Psychiatric Mental Health Nursing: Concepts Of Care in Evidence-Based Practice

by Townsend, Mary C.

• ISBN13: 9780803614512
• ISBN10: 0803614519
• Format: Hardcover
• Copyright: 2005-12-14
• Publisher: F a Davis Co

Summary

In its full-color, fifth edition, Mary Townsend's Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice is still the most clearly written text on the subject. The stress/adaptation model remains the conceptual framework for the delivery of nursing care, providing a foundation of psychiatric mental health nursing knowledge to the student. New to this edition is an increased coverage of the biological causes of disease. Selected DSM-IV-TR disorders, such as schizophrenia, anxiety, and mood disorders, will include graphic brain illustrations and boxed information on psychobiological aspects of the disorder and its treatment, including the reasons specific medications can cause certain side effects.

Table of Contents

UNIT ONE Basic Concepts in Psychiatric / Mental Health Nursing
The Concept of Stress Adaptation	3	(10)
Stress as a Biological Response	4	(2)
Stress as an Environmental Event	6	(1)
Stress as a Transaction Between the Individual and the Environment	6	(2)
Precipitating Event	6	(1)
Individual's Perception of the Event	6	(1)
Predisposing Factors	7	(1)
Stress Management	8	(1)
Adaptive Coping Strategies	8	(1)
Summary	9	(2)
Review Questions	11	(1)
References	12	(1)
Classical References	12	(1)
Mental Health/Mental Illness: Historical and Theoretical Concepts	13	(20)
Historical Overview of Psychiatirc Care	14	(1)
Mental Health	15	(1)
Mental Illness	16	(1)
Psychological Adaptation to Stress	17	(7)
Anxiety	17	(2)
Behavioral Adaptation Responses to Anxiety	19	(4)
Grief	23	(1)
Stages of Grief	23	(1)
Anticipatory Grief	23	(1)
Resolution	23	(1)
Maladaptive Grief Responses	24	(1)
Mental Health/Mental Illness Continuum	24	(1)
The DSM-IV-TR Multiaxial Evaluation System	24	(1)
Summary	25	(2)
Review Questions	27	(2)
References	29	(1)
Classical References	29	(4)
UNIT TWO Foundations for Psychiatric/Mental Health Nursing
Theoretical Models of Personality Development	33	(17)
Psychoanalytic Theory	34	(2)
Structure of the Personality	34	(1)
Topography of the Mind	34	(1)
Dynamics of the Personality	35	(1)
Freud's Stages of Personality Development	35	(1)
Relevance of Psychoanalytic Theory to Nursing Practice	36	(1)
Interpersonal Theory	36	(2)
Sullivan's Stages of Personality Development	37	(1)
Relevance of Interpersonal Theory to Nursing Practice	37	(1)
Theory of Psychosocial Development	38	(2)
Erikson's Stages of Personality Development	38	(2)
Relevance of Psychosocial Development Theory to Nursing Practice	40	(1)
Theory of Object Relations	40	(2)
Phase I: The Autistic Phase (Birth to 1 Month)	41	(1)
Phase II: The Symbiotic Phase (1 to 5 Months)	41	(1)
Phase III: Separation-Individuation (5 to 36 Months)	41	(1)
Cognitive Development Theory	42	(1)
Stage 1: Sensorimotor (Birth to 2 Years)	42	(1)
Stage 2: Preoperational (2 to 6 Years)	42	(1)
Stage 3: Concrete Operations (6 to 12 Years)	42	(1)
Stage 4: Formal Operations (12 to 15+ Years)	43	(1)
Relevance of Cognitive Development Theory to Nursing Practice	43	(1)
Theory of Moral Development	43	(1)
Level I: Preconventional Level (Prominent from Ages 4 to 10 Years)	43	(1)
Level II: Conventional Level (Prominent from Ages 10 to 13 Years and into Adulthood)	44	(1)
Level III: Postconventional Level (Can Occur from Adolescence Onward)	44	(1)
Relevance of Moral Development Theory to Nursing Practice	44	(1)
A Nursing Model---Hildegard E. Peplau	44	(3)
Peplau's Stages of Personality Development	45	(2)
Relevance of Peplau's Model to Nursing Practice	47	(1)
Summary	47	(1)
Review Questions	48	(1)
References	49	(1)
Classical References	49	(1)
Concepts of Psychobiology	50	(25)
The Nervous System: An Anatomical Review	51	(11)
The Brain	51	(4)
Nerve Tissue	55	(3)
Autonomic Nervous System	58	(1)
Neurotransmitters	58	(4)
Neuroenocrinology	62	(6)
Pituitary Gland	63	(3)
Circadian Rhythms	66	(1)
Sleep	67	(1)
Genetics	68	(3)
Psychoimmunology	71	(1)
Normal Immune Response	71	(1)
Implications for Nursing	71	(1)
Summary	72	(1)
Review Questions	73	(1)
