Psychiatric mental health nursing : concepts of care in evidence-based practice / Mary C. Townsend.

By: Townsend, Mary C, 1941-
Material type: TextTextPublisher: Philadelphia : F.A. Davis, c2009Edition: 6th editionDescription: xxix, 896 p. : col. ill. ; 28 cm. + 1 CD-ROM (4 3/4 in.)ISBN: 9780803619173; 0803619170Subject(s): Psychiatric nursing | Psychiatric Nursing -- methods | Evidence-Based Medicine | Mental Disorders -- nursing | Psychotherapy -- methodsDDC classification: 616.890231 Online resources: Table of contents only
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Contents

UNIT ONE
BASIC CONCEPTS IN PSYCHIATRIC/MENTAL HEALTH NURSING
Chapter 1
The Concept of Stress Adaptation 2
STRESS AS A BIOLOGICAL RESPONSE 3
STRESS AS AN ENVIRONMENTAL EVENT 5
STRESS AS A TRANSACTION BETWEEN THE INDIVIDUAL AND THE
ENVIRONMENT 5
Precipitating Event 5
The Individual's Perception of the Event 5
Predisposing Factors 6
STRESS MANAGEMENT 7
Adaptive Coping Strategies 7
SUMMARY AND KEY POINTS 8
REVIEW QUESTIONS 9

REFERENCES 10
CLASSICAL REFERENCES 10
Chapter 2
Mental Health/ Mental Illness: Historical and Theoretical Concepts 11
HISTORICAL OVERVIEW OF PSYCHIATRIC CARE 12

MENTAL HEALTH 13
MENTAL ILLNESS 14
PSYCHOLOGICAL ADAPTATION TO STRESS 15
Anxiety 15
Behavioral Adaptation Responses to Anxiety 17
Grief 20

MENTAL HEALTH/MENTAL ILLNESS CONTINUUM 22

THE DSM-IV-TR MULTIAXIAL EVALUATION SYSTEM 23
SUMMARY AND KEY POINTS 24
REVIEW QUESTIONS 25
REFERENCES 27
CLASSICAL REFERENCES 27

UNIT TWO
FOUNDATIONS FOR PSYCHIATRIC/MENTAL HEALH NURSING
Chapter 3
Theoretical Models of Personality Development 30
PSYCHOANALYTIC THEORY 31
Structure of the Personality 31
Topography of the Mind 31
Dynamics of the Personality 32
Freud's Stages of Personality Development 32
Relevance of Psychoanalytic Theory to Nursing Practice 34
INTERPERSONAL THEORY 34
Sullivan's Stages of Personality Development 34
Relevance of Interpersonal Theory to Nursing Practice 35
THEORY OF PSYCHOSOCIAL DEVELOPMENT 35
Erikson's Stages of Personality Development 35
Relevance of Psychosocial Development Theory to Nursing Practice 38
THEORY OF OBJECT RELATIONS 38
Phase I: The Autistic Phase (Birth to 1 Month) 38
Phase II: The Symbiotic Phase (1 to 5 Months) 38
Phase III: Separation-Individuation (5 to 36 months) 39

COGNITIVE DEVELOPMENT THEORY 39
Stage 1: Sensorimotor (Birth to 2 Years) 39
Stage 2: Preoperational (2 to 6 Years) 40
Stage 3: Concrete Operations (6 to 12 Years) 40
Stage 4: Formal Operations (12 to 15+ Years) 40
Relevance of Cognitive Development Theory to Nursing Practice 40
THEORY OF MORAL DEVELOPMENT 40
Level I: Preconventional Level (Prominent from Ages 4 to 10 Years) 41
Level II: Conventional Level (Prominent from Ages 10 to 13 Years and into
Adulthood) 41
Level III: Postconventional Level (Can Occur from Adolescence Onward) 41
Relevance of Moral Development Theory to Nursing Practice 42
A NURSING MODEL-HILDEGARD E. PEPLAU 42
Peplau's Stages of Personality Development 42
Relevance of Peplau's Model to Nursing Practice 44
SUMMARY AND KEY POINTS 45
REVIEW QUESTIONS 46
REFERENCES 47
CLASSICAL REFERENCES 47

Chapter 4
Concepts of Psychobiology 48
THE NERVOUS SYSTEM: AN ANATOMICAL REVIEW 49
The Brain 49
Nerve Tissue 53
Autonomic Nervous System 53
Neurotransmitters 55

NEUROENDOCRINOLOGY 60
Pituitary Gland 60
Circadian Rhythms 63
Sleep 64
GENETICS 66
PSYCHOIMMUNOLOGY 66
Normal Immune Response 66
IMPLICATIONS FOR NURSING 68
SUMMARY AND KEY POINTS 69
REVIEW QUESTIONS 70
REFERENCES 71

