Psychiatric Nursing Care Plans

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  • Edition: 5th
  • Format: Paperback
  • Copyright: 2006-04-28
  • Publisher: Mosby

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The most comprehensive psychiatric nursing care planning text available assists students and practitioners in providing effective care in a variety of settings. Clear presentation of information, consistent use of the nursing process, correlation of nursing and medical diagnoses, and prioritization of interventions make this text an invaluable resource. Grounded in the latest classification of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the most current list of NANDA-approved nursing diagnoses, this text covers a wide range of disorders, their psychopathology, and appropriate nursing interventions with rationales. Care plans use real clinical situations and include therapeutic and nontherapeutic dialogue examples to familiarize nurses with likely scenarios and equip them with the tools they need to feel confident in any clinical setting. The first chapter, The Nursing Process, effectively describes the central principles of psychiatric nursing practice in detailing the ANAs six-step nursing process along with additional information on therapeutic nurse-client communication skills, client history and assessment tools, NIC and NOC, and more. The six-step nursing process format is maintained throughout to emphasize a practice-oriented, problem-solving approach to psychiatric care. Major psychiatric disorders are reviewed consistently and completely with sections including Etiology, Epidemiology, Assessment and Diagnostic Criteria, Interventions, and Prognosis and Discharge Criteria. With this basis of knowledge, relevant care plans are offered in the second section of each chapter. Care plans based on DSM-IV-TR medical and NANDA nursing diagnoses are logically and consistently organized with Assessment Data, Outcome Criteria, Planning and Implementation, and Evaluation sections. Assessment Data sections include detailed related factors (etiology) and defining characteristics or risk factors as appropriate for the specific diagnosis. Outcome Criteria sections give the reader clear indications of the desired end state. Planning and Implementation sections list specific, relevant, and practical nursing interventions with rationales in a clear, comprehensible two-column format. UNIQUE! Therapeutic and non-therapeutic dialogue examples are presented throughout to promote more effective client communication. Evaluation sections state the role of outcome evaluation as a critical and ongoing step in the nursing process. Client and Family Teaching boxes include Nurse Needs to Know and Teach Client and Family sections covering all aspects of post-treatment instructions for clients and caregivers. DSM-IV-TR boxes list all related DSM-IV-TR diagnoses for quick reference. Helpful appendices contain information and strategies that are timely and useful in the care of clients with mental and emotional disorders including such topics as psychiatric and psychosocial therapies, grief and loss, spirituality, and many more. New care plans, many that focus on the family, join completely updated and revised care plans to make this text the most comprehensive psychiatric nursing care planning text available. Dynamic internal design emphasizes the care plans as the focus of the text; tabbed pages noting the relevant disorder and a complete list of care plans with page number references make finding a specific care plan easier than ever before. Appropriate Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) labels are presented with each care plan in order that students become familiar with these emerging classifications and practicing nurses can easily identify them for use in their care setting if applicable. A comprehensive pharmacotherapy appendix includes the most recent psychotropic drug information and appropriate related client care. O