References	74	(1)
Ethical and Legal Issues in Psychiatric/Mental Health Nursing	75	(14)
Ethical Considerations	76	(4)
Theoretical Perspectives	76	(1)
Ethical Dilemmas	77	(1)
Ethical Principles	77	(1)
A Model for Making Ethical Decisions	78	(1)
Ethical Issues in Psychiatric/Mental Health Nursing	79	(1)
Legal Considerations	80	(6)
Nurse Practice Acts	80	(1)
Types of Law	81	(1)
Classifications Within Statutory and Common Law	81	(1)
Legal Issues in Psychiatric/Mental Health Nursing	82	(1)
Commitment Issues	83	(2)
Nursing Liability	85	(1)
Summary	86	(1)
Review Questions	87	(1)
References	88	(1)
Cultural Concepts Relevant to Psychiatric/Mental Health Nursing	89	(18)
Introduction	89	(1)
How do Cultures Differ?	90	(1)
Communication	90	(1)
Space	90	(1)
Social Organization	90	(1)
Time	90	(1)
Environmental Control	91	(1)
Biological Variations	91	(1)
Application of the Nursing Process	91	(8)
Background Assessment Data	91	(5)
Culture-Bound Syndromes	96	(1)
Diagnosis/Outcome Identification	96	(1)
Planning/Implementation	96	(3)
Evaluation	99	(1)
Summary	99	(2)
Review Questions	101	(1)
References	102	(1)
Classical Reference	103	(4)
UNIT THREE Therapeutic Approaches in Psychiatric Nursing Care
Relationship Development	107	(11)
Role of the Psychiatric Nurse	108	(1)
Dynamics of a Therapeutic Nurse-Client Relationship	108	(3)
Therapeutic Use of Self	109	(1)
Gaining Self-Awareness	109	(1)
The Johari Window	110	(1)
Conditions Essential to Development of a Therapeutic Relationship	111	(2)
Rapport	111	(1)
Trust	111	(1)
Respect	112	(1)
Genuineness	112	(1)
Empathy	113	(1)
Phases of a Therapeutic Nurse-Client Relationship	113	(2)
The Preinteraction Phase	114	(1)
The Orientation (Introductory) Phase	114	(1)
The Working Phase	114	(1)
The Termination Phase	115	(1)
Summary	115	(1)
Review Questions	116	(1)
References	116	(1)
Classical References	117	(1)
Therapeutic Communication	118	(13)
What Is Communication?	119	(1)
The Impact of Preexisting Conditions	119	(2)
Values, Attitudes, and Beliefs	119	(1)
Culture or Religion	120	(1)
Social Status	120	(1)
Gender	120	(1)
Age or Developmental Level	120	(1)
Environment in Which the Transaction Takes Place	120	(1)
Nonverbal Communication	121	(2)
Physical Appearance and Dress	121	(1)
Body Movement and Posture	121	(1)
Touch	121	(1)
Facial Expressions	122	(1)
Eye Behavior	122	(1)
Vocal Cues, or Paralanguage	122	(1)
Therapeutic Communication Techniques	123	(1)
Nontherapeutic Communication Techniques	124	(1)
Active Listening	124	(2)
Process Recordings	126	(1)
Feedback	126	(2)
Summary	128	(1)
Review Questions	129	(1)
References	130	(1)
Classical References	130	(1)
The Nursing Process in Psychiatric/Mental Health Nursing	131	(20)
The Nursing Process	132	(8)
Definition	132	(1)
Standards of Care	132	(8)
Why Nursing Diagnosis?	140	(2)
Nursing Case Management	142	(2)
Critical Pathways of Care	143	(1)
Applying the Nursing Process in the Psychiatric Setting	144	(1)
Concept Mapping	145	(1)
Documentation of the Nursing Process	145	(4)
Problem-Oriented Recording	147	(1)
Focus Charting	147	(1)
The PIE Method	148	(1)
Summary	149	(1)
Review Questions	150	(1)
References	150	(1)
Therapeutic Groups	151	(11)
Functions of a Group	152	(1)
Types of Groups	152	(1)
Task Groups	152	(1)
Teaching Groups	152	(1)
Supportive/Therapeutic Groups	152	(1)
Self-Help Groups	153	(1)
Physical Conditions That Influence Group Dynamics	153	(1)
Seating	153	(1)
Size	153	(1)
Membership	153	(1)
Curative Factors	153	(1)
Phases of Group Development	154	(1)
Phase I. Initial or Orientation Phase	154	(1)
Phase II. Middle or Working Phase	154	(1)
Phase III. Final or Termination Phase	155	(1)
Leadership Styles	155	(1)
Autocratic	155	(1)
Democratic	155	(1)
Laissez-Faire	155	(1)
Member Roles	156	(1)
Psychodrama	156	(1)
The Role of the Nurse in Group Therapy	156	(1)
Summary	157	(2)
Review Questions	159	(2)
References	161	(1)
Classical References	161	(1)
Intervention with Families	162	(22)
Stages of Family Development	163	(2)
Stage I. The Single Young Adult	164	(1)
Stage II. The Newly Married Couple	164	(1)
Stage III. The Family with Young Children	164	(1)
Stage IV. The Family with Adolescents	164	(1)