Chapter 5
Ethical and Legal Issues in Psychiatric/ Mental Health Nursing 72
ETHICAL CONSIDERATIONS 73
Theoretical Perspectives 73
Ethical Dilemmas 74
Ethical Principles 74
A Model for Making Ethical Decisions 75
Ethical Issues in Psychiatric/Mental Health Nursing 76
LEGAL CONSIDERATIONS 76
Nurse Practice Acts 77
Types of Law 78
Classifications Within Statutory and Common Law 78
Legal Issues in Psychiatric/Mental Health Nursing 78
Commitment Issues 81
Nursing Liability 82

SUMMARY AND KEY POINTS 83
REVIEW QUESTIONS 85
REFERENCES 86

Chapter 6
Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health
Nursing 87
CULTURAL CONCEPTS 88

HOW DO CULTURES DIFFER? 88
Communication 88
Space 89
Social Organization 89
Time 89
Environmental Control 89
Biological Variations 89
APPLICATION OF THE NURSING PROCESS 90
Background Assessment Data 90
Culture-Bound Syndromes 99
Diagnosis/Outcome Identification 99
Planning/Implementation 99
Evaluation 101
SPIRITUAL CONCEPTS 101
Spiritual Needs 101
Assessment of Spiritual and Religious Needs 103
Diagnoses/Outcome Identification/Evaluation 105
Planning/Implementation 105
Evaluation 105
SUMMARY AND KEY POINTS 107
REVIEW QUESTIONS 109
REFERENCES 110
CLASSICAL REFERENCES 111

UNIT THREE
THERAPEUTIC APPROACHES IN PSYCHIATRIC NURSING CARE
Chapter 7
Relationship Development 114
ROLE OF THE PSYCHIATRIC NURSE 115

DYNAMICS OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP 116
Therapeutic Use of Self 116
Gaining Self-Awareness 116
The Johari Window 117

CONDITIONS ESSENTIAL TO DEVELOPMENT OF A THERAPEUTIC
RELATIONSHIP 119
Rapport 119
Trust 119
Respect 119
Genuineness 120
Empathy 120

PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP 121
The Preinteraction Phase 121
The Orientation (Introductory) Phase 121
The Working Phase 121
The Termination Phase 122
BOUNDARIES IN THE NURSE-CLIENT RELATIONSHIP 123

SUMMARY AND KEY POINTS 124
REVIEW QUESTIONS 125
REFERENCES 126
CLASSICAL REFERENCES 126

Chapter 8
Therapeutic Communication 127
WHAT IS COMMUNICATION? 128
THE IMPACT OF PREEXISTING CONDITIONS 128
Values, Attitudes, and Beliefs 128
Culture or Religion 128
Social Status 129
Gender 129
Age or Developmental Level 129
Environment in Which the Transaction Takes Place 129

NONVERBAL COMMUNICATION 130
Physical Appearance and Dress 130
Body Movement and Posture 130
Touch 130
Facial Expressions 131
Eye Behavior 131
Vocal Cues, or Paralanguage 131
THERAPEUTIC COMMUNICATION TECHNIQUES 132

NONTHERAPEUTIC COMMUNICATION TECHNIQUES 132
ACTIVE LISTENING 135
PROCESS RECORDINGS 135
FEEDBACK 135
SUMMARY AND KEY POINTS 137
REVIEW QUESTIONS 138

REFERENCES 139
CLASSICAL REFERENCES 139

Chapter 9
The Nursing Process in Psychiatric/Mental Health Nursing 140
THE NURSING PROCESS 141
Definition 141
Standards of Practice 141

WHY NURSING DIAGNOSIS? 149

NURSING CASE MANAGEMENT 149
Critical Pathways of Care 151
APPLYING THE NURSING PROCESS IN THE PSYCHIATRIC SETTING 151
CONCEPT MAPPING 153
DOCUMENTATION OF THE NURSING PROCESS 155
Problem-Oriented Recording 155
Focus Charting 156
The PIE Method 156
Electronic Documentation 157

SUMMARY AND KEY POINTS 158
REVIEW QUESTIONS 160

REFERENCES 160
Chapter 10
Therapeutic Groups 161
FUNCTIONS OF A GROUP 162

TYPES OF GROUPS 162
Task Groups 162
Teaching Groups 162
Supportive/Therapeutic Groups 162
Self-Help Groups 163

PHYSICAL CONDITIONS THAT INFLUENCE GROUP DYNAMICS 163
Seating 163
Size 163
Membership 163

CURATIVE FACTORS 164
PHASES OF GROUP DEVELOPMENT 164
Phase I. Initial or Orientation Phase 164
Phase II. Middle or Working Phase 164
Phase III. Final or Termination Phase 165
LEADERSHIP STYLES 165
Autocratic 165
Democratic 165
Laissez-Faire 165
MEMBER ROLES 166

