoral and Spiritual Care
Bereavement Counseling
Twenty-Four-Hour On-Call
Staff Support
Advance Directives
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
Classical References
IMPLICATIONS OF RESEARCH FOR EVIDENCED-BASED PRACTICE
IMPLICATIONS OF RESEARCH FOR EVIDENCE-BASED PRACTICE
INTERNET REFERENCES
CHAPTER 29 Military Families
KEY TERMS
OBJECTIVES
HOMEWORK ASSIGNMENT
Introduction
Historical Aspects
Epidemiological Statistics
Application of the Nursing Process
Assessment
The Military Family
Military Spouses and Children
The Impact of Deployment
Predeployment.
Deployment.
Sustainment.
Redeployment.
Postdeployment.
Women in the Military
Special Concerns of Women in the Military
Sexual Harassment.
Sexual Assault.
Differential treatment and conditions.
FIGURE 29-1 Percentage of veterans according to period of service.
Parenting Issues.
Veterans
Traumatic Brain Injury
TABLE 29-1 Criteria and Symptomatology of Traumatic Brain Injury According to Level of Severity
Posttraumatic Stress Disorder
Depression and Suicide
Substance Use Disorder
Diagnosis/Outcome Identification
Planning/Implementation/Evaluation
TABLE 29-2 Nursing Diagnoses: Planning Care for Military Families
Treatment Modalities
Posttraumatic Stress Disorder
Psychosocial Therapies.
Psychopharmacology.
TABLE 29-3 Nursing Interventions for Veteran Clients and Military Families
Complementary Therapies.
Traumatic Brain Injury
Psychosocial Therapies.
Rehabilitation Therapies.
Psychopharmacology.
Summary and Key Points
Review Questions Self-Examination/Learning Exercise
References
MOVIE CONNECTIONS
INTERNET REFERENCES
Back Matter
Appendix A NANDA Nursing Diagnoses: Taxonomy II
Domains, Classes, and Diagnoses
Domain 1: Health Promotion
Domain 2: Nutrition
Domain 3: Elimination and Exchange
Domain 4: Activity/Rest
Domain 5: Perception/Cognition
Domain 6: Self-Perception
Domain 7: Role Relationships
Domain 8: Sexuality
Domain 9: Coping/Stress Tolerance
Domain 10: Life Principles
Domain 11: Safety/Protection
Domain 12: Comfort
Domain 13: Growth/Development
Appendix B Assigning Nursing Diagnoses to Client Behaviors
Behaviors
NANDA Nursing Diagnoses
Appendix C Mental Status Assessment
Identifying Data
General Description
Appearance
Motor Activity
Speech Patterns
General Attitude
Emotions
Mood
Affect
Thought Processes
Form of Thought
Content of Thought
Perceptual Disturbances
Sensorium and Cognitive Ability
Impulse Control
Judgment and Insight
Appendix D Glossary
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Y
Appendix E Answers to Review Questions
Appendix F Examples of Answers to Communication Exercises
Appendix G DSM-5 Classification: Categories and Codes*
Neurodevelopmental Disorders
Intellectual Disabilities
Communication Disorders
Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Specific Learning Disorder
Motor Disorders
Tic Disorders
Other Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom and Related Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders
Breathing-Related Sleep Disorders
Parasomnias
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse-Control, and Conduct Disorders
Substance-Related and Addictive Disorders
Substance-Related Disorders
Alcohol-Related Disorders
Caffeine-Related Disorders
Cannabis-Related Disorders
Hallucinogen-Related Disorders
Inhalant-Related Disorders
Opioid-Related Disorders
Sedative-, Hypnotic-, or Anxiolytic-Related Disorders
Tobacco-Related Disorders
Other (or Unknown) Substance-Related Disorders
Non-Substance-Related Disorders
Neurocognitive Disorders
Major and Mild Neurocognitive Disorders
Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease
Major or Mild Frontotemporal Neurocognitive Disorder
Major or Mild Neurocognitive Disorder With Lewy Bodies
Major or Mild Vascular Neurocognitive Disorder
Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury
Substance/Medication-Induced Major or Mild Neurocognitive Disordera
Major or Mild Neurocognitive Disorder Due to HIV Infection
Major or Mild Neurocognitive Disorder Due to Prion Disease
Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease
Major or Mild Neurocognitive Disorder Due to Huntington’s Disease
Major or Mild Neurocognitive Disorder Due to Another Medical Condition
Major or Mild Neurocognitive Disorder Due to Multiple Etiologies
Unspecified Neurocognitive Disorder
Personality Disorders
Cluster A Personality Disorders
Cluster B Personality Disorders
Cluster C Personality Disorders
Other Personality Disorders
Paraphilic Disorders
Other Mental Disorders
Medication-Induced Movement Disorders and Other Adverse Effects of Medication
Other Conditions That May Be a Focus of Clinical Attention
Relational Problems
Problems Related to Family Upbringing
Other Problems Related to Primary Support Group
Abuse and Neglect
Child Maltreatment and Neglect Problems
Child Physical Abuse, Confirmed
Child Physical Abuse, Suspected
Other Circumstances Related to Child Physical Abuse
Child Sexual Abuse, Confirmed
Child Sexual Abuse, Suspected
Other Circumstances Related to Child Sexual Abuse
Child Neglect, Confirmed
Child Neglect, Suspected
Other Circumstances Related to Child Neglect
Child Psychological Abuse, Confirmed
Child Psychological Abuse, Suspected
Other Circumstances Related to Child Psychological Abuse
Adult Maltreatment and Neglect Problems
Spouse or Partner Violence, Physical, Confirmed
Spouse or Partner Violence, Physical, Suspected
Other Circumstances Related to Spouse or Partner Violence, Physical
Spouse or Partner Violence, Sexual, Confirmed
Spouse or Partner Violence, Sexual, Suspected
Other Circumstances Related to Spouse or Partner Violence, Sexual
Spouse or Partner Neglect, Confirmed
Spouse or Partner Neglect, Suspected
Other Circumstances Related to Spouse or Partner Neglect
Spouse or Partner Abuse, Psychological, Confirmed
Spouse or Partner Abuse, Psychological, Suspected
Other Circumstances Related to Spouse or Partner Abuse, Psychological
Adult Physical Abuse by Nonspouse or Nonpartner, Confirmed
Adult Physical Abuse by Nonspouse or Nonpartner, Suspected
Adult Sexual Abuse by Nonspouse or Nonpartner, Confirmed
Adult Sexual Abuse by Nonspouse or Nonpartner, Suspected
Adult Psychological Abuse by Nonspouse or Nonpartner, Confirmed
Adult Psychological Abuse by Nonspouse or Nonpartner, Suspected
Other Circumstances Related to Adult Abuse by Nonspouse or Nonpartner
Educational and Occupational Problems
Educational Problems
Occupational Problems
Housing and Economic Problems
Housing Problems
Economic Problems
Other Problems Related to the Social Environment
Problems Related to Crime or Interaction With the Legal System
Other Health Service Encounters for Counseling and Medical Advice
Problems Related to Other Psychosocial, Personal, and Environmental Circumstances
Other Circumstances of Personal History
Problems Related to Access to Medical and Other Health Care
Nonadherence to Medical Treatment
Index

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