Stage V. The Family Launching Grown Children	164	(1)
Stage VI. The Family in Later Life	165	(1)
Major Variations	165	(1)
Divorce	165	(1)
Remarriage	165	(1)
Cultural Variations	165	(1)
Family Functioning	166	(5)
Communication	167	(1)
Self-Concept Reinforcement	168	(1)
Family Members' Expectations	168	(1)
Handling Differences	169	(1)
Family Interactional Patterns	170	(1)
Family Climate	170	(1)
Therapeutic Modalities with Families	171	(6)
The Family as a System	171	(2)
The Structural Model	173	(1)
The Strategic Model	174	(2)
The Evolution of Family Therapy	176	(1)
The Nursing Process	177	(4)
Assessment	177	(3)
Diagnosis	180	(1)
Outcome Identification	180	(1)
Planning/Implementation	180	(1)
Evaluation	181	(1)
Summary	181	(1)
Review Questions	182	(1)
References	183	(1)
Classical References	183	(1)
Milieu Therapy---The Therapeutic Community	184	(9)
Milieu, Defined	184	(1)
Current Status of the Therapeutic Community	185	(1)
Basic Assumptions	185	(1)
Conditions That Promote a Therapeutic Community	185	(2)
The Program of Therapeutic Community	187	(1)
The Role of the Nurse	188	(1)
Summary	189	(2)
Review Questions	191	(1)
References	192	(1)
Classical References	192	(1)
Crisis Intervention	193	(14)
Characteristics of a Crisis	193	(1)
Phases in the Development of a Crisis	194	(1)
Types of Crises	195	(2)
Class 1: Dispositional Crises	195	(1)
Class 2: Crises of Anticipated Life Transitions	196	(1)
Class 3: Crises Resulting from Traumatic Stress	196	(1)
Class 4: Maturational/Developmental Crises	196	(1)
Class 5: Crises Reflecting Psychopathology	196	(1)
Class 6: Psychiatric Emergencies	197	(1)
Crisis Intervention	197	(1)
Phases of Crisis Intervention: The Role of the Nurse	197	(2)
Phase 1. Assessment	198	(1)
Phase 2. Planning of Therapeutic Intervention	198	(1)
Phase 3. Intervention	198	(1)
Phase 4. Evaluation of Crisis Resolution and Anticipatory Planning	198	(1)
Disaster Nursing	199	(1)
Application of the Nursing Process	199	(5)
Background Assessment Data	199	(1)
Nursing Diagnoses/Outcome Identification	199	(1)
Planning/Implementation	199	(1)
Evaluation	199	(5)
Summary	204	(1)
Review Questions	205	(1)
References	206	(1)
Classical References	206	(1)
Relaxation Therapy	207	(10)
The Stress Epidemic	207	(1)
Physiological, Cognitive, and Behavioral Manifestations of Relaxation	208	(2)
Methods of Achieving Relaxation	210	(3)
Deep Breathing Exercises	210	(1)
Progressive Relaxation	210	(1)
Modified (or Passive) Progressive Relaxation	211	(1)
Meditation	212	(1)
Mental Imagery	212	(1)
Biofeedback	212	(1)
Physical Exercise	213	(1)
The Role of the Nurse in Relaxation Therapy	213	(1)
Assessment	213	(1)
Diagnosis	214	(1)
Outcome Identification/Implementation	214	(1)
Evaluation	214	(1)
Summary	214	(2)
Review Questions	216	(1)
References	216	(1)
Assertiveness Training	217	(11)
Assertive Communication	218	(1)
Basic Human Rights	218	(1)
Response Patterns	218	(2)
Nonassertive Behavior	218	(1)
Assertive Behavior	219	(1)
Aggressive Behavior	219	(1)
Passive-Aggressive Behavior	219	(1)
Behavioral Components of Assertive Behavior	220	(1)
Techniques that Promote Assertive Behavior	221	(1)
Thought-Stopping Techniques Method	222	(1)
Role of the Nurse	222	(3)
Assessment	222	(1)
Diagnosis	223	(1)
Outcome Identification/Implementation	223	(2)
Evaluation	225	(1)
Summary	225	(1)
Review Questions	226	(1)
References	227	(1)
Promoting Self-Esteem	228	(12)
Components of Self-Concept	229	(1)
Physical Self or Body Image	229	(1)
Personal Identity	229	(1)
Self-Esteem	229	(1)
The Development of Self-Esteem	229	(2)
Developmental Progression of the Self-Esteem Through the Life Span	230	(1)
The Manifestations of Low Self-Esteem	231	(2)
Focal Stimuli	231	(1)
Contextual Stimuli	231	(1)
Residual Stimuli	232	(1)
Symptoms of Low Self-Esteem	232	(1)
Boundaries	233	(1)
Boundary Pliancy	233	(1)
Establishing Boundaries	234	(1)
The Nursing Process	234	(3)
Assessment	234	(1)
Diagnosis/Outcome Identification	234	(1)
Outcome Criteria	235	(1)
Planning/Implementation	235	(1)
Evaluation	235	(2)
Summary	237	(1)
Review Questions	238	(1)
References	239	(1)
Classical References	239	(1)
Anger/Aggression Management	240	(10)
Anger and Aggression, Defined	241	(1)