PSYCHODRAMA 167
THE ROLE OF THE NURSE IN GROUP THERAPY 167
SUMMARY AND KEY POINTS 167
REVIEW QUESTIONS 169

REFERENCES 171
CLASSICAL REFERENCES 171
Chapter 11
Intervention with Families 172
STAGES OF FAMILY DEVELOPMENT 173
Stage I. The Single Young Adult 173
Stage II. The Newly Married Couple 173
Stage III. The Family with Young Children 173
Stage IV. The Family with Adolescents 173
Stage V. The Family Launching Grown Children 174
Stage VI. The Family in Later Life 175
MAJOR VARIATIONS 175
Divorce 175
Remarriage 175
Cultural Variations 175
FAMILY FUNCTIONING 176
Communication 177
Self-Concept Reinforcement 178
Family Members' Expectations 178
Handling Differences 179
Family Interactional Patterns 180
Family Climate 180
THERAPEUTIC MODALITIES WITH FAMILIES 181
The Family as a System 181
The Structural Model 183
The Strategic Model 184
The Evolution of Family Therapy 186
THE NURSING PROCESS-A CASE STUDY 187
Assessment 187
Diagnosis 190
Outcome Identification 190
Planning/Implementation 190
Evaluation 191

SUMMARY AND KEY POINTS 191
REVIEW QUESTIONS 193

REFERENCES 194
CLASSICAL REFERENCES 194
Chapter 12
Milieu Therapy-The Therapeutic Community 195
MILIEU, DEFINED 195

CURRENT STATUS OF THE THERAPEUTIC COMMUNITY 196
BASIC ASSUMPTIONS 196

CONDITIONS THAT PROMOTE A THERAPEUTIC COMMUNITY 197
THE PROGRAM OF THERAPEUTIC COMMUNITY 198
THE ROLE OF THE NURSE 199
SUMMARY AND KEY POINTS 201
REVIEW QUESTIONS 202

REFERENCES 203
CLASSICAL REFERENCES 203
Chapter 13
Crisis Intervention 204
CHARACTERISTICS OF A CRISIS 205

PHASES IN THE DEVELOPMENT OF A CRISIS 205
TYPES OF CRISES 206
Class 1: Dispositional Crises 206
Class 2: Crises of Anticipated Life Transitions 207
Class 3: Crises Resulting from Traumatic Stress 207
Class 4: Maturational/Developmental Crises 208
Class 5: Crises Reflecting Psychopathology 208
Class 6: Psychiatric Emergencies 208

CRISIS INTERVENTION 209
PHASES OF CRISIS INTERVENTION: THE ROLE OF THE NURSE 209
Phase 1. Assessment 209
Phase 2. Planning of Therapeutic Intervention 209
Phase 3. Intervention 210
Phase 4. Evaluation of Crisis Resolution and Anticipatory Planning 211

DISASTER NURSING 211

APPLICATION OF THE NURSING PROCESS TO DISASTER NURSING 211
Background Assessment Data 211
Nursing Diagnoses/Outcome Identification 211
Planning/Implementation 212
Evaluation 212
SUMMARY AND KEY POINTS 217
REVIEW QUESTIONS 218

REFERENCES 219
CLASSICAL REFERENCES 219
Chapter 14
Relaxation Therapy 220
THE STRESS EPIDEMIC 220
PHYSIOLOGICAL, COGNITIVE, AND BEHAVIORAL MANIFESTATIONS OF RELAXATION
221
METHODS OF ACHIEVING RELAXATION 223
Deep Breathing Exercises 223
Progressive Relaxation 223
Modified (or Passive) Progressive Relaxation 224
Meditation 225
Mental Imagery 225
Biofeedback 226
Physical Exercise 226

THE ROLE OF THE NURSE IN RELAXATION THERAPY 226
Assessment 227
Diagnosis 227
Outcome Identification/Implementation 227
Evaluation 228
SUMMARY AND KEY POINTS 228
REVIEW QUESTIONS 229

REFERENCES 229

Chapter 15
Assertiveness Training 230
ASSERTIVE COMMUNICATION 231
BASIC HUMAN RIGHTS 231
RESPONSE PATTERNS 231
Nonassertive Behavior 231
Assertive Behavior 232
Aggressive Behavior 232
Passive-Aggressive Behavior 232

BEHAVIORAL COMPONENTS OF ASSERTIVE BEHAVIOR 232

TECHNIQUES THAT PROMOTE ASSERTIVE BEHAVIOR 233
THOUGHT-STOPPING TECHNIQUES 234
Method 235
ROLE OF THE NURSE 235
Assessment 235
Diagnosis 236
Outcome Identification/Implementation 236
Evaluation 238
SUMMARY AND KEY POINTS 238
REVIEW QUESTIONS 239

REFERENCES 240
Chapter 16
Promoting Self-Esteem 241
COMPONENTS OF SELF-CONCEPT 242
Physical Self or Body Image 242
Personal Identity 242
Self -Esteem 242

DEVELOPMENT OF SELF-ESTEEM 242
Developmental Progression of Self-Esteem Through the Life Span 243