Table of Contents

The Nursing Processp. 1
Assessmentp. 2
Assessment of Mental Statusp. 3
The Interviewp. 3
Essential Qualities for a Therapeutic Relationshipp. 3
Principles of a Therapeutic Nurse-Client Relationshipp. 6
The Nurse-Client Relationshipp. 7
Impasses That Obstruct a Therapeutic Relationshipp. 9
Interpersonal Techniquesp. 9
Nursing Diagnosisp. 9
Nursing Diagnoses and Medical Diagnosesp. 9
Components of the Nursing Diagnosis Statementp. 9
Risk Nursing Diagnosisp. 13
Outcome Identificationp. 14
Planningp. 15
Clinical Pathwaysp. 15
Implementationp. 16
Impact of Interventions on Etiologyp. 20
Interventions and Medical Actionsp. 20
Rationale Statementsp. 20
Evaluationp. 20
Legal and Ethical Issuesp. 21
Confidentialityp. 21
Duty to Warnp. 21
Clients Rightsp. 21
Voluntary and Involuntary Treatmentp. 21
Forensic Evaluationsp. 21
Malpracticep. 21
Documentationp. 22
The Nursing Process in Community and Home Settingsp. 22
Psychiatric Home Health Care Case Management Systemp. 22
Nursing Outcomes Classification and Nursing Interventions Classificationp. 22
Application of the Nursing Processp. 23
Case Study: The Client with Anxietyp. 23
Anxiety and Related Disordersp. 27
Anxietyp. 27
Responses to Anxietyp. 29
Anxiety Escalationp. 30
Anxiety Transmissionp. 30
Etiologyp. 31
Biologic Factorsp. 31
Mind-Body Connectionp. 31
Other Factorsp. 32
Epidemiologyp. 32
Anxiety Disordersp. 32
Assessment and Diagnostic Criteriap. 33
Panic Disorderp. 33
Panic Disorder with Agoraphobia and Agoraphobia without History of Panic Disorderp. 33
Specific Phobiap. 34
Social Phobiap. 34
Obsessive-Compulsive Disorderp. 34
Posttraumatic Stress Disorderp. 34
Acute Stress Disorderp. 35
Generalized Anxiety Disorderp. 35
Somatoform Disordersp. 35
Somatization Disorderp. 35
Conversion Disorderp. 35
Pain Disorderp. 35
Hypochondriasisp. 35
Body Dysmorphic Disorderp. 36
Factitious Disordersp. 36
Dissociative Disordersp. 36
Dissociative Identity Disorderp. 36
Dissociative Fuguep. 36
Dissociative Amnesiap. 36
Depersonalization Disorderp. 37
Interventionsp. 37
Treatment Settingsp. 37
Medicationsp. 37
Therapiesp. 37
Prognosis and Discharge Criteriap. 38
Care Plan: Anxiety Disorders (All Types)
Anxietyp. 40
Compromised Family Copingp. 46
Care Plan: Phobia
Ineffective Copingp. 50
Care Plan: Obsessive-Compulsive Disorder
Impaired Social Interactionp. 56
Care Plan: Posttraumatic Stress Disorder/Acute Stress Disorder
Posttrauma Syndromep. 62
Care Plan: Somatoform Disorders
Ineffective Copingp. 67
Care Plans: Dissociative Disorders
Ineffective Copingp. 73
Risk for Self-Directed Violence/Risk for Other-Directed Violencep. 78
Mood Disordersp. 81
Etiologyp. 82
Epidemiologyp. 83
Depressionp. 83
Bipolar Disorderp. 83
Assessment and Diagnostic Criteriap. 84
Episodes of Mood Disordersp. 84
Additional Criteria for Episodesp. 85
Major Depressive Disorderp. 86
Dysthymic Disorderp. 86
Bipolar I and II Disordersp. 86
Cyclothymic Disorderp. 87
Mood Disorder due to Medical Conditionp. 87
Substance-Induced Mood Disorderp. 87
Complicationsp. 87
Interventionsp. 89
Treatment Settingsp. 89
Medicationsp. 89
Electroconvulsive Therapyp. 90
Therapiesp. 90
Neuromodulation Devicesp. 91
Prognosis and Discharge Criteriap. 91
Care Plans: Depression (All Types)
Risk for Suicidep. 95
Impaired Social Interactionp. 100
Chronic Low Self-Esteemp. 103
Ineffective Copingp. 106
Hopelessnessp. 109
Powerlessnessp. 111
Self-Care Deficitp. 114
Interrupted Family Processesp. 115
Care Plans: Mania (All Types)
Risk for Self-Directed Violence/Risk for Other-Directed Violencep. 119
Risk for Injuryp. 122
Impaired Social Interactionp. 123
Disturbed Thought Processesp. 126
Defensive Copingp. 130
Imbalanced Nutrition: Less than Body Requirementsp. 133
Compromised Family Copingp. 135
Schizophrenia and Other Psychotic Disordersp. 139
Etiologyp. 140
Epidemiologyp. 140
Onset of Schizophreniap. 140
Course of Schizophreniap. 141
Drug Usep. 141
Mortality and Suicidep. 142