Predisposing Factors to Anger and Aggression	242	(1)
Modeling	242	(1)
Operant Conditioning	242	(1)
Neurophysiological Disorders	242	(1)
Biochemical Factors	242	(1)
Socioeconomic Factors	242	(1)
Environmental Factors	242	(1)
The Nursing Process	243	(3)
Assessment	243	(1)
Diagnosis/Outcome Identification	244	(1)
Planning/Implementation	244	(2)
Evaluation	246	(1)
Summary	246	(2)
Review Questions	248	(1)
References	249	(1)
The Suicidal Client	250	(15)
Historical Perspectives	250	(1)
Epidemiological Factors	251	(1)
Risk Factors	251	(2)
Marital Status	251	(1)
Gender	251	(1)
Age	252	(1)
Religion	252	(1)
Socioeconomic Status	252	(1)
Ethnicity	253	(1)
Other Risk Factors	253	(1)
Predisposing Factors: Theories of Suicide	253	(1)
Psychological Theories	253	(1)
Sociological Theory	254	(1)
Biological Theories	254	(1)
Application of the Nursing Process with the Suicidal Client	254	(7)
Assessment	254	(2)
Diagnosis/Outcome Identification	256	(1)
Planning/Implementation	256	(4)
Evaluation	260	(1)
Summary	261	(1)
Review Questions	262	(1)
References	263	(1)
Classical References	264	(1)
Behavior Therapy	265	(9)
Classical Conditioning	266	(1)
Operant Conditioning	266	(1)
Techniques for Modifying Client Behavior	267	(2)
Shaping	267	(1)
Modeling	267	(1)
Premack Principle	268	(1)
Extinction	268	(1)
Contingency Contracting	268	(1)
Token Economy	268	(1)
Time Out	268	(1)
Reciprocal Inhibition	268	(1)
Overt Sensitization	268	(1)
Covert Sensitization	269	(1)
Systematic Desensitization	269	(1)
Flooding	269	(1)
Role of the Nurse in Behavior Therapy	269	(2)
Summary	271	(1)
Review Questions	272	(1)
References	273	(1)
Classical References	273	(1)
Cognitive Therapy	274	(11)
Historical Background	275	(1)
Indications for Cognitive Therapy	275	(1)
Goals and Principles of Cognitive Therapy	275	(1)
Basic Concepts	276	(2)
Automatic Thoughts	276	(1)
Schemas (Core Beliefs)	277	(1)
Techniques of Cognitive Therapy	278	(1)
Didactic (Educational) Aspects	278	(1)
Cognitive Techniques	278	(1)
Behavioral Interventions	279	(1)
Role of the Nurse in Cognitive Therapy	279	(3)
Summary	282	(1)
Review Questions	283	(1)
References	284	(1)
Classical References	284	(1)
Psychopharmacology	285	(29)
Historical Perspectives	286	(1)
How Do Psychotropics Work?	286	(1)
Applying the Nursing Process in Psychopharmacological Therapy	287	(23)
Antianxiety Agents	287	(4)
Antidepressants	291	(5)
Mood-stabilizing Agents	296	(5)
Antipsychotic Agents	301	(5)
Sedative-Hypnotics	306	(2)
Agents for Attention-Deficit/Hyperactivity Disorder (ADHD)	308	(2)
Summary	310	(2)
Review Questions	312	(1)
References	313	(1)
Electroconvulsive Therapy	314	(8)
Electroconvulsive Therapy, Defined	315	(1)
Historical Perspectives	315	(1)
Indications	316	(1)
Major Depression	316	(1)
Mania	316	(1)
Schizophrenia	316	(1)
Other Conditions	316	(1)
Contraindications	316	(1)
Mechanism of Action	316	(1)
Side Effects	316	(1)
Risks Associated with Electroconvulsive Therapy	317	(1)
Mortality	317	(1)
Permanent Memory Loss	317	(1)
Brain Damage	317	(1)
The Role of the Nurse in Electroconvulsive Therapy	317	(2)
Assessment	317	(1)
Diagnosis/Outcome Identification	317	(1)
Planning/Implementation	317	(2)
Evaluation	319	(1)
Summary	319	(1)
Review Questions	320	(1)
References	321	(1)
Complementary Therapies	322	(15)
Commonalities and Contrasts	324	(1)
Types of Complementary Therapies	324	(10)
Herbal Medicine	324	(1)
Acupressure and Acupuncture	325	(2)
Diet and Nutrition	327	(4)
Chiropractic Medicine	331	(1)
Therapeutic Touch and Massage	332	(1)
Yoga	333	(1)
Pet Therapy	333	(1)
Summary	334	(1)
Review Questions	335	(1)
References	335	(2)
Client Education	337	(18)
Historical Perspectives	338	(1)
Theories of Teaching and Learning	339	(1)
Behaviorist Theory	339	(1)
Cognitive Theory	339	(1)
Humanistic Theory	339	(1)
Domains of Learning	340	(1)
Affective Domain	340	(1)
Cognitive Domain	340	(1)
Psychomotor Domain	340	(1)
Age and Developmental Considerations	340	(2)
The Adult Learner	340	(1)
Teaching Children and Adolescents	341	(1)
Teaching the Elderly	341	(1)
The Nursing Process in Client Education	342	(5)
Assessment	342	(2)
Nursing Diagnosis	344	(1)
Outcome Identification	344	(1)
Planning/Implementation	344	(2)