MANIFESTATIONS OF LOW SELF-ESTEEM 244
Focal Stimuli 244
Contextual Stimuli 244
Residual Stimuli 245
Symptoms of Low Self-Esteem 245
BOUNDARIES 245
Boundary Pliancy 246
Rigid Boundaries 246
Flexible Boundaries 246
Enmeshed Boundaries 247
Establishing Boundaries 247
THE NURSING PROCESS 247
Assessment 247
Diagnosis/Outcome Identification 247
Outcome Criteria 248
Planning/Implementation 248
Evaluation 250

SUMMARY AND KEY POINTS 250
REVIEW QUESTIONS 252

REFERENCES 253
CLASSICAL REFERENCES 253

Chapter 17
Anger/Aggression Management 254
ANGER AND AGGRESSION, DEFINED 255
PREDISPOSING FACTORS TO ANGER AND AGGRESSION 256
Modeling 256
Operant Conditioning 256
Neurophysiological Disorders 256
Biochemical Factors 256
Socioeconomic Factors 256
Environmental Factors 256

THE NURSING PROCESS 257
Assessment 257
Diagnosis/Outcome Identification 258
Planning/Implementation 258
Evaluation 261

SUMMARY AND KEY POINTS 261
REVIEW QUESTIONS 262

REFERENCES 263
Chapter 18
The Suicidal Client 264
HISTORICAL PERSPECTIVES 264
EPIDEMIOLOGICAL FACTORS 265
RISK FACTORS 265
Marital Status 265
Gender 265
Age 266
Religion 266
Socioeconomic Status 266
Ethnicity 266
Other Risk Factors 266

PREDISPOSING FACTORS: THEORIES OF SUICIDE 267
Psychological Theories 267
Sociological Theory 267
Biological Theories 268

APPLICATION OF THE NURSING PROCESS WITH THE SUICIDAL CLIENT 268
Assessment 268
Diagnosis/Outcome Identification 270
Planning/Implementation 270
Evaluation 275
SUMMARY AND KEY POINTS 275
REVIEW QUESTIONS 276

REFERENCES 277
CLASSICAL REFERENCES 278
Chapter 19
Behavior Therapy 279
CLASSICAL CONDITIONING 280
OPERANT CONDITIONING 281
TECHNIQUES FOR MODIFYING CLIENT BEHAVIOR 281
Shaping 281
Modeling 281
Premack Principle 282
Extinction 282
Contingency Contracting 282
Token Economy 282
Time Out 282
Reciprocal Inhibition 282
Overt Sensitization 283
Covert Sensitization 283
Systematic Desensitization 283
Flooding 283

ROLE OF THE NURSE IN BEHAVIOR THERAPY 283
SUMMARY AND KEY POINTS 285
REVIEW QUESTIONS 287

REFERENCES 288
CLASSICAL REFERENCES 288
Chapter 20
Cognitive Therapy 289
HISTORICAL BACKGROUND 290
INDICATIONS FOR COGNITIVE THERAPY 290
GOALS AND PRINCIPLES OF COGNITIVE THERAPY 290
BASIC CONCEPTS 291
Automatic Thoughts 291
Schemas (Core Beliefs) 292

TECHNIQUES OF COGNITIVE THERAPY 292
Didactic (Educational) Aspects 292
Cognitive Techniques 293
Behavioral Interventions 294

ROLE OF THE NURSE IN COGNITIVE THERAPY 295

SUMMARY AND KEY POINTS 298
REVIEW QUESTIONS 299

REFERENCES 300
CLASSICAL REFERENCES 300

Chapter 21
Psychopharmacology 301
HISTORICAL PERSPECTIVES 302
ROLE OF THE NURSE 302
Ethical and Legal Implications 302
Assessment 302
Medication Administration and Evaluation 302
Client Education 302

HOW DO PSYCHOTROPICS WORK? 304
APPLYING THE NURSING PROCESS IN PSYCHOPHARMACOLOGICAL THERAPY 306
Antianxiety Agents 306
Antidepressants 308
Mood-Stabilizing Agents 315
Antipsychotic Agents 321
Sedative-Hypnotics 327
Agents for Attention Deficit Hyperactivity Disorder (ADHD) 329

SUMMARY AND KEY POINTS 332
REVIEW QUESTIONS 334

REFERENCES 335
Chapter 22
Electroconvulsive Therapy 336
ELECTROCONVULSIVE THERAPY, DEFINED 337
HISTORICAL PERSPECTIVES 337
INDICATIONS 338
Major Depression 338
Mania 338
Schizophrenia 338
Other Conditions 338
CONTRAINDICATIONS 338
MECHANISM OF ACTION 338
SIDE EFFECTS 338
RISKS ASSOCIATED WITH ELECTROCONVULSIVE THERAPY 339
Mortality 339
Permanent Memory Loss 339
Brain Damage 339