Assessment and Diagnostic Criteriap. 142
Symptoms of Schizophreniap. 142
Acute Phase of Schizophreniap. 142
DSM-IV-TR Criteriap. 145
Types of Schizophreniap. 145
Paranoid Typep. 145
Disorganized Typep. 145
Catatonic Typep. 145
Undifferentiated Typep. 145
Residual Typep. 145
Associated Typesp. 146
Other Psychotic Disordersp. 146
Delusional Disorderp. 146
Brief Psychotic Disorderp. 146
Shared Psychotic Disorderp. 146
Psychotic Disorder due to Medical Conditionp. 146
Substance-Induced Psychotic Disorderp. 146
Interventionsp. 146
Medicationsp. 147
Therapiesp. 147
Community-Based Treatmentp. 148
Prognosis and Discharge Criteriap. 149
Care Plans: Schizophrenia (All Types)
Disturbed Sensory Perceptionp. 152
Disturbed Thought Processesp. 157
Risk for Self-Directed Violence/Risk for Other-Directed Violencep. 163
Social Isolationp. 168
Impaired Verbal Communicationp. 171
Defensive Copingp. 175
Disabled Family Copingp. 179
Self-Care Deficitp. 181
Adjustment Disordersp. 185
Etiologyp. 185
Epidemiologyp. 185
Assessment and Diagnostic Criteriap. 186
DSM-IV-TR Criteriap. 186
Interventionsp. 187
Treatment Settingsp. 187
Medicationsp. 187
Psychosocial Therapiesp. 187
Prognosis and Discharge Criteriap. 188
Care Plans: Adjustment Disorders (All Types)
Ineffective Copingp. 190
Dysfunctional Grievingp. 195
Interrupted Family Processesp. 197
Personality Disordersp. 203
Etiologyp. 203
Epidemiologyp. 204
Assessment and Diagnostic Criteriap. 205
DSM-IV-TR Criteriap. 205
Interventionsp. 208
Medicationsp. 208
Therapeutic Nurse-Client Relationshipp. 208
Prognosis and Discharge Criteriap. 208
Care Plans: Personality Disorders (All Types)
Defensive Copingp. 211
Chronic Low Self-Esteemp. 234
Ineffective Copingp. 258
Interrupted Family Processesp. 272
Disorders of Infancy, Childhood, and Adolescencep. 278
Etiologyp. 278
Epidemiologyp. 279
Prevalencep. 279
Suicidesp. 279
Assessment and Diagnostic Criteriap. 280
DSM-IV-TR Criteriap. 280
Mental Retardationp. 280
Etiologyp. 280
Epidemiologyp. 281
Mild Mental Retardationp. 281
Moderate Mental Retardationp. 281
Severe Mental Retardationp. 282
Profound Mental Retardationp. 282
Learning Disordersp. 282
Reading Disorderp. 282
Mathematics Disorderp. 282
Disorder of Written Expressionp. 282
Motor Skills Disorderp. 282
Developmental Coordination Disorderp. 282
Communication Disordersp. 282
Expressive and Receptive Language Disordersp. 282
Phonologic Disorderp. 282
Stutteringp. 283
Pervasive Developmental Disordersp. 283
Autistic Disorderp. 283
Rett's Disorderp. 284
Childhood Disintegrative Disorderp. 284
Asperger's Disorderp. 284
Attention Deficit and Disruptive Behavior Disordersp. 284
Attention-Deficit/Hyperactivity Disorderp. 284
Conduct Disorder (Solitary Aggressive Type)p. 285
Oppositional Defiant Disorderp. 285
Feeding and Eating Disorders of Infancy or Early Childhoodp. 285
Picap. 285
Rumination Disorderp. 285
Feeding Disorder of Infancy or Early Childhoodp. 285
Tic Disorderp. 285
Tourette's Disorderp. 285
Elimination Disordersp. 286
Enuresisp. 286
Encopresisp. 286
Other Disorders of Infancy, Childhood, or Adolescencep. 286
Separation Anxiety Disorderp. 286
Selective Mutismp. 287
Reactive Attachment Disorder of Infancy or Early Childhoodp. 287
Stereotypic Movement Disorderp. 287
Interventionsp. 287
Prevention Programsp. 287
Medicationsp. 287
Therapiesp. 288
Prognosis and Discharge Criteriap. 290
Care Plan: Attention Deficit and Disruptive Behavior Disorders
Risk for Self-Directed Violence/Risk for Other-Directed Violencep. 293
Care Plan: Mental Retardation or Pervasive Development Disorders
Delayed Growth and Developmentp. 301
Care Plan: Disorders of Infancy, Childhood, and Adolescence (All Types)
Chronic Low Self-Esteemp. 313
Compromised Family Copingp. 320
Cognitive Disorders: Delirium, Dementia, and Amnestic Disordersp. 325
Etiologyp. 325
Epidemiologyp. 326
Deliriump. 326
Dementiap. 327
Amnestic and Other Cognitive Disordersp. 327
Assessment and Diagnostic Criteriap. 328
Deliriump. 328
Dementiap. 329