Evaluation	346	(1)
Documentation of Client Education	347	(1)
Summary	348	(1)
Review Questions	349	(1)
References	350	(1)
Classical References	351	(4)
UNIT FOUR NURSING CARE OF CLIENTS WITH ALTERATIONS IN PSYCHOSOCIAL ADAPTATION
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence	355	(32)
Mental Retardation	356	(3)
Predisposing Factors	356	(1)
Application of the Nursing Process	357	(2)
Autistic Disorder	359	(4)
Predisposing Factors	359	(1)
Application of the Nursing Process	360	(3)
Attention-Deficit/Hyperactivity Disorder	363	(5)
Predisposing Factors	363	(1)
Application of the Nursing Process	364	(3)
Psychopharmacological Intervention	367	(1)
Conduct Disorder	368	(4)
Predisposing Factors	368	(1)
Application of the Nursing Process	369	(3)
Oppositional Defiant Disorder	372	(3)
Predisposing Factors	372	(1)
Application of the Nursing Process	372	(3)
Tourette's Disorder	375	(3)
Predisposing Factors	375	(1)
Application of the Nursing Process	375	(3)
Separation Anxiety Disorder	378	(3)
Predisposing Factors	378	(1)
Application of the Nursing Process	378	(3)
General Therapeutic Approaches	381	(1)
Behavior Therapy	381	(1)
Family Therapy	381	(1)
Group Therapy	381	(1)
Psychopharmacology	382	(1)
Summary	382	(2)
Review Questions	384	(1)
References	385	(2)
Delirium, Dementia, and Amnestic Disorders	387	(23)
Delirium	388	(1)
Predisposing Factors	388	(1)
Dementia	389	(6)
Predisposing Factors	390	(5)
Amnestic Disorders	395	(1)
Predisposing Factors	395	(1)
Application of the Nursing Process	396	(6)
Assessment	396	(4)
Diagnosis/Outcome Identification	400	(1)
Planning/Implementation	400	(2)
Evaluation	402	(1)
Medical Treatment Modalities	402	(3)
Delirium	402	(1)
Dementia	402	(3)
Summary	405	(1)
Review Questions	406	(2)
References	408	(2)
Substance-related Disorders	410	(43)
Substance-Use Disorders	411	(1)
Substance Abuse	411	(1)
DSM-IV-TR Criteria for Substance Abuse	411	(1)
Substance Dependence	411	(1)
DSM-IV-TR Criteria for Substance Dependence	412	(1)
Substance-Induced Disorders	412	(1)
Substance Intoxication	412	(1)
DSM-IV-TR Criteria for Substance Intoxication	412	(1)
Substance Withdrawal	412	(1)
DSM-IV-TR Criteria for Substance Withdrawal	413	(1)
Classes of Psychoactive Substances	413	(1)
Predisposing Factors	413	(1)
Biological Factors	413	(1)
Psychological Factors	413	(1)
Sociocultural Factors	414	(1)
The Dynamics of Substance-Related Disorders	414	(20)
Alcohol Abuse and Dependence	414	(3)
Alcohol Intoxication	417	(1)
Alcohol Withdrawal	417	(1)
Sedative, Hypnotic, or Anxiolytic Abuse and Dependence	418	(2)
Sedative, Hypnotic, or Anxiolytic Intoxication	420	(1)
Sedative, Hypnotic, or Anxiolytic Withdrawal	420	(1)
CNS Stimulant Abuse and Dependence	420	(3)
CNS Stimulant Intoxication	423	(1)
CNS Stimulant Withdrawal	423	(1)
Inhalant Abuse and Dependence	423	(1)
Opioid Abuse and Dependence	424	(2)
Hallucinogen Abuse and Dependence	426	(2)
Cannabis Abuse and Dependence	428	(6)
Application of the Nursing Process	434	(7)
Assessment	434	(2)
Diagnosis/Outcome Identification	436	(1)
Planning/Implementation	436	(3)
Evaluation	439	(2)
The Impaired Nurse	441	(1)
Codependency	442	(2)
The Codependent Nurse	443	(1)
Treating Codependence	443	(1)
Treatment Modalities for Substance-Related Disorders	444	(4)
Alcoholics Anonymous	444	(1)
Pharmacotherapy	445	(1)
Counseling	446	(1)
Group Therapy	446	(1)
Psychopharmacology for Substance Intoxication and Substance Withdrawal	447	(1)
Summary	448	(1)
Review Questions	449	(2)
References	451	(1)
Classical References	452	(1)
Schizophrenia and Other Psychotic Disorders	453	(30)
Nature of the Disorder	454	(1)
Phase I: The Schizoid Personality	454	(1)
Phase II: The Prodromal Phase	454	(1)
Phase III: Schizophrenia	455	(1)
Phase IV: Residual Phase	455	(1)
Prognosis	455	(1)
Predisposing Factors	455	(5)
Biological Influences	455	(3)
Psychological Influences	458	(1)
Environmental Influences	458	(1)
The Transactional Model	458	(2)
Types of Schizophrenia and Other Psychotic Disorders	460	(2)
Disorganized Schizophrenia	460	(1)
Catatonic Schizophrenia	460	(1)
Paranoid Schizophrenia	460	(1)
Undifferentiated Schizophrenia	460	(1)
Residual Schizophrenia	460	(1)
Schizoaffective Disorder	460	(1)