THE ROLE OF THE NURSE IN ELECTROCONVULSIVE THERAPY 339
Assessment 339
Diagnosis/Outcome Identification 340
Planning/Implementation 340
Evaluation 341

SUMMARY AND KEY POINTS 341
REVIEW QUESTIONS 342

REFERENCES 343
Chapter 23
Complementary Therapies 344
COMMONALITIES AND CONTRASTS 347
TYPES OF COMPLEMENTARY THERAPIES 347
Herbal Medicine 347
Acupressure and Acupuncture 348
Diet and Nutrition 351
Chiropractic Medicine 355
Therapeutic Touch and Massage 356
Yoga 356
Pet Therapy 357

SUMMARY AND KEY POINTS 358
REVIEW QUESTIONS 359

REFERENCES 359
Chapter 24
Client Education 361
HISTORICAL PERSPECTIVES 362
THEORIES OF TEACHING AND LEARNING 363
Behaviorist Theory 363
Cognitive Theory 363
Humanistic Theory 363

DOMAINS OF LEARNING 364
Affective Domain 364
Cognitive Domain 364
Psychomotor Domain 364

AGE AND DEVELOPMENTAL CONSIDERATIONS 364
The Adult Learner 364
Teaching Children and Adolescents 365
Teaching the Elderly 365

THE NURSING PROCESS IN CLIENT EDUCATION 366
Assessment 366
Nursing Diagnosis 368
Outcome Identification 368
Planning/Implementation 368
Evaluation 370

DOCUMENTATION OF CLIENT EDUCATION 371

SUMMARY AND KEY POINTS 371
REVIEW QUESTIONS 373

REFERENCES 374
CLASSICAL REFERENCES 374

UNIT FOUR
NURSING CARE OF CLIENTS WITH ALTERATIONS IN
PSYCHOSOCIAL ADAPTATION
Chapter 25
Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence 376
MENTAL RETARDATION 377
Predisposing Factors 377
Application of the Nursing Process to Mental Retardation 378

AUTISTIC DISORDER 380
Clinical Findings 380
Epidemiology and Course 380
Predisposing Factors 381
Application of the Nursing Process to Autistic Disorder 381
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 384
Clinical Findings, Epidemiology, and Course 384
Predisposing Factors 385
Application of the Nursing Process to ADHD 387
Psychopharmacological Intervention for ADHD 390

CONDUCT DISORDER 393
Predisposing Factors 394
Application of the Nursing Process to Conduct Disorder 394

OPPOSITIONAL DEFIANT DISORDER 397
Clinical Findings, Epidemiology, and Course 397
Predisposing Factors 397
Application of the Nursing Process to ODD 398

TOURETTE'S DISORDER 401
Clinical Findings, Epidemiology, and Course 401
Predisposing Factors 401
Application of the Nursing Process to Tourette's Disorder 401
Psychopharmacological Intervention for Tourette's Disorder 404

SEPARATION ANXIETY DISORDER 404
Clinical Findings, Epidemiology, and Course 404
Predisposing Factors 404
Application of the Nursing Process to Separation Anxiety Disorder 405
GENERAL THERAPEUTIC APPROACHES 407
Behavior Therapy 407
Family Therapy 408
Group Therapy 408
Psychopharmacology 408

SUMMARY AND KEY POINTS 408
REVIEW QUESTIONS 410

REFERENCES 411
INTERNET REFERENCES 412

Chapter 26
Delirium, Dementia, and Amnestic Disorders 413
DELIRIUM 414
Clinical Findings and Course 414
Predisposing Factors 414
DEMENTIA 415
Clinical Findings, Epidemiology, and Course 415
Predisposing Factors 417

AMNESTIC DISORDERS 422
Predisposing Factors 422
APPLICATION OF THE NURSING PROCESS 422
Assessment 422
Nursing Diagnosis/Outcome Identification 426
Planning/Implementation 427
Concept Care Mapping 430
Client/Family Education 430
Evaluation 432

MEDICAL TREATMENT MODALITIES 432
Delirium 432
Dementia 432

SUMMARY AND KEY POINTS 437
REVIEW QUESTIONS 438

REFERENCES 439
INTERNET REFERENCES 440

Chapter 27
Substance-Related Disorders 441
SUBSTANCE-USE DISORDERS 442
Substance Abuse 442
DSM-IV-TR Criteria for Substance Abuse 442
Substance Dependence 442
DSM-IV-TR Criteria for Substance Dependence 443

SUBSTANCE-INDUCED DISORDERS 443
Substance Intoxication 443
DSM-IV-TR Criteria for Substance Intoxication 443
Substance Withdrawal 443
DSM-IV-TR Criteria for Substance Withdrawal 443

CLASSES OF PSYCHOACTIVE SUBSTANCES 444

PREDISPOSING FACTORS TO SUBSTANCE-RELATED DISORDERS 444
Biological Factors 444
Psychological Factors 444
Sociocultural Factors 444