Brief Psychotic Disorder	461	(1)
Schizophreniform Disorder	461	(1)
Delusional Disorder	461	(1)
Shared Psychotic Disorder	461	(1)
Psychotic Disorder Due to a General Medical Condition	462	(1)
Substance-Induced Psychotic Disorder	462	(1)
Application of the Nursing Process	462	(11)
Background Assessment Data	462	(3)
Diagnosis/Outcome Identification	465	(1)
Planning/Implementation	466	(5)
Evaluation	471	(2)
Treatment Modalities for Schizophrenia and Other Psychotic Disorders	473	(4)
Psychological Treatments	473	(1)
Social Treatment	474	(1)
Organic Treatment	475	(2)
Summary	477	(2)
Review Questions	479	(2)
References	481	(2)
Mood Disorders	483	(40)
Historical Perspective	484	(1)
Epidemiology	484	(1)
Gender	484	(1)
Age	485	(1)
Social Class	485	(1)
Race and Culture	485	(1)
Marital Status	485	(1)
Seasonality	485	(1)
Types of Mood Disorders	485	(3)
Depressive Disorders	485	(1)
Bipolar Disorders	486	(2)
Other Mood Disorders	488	(1)
Depressive Disorders	488	(8)
Predisposing Factors	488	(4)
Developmental Implications	492	(4)
Application of the Nursing Process to Depressive Disorders	496	(6)
Background Assessment Data	496	(1)
Diagnosis/Outcome Identification	497	(1)
Planning/Implementation	498	(2)
Client/Family Education	500	(1)
Evaluation of Care for the Depressed Client	500	(2)
Bipolar Disorder (Mania)	502	(5)
Predisposing Factors	502	(2)
Developmental Implications	504	(3)
Application of the Nursing Process to Bipolar Disorder (Mania)	507	(5)
Background Assessment Data	507	(1)
Stage I: Hypomania	507	(1)
Stage II: Acute Mania	507	(1)
Stage III: Delirious Mania	508	(1)
Diagnosis/Outcome Identification	508	(1)
Planning/Implementation	508	(1)
Client/Family Education	508	(2)
Evaluation of Care for the Manic Client	510	(2)
Treatment Modalities for Mood Disorders	512	(6)
Psychological Treatments	512	(3)
Organic Treatments	515	(3)
Summary	518	(1)
Review Questions	519	(2)
References	521	(1)
Classical References	522	(1)
Anxiety Disorders	523	(37)
Historical Aspects	524	(1)
Epidemiological Statistics	524	(1)
How Much Is Too Much?	524	(2)
Application of the Nursing Process	526	(18)
Panic Disorder	526	(1)
Generalized Anxiety Disorder	526	(4)
Phobias	530	(9)
Obsessive-Compulsive Disorder	539	(5)
Posttraumatic Stress Disorder	544	(8)
Background Assessment Data	544	(6)
Anxiety Disorder Due to a General Medical Condition	550	(1)
Substance-Induced Anxiety Disorder	550	(2)
Treatment Modalities	552	(4)
Individual Psychotherapy	552	(1)
Cognitive Therapy	552	(1)
Behavior Therapy	553	(1)
Psychopharmacology	554	(2)
Summary	556	(1)
Review Questions	557	(2)
References	559	(1)
Classical References	559	(1)
Somatoform and Sleep Disorders	560	(36)
Somatoform Disorders	561	(1)
Historical Aspects	561	(1)
Epidemiological Statistics	561	(1)
Application of the Nursing Process to Somatoform Disorders	562	(21)
Somatization Disorder	562	(2)
Pain Disorder	564	(8)
Hypochondriasis	572	(5)
Conversion Disorder	577	(3)
Body Dysmorphic Disorder	580	(3)
Sleep Disorders	583	(1)
Application of the Nursing Process to Sleep Disorders	584	(5)
Treatment Modalities	589	(2)
Somatoform Disorders	589	(1)
Sleep Disorders	590	(1)
Summary	591	(3)
Review Questions	594	(1)
References	595	(1)
Dissociative Disorders	596	(27)
Historical Aspects	597	(1)
Epidemiological Statistics	597	(1)
Application of the Nursing Process	597	(19)
Dissociative Amnesia	597	(4)
Dissociative Fugue	601	(5)
Dissociative Identity Disorder	606	(7)
Depersonalization Disorder	613	(3)
Treatment Modalities	616	(2)
Dissociative Amnesia	616	(2)
Dissociative Fugue	618	(1)
Dissociative Identity Disorder	618	(1)
Depersonalization Disorder	618	(1)
Summary	618	(2)
Review Questions	620	(2)
References	622	(1)
Classical References	622	(1)
Sexual and Gender Identity Disorders	623	(30)
Development of Human Sexuality	624	(2)
Birth Through Age 12	624	(1)
Adolescence	624	(1)
Adulthood	625	(1)
Sexual Disorders	626	(16)
Paraphilias	626	(4)
Sexual Dysfunctions	630	(4)
Application of the Nursing Process to Sexual Disorders	634	(8)
Gender Identity Disorder	642	(3)
Application of the Nursing Process to Gender Identity Disorders	642	(3)
Variations in Sexual Orientation	645	(3)
Homosexuality	645	(1)
Transsexualism	646	(1)
Bisexuality	647	(1)
Sexually Transmitted Diseases	648	(1)
Summary	648	(2)
Review Questions	650	(2)
References	652	(1)
Classical References	652	(1)
Eating Disorders	653	(20)
Epidemiological Factors	654	(1)
Application of the Nursing Process	654	(12)
Background Assessment Data (Symptomatology)	654	(4)
Diagnosis/Outcome Identification	658	(1)
Planning/Implementation	659	(7)
Evaluation	666	(1)
Treatment Modalities	666	(2)
Behavior Modification	666	(1)
Individual Therapy	667	(1)
Family Therapy	667	(1)
Psychopharmacology	667	(1)
Summary	668	(1)
Review Questions	669	(2)
References	671	(2)
Adjustment and Impulse Control Disorders	673	(20)
Historical and Epidemiological Factors	674	(1)
Application of the Nursing Process	674	(11)
Adjustment Disorders	674	(6)
Impulse Control Disorders	680	(1)
Intermittent Explosive Disorder	680	(1)
Kleptomania	681	(1)
Pathological Gambling	682	(1)
Pyromania	683	(1)
Trichotillomania	683	(2)
Treatment Modalities	685	(4)
Adjustment Disorders	685	(2)
Family Therapy	687	(1)
Behavioral Therapy	687	(1)
Self-Help Groups	688	(1)
Crisis Intervention	688	(1)
Psychopharmacology	688	(1)
Impulse Control Disorders	688	(1)
Kleptomania	688	(1)
Pathological Gambling	688	(1)
Pyromania	689	(1)
Trichotillomania	689	(1)
Summary	689	(2)
Review Questions	691	(1)
References	692	(1)
Classical Reference	692	(1)
Psychological Factors Affecting Medical Conditions	693	(22)
Historical Aspects	694	(1)
Application of the Nursing Process	695	(11)
Background Assessment Data: Types of Psychophysiological Disorders	695	(11)
Treatment Modalities	706	(4)
Asthma	706	(1)
Cancer	707	(1)
Coronary Heart Disease	707	(1)
Peptic Ulcer	707	(1)
Essential Hypertension	708	(1)
Rheumatoid Arthritis	709	(1)
Ulcerative Colitis	710	(1)
Summary	710	(2)
Review Questions	712	(2)
References	714	(1)
Classical References	714	(1)
Personality Disorders	715	(32)
Historical Aspects	717	(1)
Types of Personality Disorders	717	(8)
Paranoid Personality Disorder	717	(1)
Schizoid Personality Disorder	718	(1)
Schizotypal Personality Disorder	719	(1)
Antisocial Personality Disorder	720	(1)
Borderline Personality Disorder	720	(1)
Histrionic Personality Disorder	720	(1)
Narcissistic Personality Disorder	721	(1)
Avoidant Personality Disorder	722	(1)
Dependent Personality Disorder	723	(1)
Obsessive-Compulsive Personality Disorder	724	(1)
Passive-Aggressive Personality Disorder	724	(1)
Application of the Nursing Process	725	(11)
Borderline Personality Disorder	725	(3)
Antisocial Personality Disorder	728	(8)
Treatment Modalities	736	(2)
Summary	738	(2)
Review Questions	740	(3)
References	743	(1)
Classical References	743	(4)
UNIT FIVE PSYCHIATRIC/MENTAL HEALTH NURSING OF SPECIAL POPULATIONS
The Aging Individual	747	(27)
How Old Is Old?	748	(1)
Epidemiological Statistics	748	(1)
The Population	748	(1)
Marital Status	748	(1)
Living Arrangements	749	(1)
Economic Status	749	(1)
Employment	749	(1)
Health Status	749	(1)
Theories of Aging	749	(3)
Biological Theories	749	(1)
Psychosocial Theories	750	(2)
The Normal Aging Process	752	(6)
Biological Aspects of Aging	752	(2)
Psychological Aspects of Aging	754	(1)
Sociocultural Aspects of Aging	755	(1)
Sexual Aspects of Aging	756	(2)
Special Concerns of the Elderly	758	(4)
Retirement	758	(1)
Long-Term Care	759	(1)
Elder Abuse	760	(1)
Suicide	761	(1)
Application of the Nursing Process	762	(6)
Assessment	762	(1)
Diagnosis/Outcome Identification	763	(1)
Planning/Implementation	764	(4)
Summary	768	(2)
Review Questions	770	(2)
References	772	(1)
Classical References	773	(1)
The Individual with HIV Disease	774	(24)
Pathophysiology Incurred by Infection with the HIV	775	(1)
The Normal Immune Response	775	(1)
The Immune Response to HIV	775	(1)
Historical Aspects	776	(1)
Epidemiological Statistics	776	(1)
Predisposing Factors	777	(1)
Sexual Transmission	777	(1)
Bloodborne Transmission	778	(1)
Perinatal Transmission	778	(1)
Other Possible Modes of Transmission	778	(1)
Application of the Nursing Process	778	(11)
Background Assessment Data	778	(5)
Diagnosis/Outcome Identification	783	(1)
Planning/Implementation	784	(4)
Client/Family Education	788	(1)
Evaluation	788	(1)