THE DYNAMICS OF SUBSTANCE-RELATED DISORDERS 445
Alcohol Abuse and Dependence 445
Alcohol Intoxication 449
Alcohol Withdrawal 450
Sedative, Hynotic, or Anxiolytic Abuse and Dependence 450
Sedative, Hypnotic, or Anxiolytic Intoxication 452
Sedative, Hypnotic, or Anxiolytic Withdrawal 452
CNS Stimulant Abuse and Dependence 452
CNS Stimulant Intoxication 455
CNS Stimulant Withdrawal 455
Inhalant Abuse and Dependence 456
Inhalant Intoxication 456
Opioid Abuse and Dependence 456
Opioid Intoxication 458
Opioid Withdrawal 458
Hallucinogen Abuse and Dependence 459
Hallucinogen Intoxication 461
Cannabis Abuse and Dependence 461
Cannabis Intoxication 463

APPLICATION OF THE NURSING PROCESS 463
Assessment 463
Diagnosis/Outcome Identification 470
Planning/Implementation 471
Concept Care Mapping 474
Client/Family Education 474
Evaluation 474

THE CHEMICALLY IMPAIRED NURSE 476

CODEPENDENCY 477
The Codependent Nurse 477
Treating Codependence 478

TREATMENT MODALITIES FOR SUBSTANCE-RELATED DISORDERS 478
Alcoholics Anonymous 478
Pharmacotherapy 478
Counseling 480
Group Therapy 481
Psychopharmacology for Substance Intoxication and Substance Withdrawal
481

SUMMARY AND KEY POINTS 484
REVIEW QUESTIONS 485

REFERENCES 487
CLASSICAL REFERENCES 488
INTERNET REFERENCES 488

Chapter 28
Schizophrenia and Other Psychotic Disorders 489
NATURE OF THE DISORDER 490
Phase I: The Premorbid Phase 490
Phase II: The Prodromal Phase 491
Phase III: Schizophrenia 491
Phase IV: Residual Phase 491
Prognosis 491

PREDISPOSING FACTORS 492
Biological Influences 492
Psychological Influences 494
Environmental Influences 494
Stressful Life Events 494
The Transactional Model 494

TYPES OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS 496
Disorganized Schizophrenia 496
Catatonic Schizophrenia 496
Paranoid Schizophrenia 496
Undifferentiated Schizophrenia 496
Residual Schizophrenia 496
Schizoaffective Disorder 496
Brief Psychotic Disorder 497
Schizophreniform Disorder 497
Delusional Disorder 497
Shared Psychotic Disorder 497
Psychotic Disorder Due to a General Medical Condition 498
Substance-Induced Psychotic Disorder 498

APPLICATION OF THE NURSING PROCESS 498
Background Assessment Data 498
Diagnosis/Outcome Identification 502
Planning/Implementation 503
Concept Care Mapping 506
Client/Family Education 506
Evaluation 506

TREATMENT MODALITIES FOR SCHIZOPHRENIA AND OTHER PSYCHOTIC
DISORDERS 508
Psychological Treatments 508
Social Treatment 509
Organic Treatment 510

SUMMARY AND KEY POINTS 514
REVIEW QUESTIONS 516

REFERENCES 517
INTERNET REFERENCES 518

Chapter 29
Mood Disorders 519

HISTORICAL PERSPECTIVE 520
EPIDEMIOLOGY 520
Gender 521
Age 521
Social Class 521
Race and Culture 521
Marital Status 522
Seasonality 522

TYPES OF MOOD DISORDERS 522
Depressive Disorders 522
Bipolar Disorders 524
Other Mood Disorders 525

DEPRESSIVE DISORDERS 525
Predisposing Factors 525
Developmental Implications 529

APPLICATION OF THE NURSING PROCESS TO DEPRESSIVE DISORDERS 532
Background Assessment Data 532
Diagnosis/Outcome Identification 534
Planning/Implementation 535
Concept Care Mapping 538
Client/Family Education 538
Evaluation of Care for the Depressed Client 538

BIPOLAR DISORDER (MANIA) 540
Predisposing Factors 540
Developmental Implications 542

APPLICATION OF THE NURSING PROCESS TO BIPOLAR DISORDER (MANIA) 543
Background Assessment Data 543
Diagnosis/Outcome Identification 544
Planning/Implementation 545
Concept Care Mapping 547
Client/Family Education 547
Evaluation of Care for the Manic Client 547

TREATMENT MODALITIES FOR MOOD DISORDERS 549
Individual Psychotherapy 549
Group Therapy for Depression and Mania 550
Family Therapy for Depression and Mania 550
Cognitive Therapy for Depression and Mania 550
Electroconvulsive Therapy for Depression and Mania 551
Transcranial Magnetic Stimulation 551
Light Therapy for Depression 551
Psychopharmacology 551