Treatment Modalities	789	(4)
Pharmacology	789	(1)
Universal Isolation Precautions	790	(2)
Hospice Care	792	(1)
Incorporating HIV Prevention in the Medical Care of Persons Living with HIV	792	(1)
Summary	793	(1)
Review Questions	794	(2)
References	796	(2)
Problems Related to Abuse or Neglect	798	(19)
Historical Perspectives	799	(1)
Predisposing Factors	799	(2)
Biological Theories	799	(2)
Psychological Theories	801	(1)
Sociocultural Theories	801	(1)
Application of the Nursing Process	801	(7)
Background Assessment Data	801	(7)
Diagnosis/Outcome Identification	808	(1)
Planning/Implementation	808	(1)
Evaluation	808	(1)
Treatment Modalities	808	(4)
Crisis Intervention	808	(3)
The Safe House or Shelter	811	(1)
Family Therapy	811	(1)
Summary	812	(1)
Review Questions	813	(2)
References	815	(1)
Classical References	816	(1)
Men's and Women's Health Issues	817	(18)
Men's Health Issues	818	(4)
Physiological Problems	818	(2)
Psychosocial Problems	820	(2)
Women's Health Issues	822	(7)
Physiological Problems	822	(4)
Psychosocial Problems	826	(3)
Summary	829	(2)
Review Questions	831	(2)
References	833	(2)
Community Mental Health Nursing	835	(27)
The Changing Focus of Care	836	(1)
The Public Health Model	837	(1)
The Role of the Nurse	838	(1)
The Psychiatric/Mental Health Registered Nurse	838	(1)
The Psychiatric/Mental Health Advanced Practice Registered Nurse	839	(1)
Case Management	839	(1)
The Community as Client	840	(17)
Primary Prevention	840	(5)
Secondary Prevention	845	(2)
Tertiary Prevention	847	(10)
Rural Mental Health Nursing	857	(1)
Summary	857	(2)
Review Questions	859	(2)
References	861	(1)
Classical References	861	(1)
Psychiatric Home Nursing Care	862	(14)
Historical Aspects	863	(1)
General Information Related to Psychiatric Home Nursing Care	863	(2)
Payment for Home Care	863	(1)
Types of Diagnoses	864	(1)
Advantages and Disadvantages of Home Care	864	(1)
Cultural and Boundary Issues	865	(1)
Role of the Nurse	865	(1)
Application of the Nursing Process	865	(2)
Legal and Ethical Issues	867	(4)
Legal Issues	867	(3)
Ethical Issues	870	(1)
Summary	871	(2)
Review Questions	873	(2)
References	875	(1)
Forensic Nursing	876	(17)
What Is Forensic Nursing?	876	(1)
Historical Perspectives	877	(1)
The Context of Forensic Nursing Practice	877	(1)
Forensic Nursing Specialties	877	(2)
Clinical Forensic Nursing Specialty	877	(1)
The Sexual Assault Nurse Examiner (SANE)	878	(1)
Forensic Psychiatric Nursing Specialty	878	(1)
Correctional/Institutional Nursing Specialty	878	(1)
Nurses in General Practice	878	(1)
Application of the Nursing Process in Clinical Forensic Nursing in Trauma Care	879	(4)
Assessment	879	(1)
Nursing Diagnosis	880	(1)
Planning/Implementation	881	(2)
Evaluation	883	(1)
Application of the Nursing Process in Forensic Psychiatric Nursing in Correctional Facilities	883	(5)
Assessment	883	(2)
Nursing Diagnosis	885	(1)
Planning/Implementation	885	(3)
Evaluation	888	(1)
Summary	888	(2)
Review Questions	890	(1)
References	891	(1)
Classical Reference	892	(1)
The Bereaved Individual	893	(18)
Theoretical Perspectives on Loss and Bereavement	894	(3)
Stages of Grief	894	(3)
Length of the Grief Process	897	(1)
Anticipatory Grief	897	(1)
Maladaptive Responses to Loss	898	(1)
Delayed or Inhibited Grief	898	(1)
Distorted (Exaggerated) Grief Response	898	(1)
Chronic or Prolonged Grieving	898	(1)
Normal versus Maladaptive Grieving	898	(1)
Application of the Nursing Process	899	(5)
Background Assessment Data: Concepts of Death-Developmental Issues	899	(1)
Background Assessment Data: Concepts of Death-Cultural Issues	900	(2)
Nursing Diagnosis/Outcome Identification	902	(1)
Planning/Implementation	902	(2)
Evaluation	904	(1)
Additional Assistance	904	(3)
Hospice	904	(2)
Advance Directives	906	(1)
Summary	907	(1)
Review Questions	908	(2)
References	910	(1)
Classical References	910	(1)
Appendix A Answers to Chapter Review Questions	911	(5)
Appendix B Mental Status Assessment	916	(2)
Appendix C DSM-IV-TR Classification: Axes I and II Categories and Codes	918	(8)
Appendix D Nanda Nursing Diagnosis: Taxonomy II	926	(4)
Appendix E Assigning Nursing Diagnoses to Client Behaviors	930	(2)
Appendix F Glossary	932	(15)
Index	947