SUMMARY AND KEY POINTS 556
REVIEW QUESTIONS 557

REFERENCES 559
CLASSICAL REFERENCES 560
INTERNET REFERENCES 560

Chapter 30
Anxiety Disorders 561
HISTORICAL ASPECTS 562
EPIDEMIOLOGICAL STATISTICS 562

HOW MUCH IS TOO MUCH? 564
APPLICATION OF THE NURSING PROCESS 564
Panic Disorder 564
Generalized Anxiety Disorder 565
Phobias 566
Obsessive-Compulsive Disorder 571
Posttraumatic Stress Disorder 574
Anxiety Disorder Due to a General Medical Condition 576
Substance-Induced Anxiety Disorder 576
Diagnosis/Outcome Identification 576
Planning/Implementation 578
Concept Care Mapping 580
Client/Family Education 583
Evaluation 583

TREATMENT MODALITIES 583
Individual Psychotherapy 583
Cognitive Therapy 584
Behavior Therapy 584
Group/Family Therapy 585
Psychopharmacology 585

SUMMARY AND KEY POINTS 588
REVIEW QUESTIONS 589

REFERENCES 590
CLASSICAL REFERENCES 591
INTERNET REFERENCES 591

Chapter 31
Somatoform and Dissociative Disorders 592

HISTORICAL ASPECTS 593

EPIDEMIOLOGICAL STATISTICS 593
APPLICATION OF THE NURSING PROCESS 595
Background Assessment Data: Types of Somatoform Disorders 595
Predisposing Factors Associated with Somatoform Disorders 598
Background Assessment Data: Types of Dissociative Disorders 600
Predisposing Factors Associated with Dissociative Disorders 602
Diagnosis/Outcome Identification 604
Planning/Implementation 605
Concept Care Mapping 609
Evaluation 609

TREATMENT MODALITIES 609
Somatoform Disorders 609
Dissociative Amnesia 612
Dissociative Fugue 612
Dissociative Identity Disorder 612
Depersonalization Disorder 613

SUMMARY AND KEY POINTS 614
REVIEW QUESTIONS 616

REFERENCES 617
CLASSICAL REFERENCES 618
INTERNET REFERENCES 618

Chapter 32
Issues Related to Human Sexuality 619
DEVELOPMENT OF HUMAN SEXUALITY 620
Birth Through Age 12 620
Adolescence 620
Adulthood 621

SEXUAL DISORDERS 622
Paraphilias 622
Sexual Dysfunctions 626
Application of the Nursing Process to Sexual Disorders 630
Treatment Modalities for Sexual Dysfunctions 636

VARIATIONS IN SEXUAL ORIENTATION 638
Homosexuality 638
Transsexualism 640
Bisexuality 640

SEXUALLY TRANSMITTED DISEASES 641

SUMMARY AND KEY POINTS 643
REVIEW QUESTIONS 645

REFERENCES 646
CLASSICAL REFERENCES 646
INTERNET REFERENCES 646
Chapter 33
Eating Disorders 647
EPIDEMIOLOGICAL FACTORS 648
APPLICATION OF THE NURSING PROCESS 648
Background Assessment Data (Anorexia Nervosa) 648
Background Assessment Data (Bulimia Nervosa) 649
Background Assessment Data (Obesity) 650
Diagnosis/Outcome Identification 652
Planning/Implementation 652
Concept Care Mapping 657
Client/Family Education 658
Evaluation 658

TREATMENT MODALITIES 659
Behavior Modification 659
Individual Therapy 659
Family Therapy 660
Psychopharmacology 660

SUMMARY AND KEY POINTS 662
REVIEW QUESTIONS 663

REFERENCES 664
INTERNET REFERENCES 665

Chapter 34
Personality Disorders 666

HISTORICAL ASPECTS 668

TYPES OF PERSONALITY DISORDERS 668
Paranoid Personality Disorder 668
Schizoid Personality Disorder 669
Schizotypal Personality Disorder 670
Antisocial Personality Disorder 671
Borderline Personality Disorder 671
Histrionic Personality Disorder 671
Narcissistic Personality Disorder 672
Avoidant Personality Disorder 673
Dependent Personality Disorder 674
Obsessive-Compulsive Personality Disorder 675
Passive-Aggressive Personality Disorder 676

APPLICATION OF THE NURSING PROCESS 676
Borderline Personality Disorder (Background Assessment Data) 676
Predisposing Factors to Borderline Personality Disorder 678
Diagnosis/Outcome Identification 679
Planning/Implementation 679
Concept Care Mapping 683
Evaluation 683
Antisocial Personality Disorder (Background Assessment Data) 683
Diagnosis/Outcome Identification 686
Planning/Implementation 687
Concept Care Mapping 689
Evaluation 689

TREATMENT MODALITIES 690
Interpersonal Psychotherapy 690
Psychoanalytical Psychotherapy 690
Milieu or Group Therapy 690
Cognitive/Behavioral Therapy 690
Psychopharmacology 690

SUMMARY AND KEY POINTS 692
REVIEW QUESTIONS 693
REFERENCES 695
CLASSICAL REFERENCES 695
INTERNET REFERENCES 695


UNIT FIVE
PSYCHIATRIC/MENTAL HEALTH NURSING OF SPECIAL
POPULATIONS
Chapter 35
The Aging Individual 698
HOW OLD IS OLD? 699

EPIDEMIOLOGICAL STATISTICS 699
The Population 699
Marital Status 699
Living Arrangements 700
Economic Status 700
Employment 700
Health Status 700
THEORIES OF AGING 700
Biological Theories 700
Psychosocial Theories 701

THE NORMAL AGING PROCESS 702
Biological Aspects of Aging 702
Psychological Aspects of Aging 705
Sociocultural Aspects of Aging 707
Sexual Aspects of Aging 707

SPECIAL CONCERNS OF THE ELDERLY POPULATION 708
Retirement 708
Long-Term Care 710
Elder Abuse 711

APPLICATION OF THE NURSING PROCESS 713
Assessment 713
Diagnosis/Outcome Identification 714
Planning/Implementation 715
Evaluation 715

SUMMARY AND KEY POINTS 720
REVIEW QUESTIONS 723

REFERENCES 724
CLASSICAL REFERENCES 725
INTERNET REFERENCES 725

Chapter 36
Victims of Abuse or Neglect 726
HISTORICAL PERSPECTIVES 727
PREDISPOSING FACTORS 727
Biological Theories 728
Psychological Theories 728
Sociocultural Theories 728

APPLICATION OF THE NURSING PROCESS 730
Background Assessment Data 730
Diagnosis/Outcome Identification 736
Planning/Implementation 736
Concept Care Mapping 739
Evaluation 739
TREATMENT MODALITIES 739
Crisis Intervention 739
The Safe House or Shelter 741
Family Therapy 741

SUMMARY AND KEY POINTS 742
REVIEW QUESTIONS 743

REFERENCES 745
CLASSICAL REFERENCES 745
INTERNET REFERENCES 745

Chapter 37
Community Mental Health Nursing 746
THE CHANGING FOCUS OF CARE 747

THE PUBLIC HEALTH MODEL 748
THE ROLE OF THE NURSE 749
The Psychiatric-Mental Health Registered Nurse (RN-PMH) 749
The Psychiatric-Mental Health Advanced Practice Registered Nurse (APRN-PMH) 750

CASE MANAGEMENT 750
THE COMMUNITY AS CLIENT 751
Primary Prevention 751
Secondary Prevention 757
Tertiary Prevention 758

SUMMARY AND KEY POINTS 772
REVIEW QUESTIONS 774

REFERENCES 775
CLASSICAL REFERENCES 776
Chapter 38
Forensic Nursing 777
WHAT IS FORENSIC NURSING? 777

HISTORICAL PERSPECTIVES 778
THE CONTEXT OF FORENSIC NURSING PRACTICE 778

FORENSIC NURSING SPECIALTIES 778
Clinical Forensic Nursing Specialty 778
The Sexual Assault Nurse Examiner (SANE) 779
Forensic Psychiatric Nursing Specialty 779
Correctional/Institutional Nursing Specialty 779
Nurses in General Practice 779

APPLICATION OF THE NURSING PROCESS IN CLINICAL FORENSIC NURSING IN
TRAUMA CARE 780
Assessment 780
Nursing Diagnosis 781
Planning/Implementation 781
Evaluation 783

APPLICATION OF THE NURSING PROCESS IN FORENSIC PSYCHIATRIC NURSING IN
CORRECTIONAL FACILITIES 783
Assessment 783
Nursing Diagnosis 786
Planning/Implementation 786
Evaluation 789
SUMMARY AND KEY POINTS 789
REVIEW QUESTIONS 790

REFERENCES 790
CLASSICAL REFERENCE 791
INTERNET REFERENCES 791
Chapter 39
The Bereaved Individual 792
THEORETICAL PERSPECTIVES ON LOSS AND BEREAVEMENT 793
Stages of Grief 793

LENGTH OF THE GRIEF PROCESS 796
ANTICIPATORY GRIEF 797
MALADAPTIVE RESPONSES TO LOSS 797
Delayed or Inhibited Grief 797
Distorted (Exaggerated) Grief Response 797
Chronic or Prolonged Grieving 797
Normal versus Maladaptive Grieving 798

APPLICATION OF THE NURSING PROCESS 798
Background Assessment Data: Concepts of Death-Developmental Issues 798
Background Assessment Data: Concepts of Death-Cultural Issues 799
Nursing Diagnosis/Outcome Identification 801
Planning/Implementation 801
Evaluation 801
ADDITIONAL ASSISTANCE 804
Hospice 804
Advance Directives 806

SUMMARY AND KEY POINTS 807
REVIEW QUESTIONS 809
REFERENCES 810
CLASSICAL REFERENCES 810
INTERNET REFERENCES 810

Includes bibliographical references and index.

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