Amnestic and Other Cognitive Disordersp. 331
Interventionsp. 331
Treatment Settingsp. 331
Medicationsp. 332
Other Treatmentsp. 332
Therapiesp. 332
Prognosis and Discharge Criteriap. 332
Care Plans: Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Acute Confusionp. 335
Disturbed Thought Processesp. 347
Impaired Social Interactionp. 356
Substance-Related Disordersp. 362
Drugs of Abusep. 362
Etiologyp. 362
Epidemiologyp. 363
Ravesp. 364
Comorbidityp. 364
Assessment and Diagnostic Criteriap. 364
Substance Intoxicationp. 364
Substance Abusep. 364
Substance Dependencep. 366
The Substances of Abusep. 366
Alcoholp. 366
Amphetaminesp. 366
Caffeinep. 366
Cannabisp. 367
Cocainep. 367
Hallucinogensp. 367
Inhalantsp. 367
Nicotinep. 368
Opiatesp. 368
Phencyclidinep. 368
Sedatives, Hypnotics, and Anxiolyticsp. 368
Polysubstance Dependencep. 368
Interventionsp. 369
Treatment Settingsp. 369
Medicationsp. 370
Therapiesp. 371
Prognosis and Discharge Criteriap. 372
Care Plans: Substance-Related Disorders
Ineffective Denialp. 376
Disabled Family Copingp. 383
Risk for Injuryp. 388
Risk for Self-Directed Violence/Risk for Other-Directed Violencep. 396
Eating Disordersp. 399
Etiologyp. 399
Epidemiologyp. 399
Comorbidityp. 399
Assessment and Diagnostic Criteriap. 399
Anorexia Nervosap. 399
Bulimia Nervosap. 400
DSM-IV-TR Categoriesp. 401
Interventionsp. 401
Therapiesp. 401
Medicationsp. 402
Prognosis and Discharge Criteriap. 402
Care Plans: Anorexia Nervosa/Bulimia Nervosa
Imbalanced Nutrition: Less than Body Requirementsp. 405
Disturbed Body Imagep. 417
Interrupted Family Processesp. 421
Sexual and Gender Identity Disordersp. 427
Etiologyp. 427
Epidemiologyp. 427
Assessment and Diagnostic Criteriap. 428
Sexual Dysfunctionsp. 428
Paraphiliasp. 431
Gender Identity Disorderp. 432
Interventionsp. 432
Treatment Settingsp. 432
Therapiesp. 432
Medicationsp. 433
Prognosis and Discharge Criteriap. 433
Care Plan: Sexual Dysfunctions
Sexual Dysfunctionp. 436
Care Plan: Sexual and Gender Identity Disorders
Interrupted Family Processesp. 440
Suicide Assessment and Intervention Guidelinesp. 446
Principlesp. 446
Nursing Interventionsp. 446
Crisis and Crisis Interventionp. 448
Types of Crisisp. 448
Developmental Crisisp. 448
Situational Crisisp. 448
Influencing Factorsp. 448
Crisis Interventionp. 449
Therapist's Rolep. 449
Active Intervention Processp. 449
Client Rightsp. 450
Guidelines for Seclusion and Restraint Based on JCAHO Standardsp. 451
Nursing Assessmentp. 451
Plan of Action and Rationalep. 451
Model for Interventionp. 451
Intervention and Rationalep. 451
Verbal Interactionp. 452
Seclusionp. 452
Procedurep. 452
Provide Continual Documentationp. 452
Restraintp. 452
Policyp. 452
Documentation (Mandatory for Restraint Order)p. 453
Procedure (Supervised by Qualified Charge Nurse)p. 453
Post-Restraint Proceduresp. 453
Grief and Loss: Caregivers, Clients, and Familiesp. 455
Griefp. 455
Phases of Griefp. 456
Phase I (1 to 3 Weeks): Shock, Numbness, Denialp. 456
Phase II (3 Weeks to 4 Months): Yearning and Protest, Anger, Confrontationp. 456
Phase III (4 to 14 Months): Apathy, Aimlessness, Disorganization, Despairp. 456
Phase IV (14 Months to Throughout Rest of Life): Recovery, Resolution, Acceptancep. 457
Anticipatory Grief: Premourning, Predeathp. 457
Interventions in Anticipatory Griefp. 457
Chronic Sorrowp. 457
Interventions in Chronic Sorrowp. 457
Summary of Theories of Griefp. 457
Lindemannp. 457
Kubler-Rossp. 458
Bowlbyp. 458
Engelp. 459
Shneidmanp. 459
Theory Synthesisp. 459
Tips for Helping Survivorsp. 459
Spirituality as a Dimension of the Personp. 460
Descriptions of Termsp. 460
Spiritualityp. 460
Religionp. 460
Faithp. 461
Spirituality in Mental Healthp. 461
Role of the Chaplain in Mental Healthp. 461
Stages of Faith in Spiritual Practice and Interventionsp. 461
Impartial Individualp. 461
Institutional Individualp. 461
Individual Seekerp. 461
Integrated Individualsp. 462
Summary of Spiritualityp. 462
Care Plan: Spirituality
Spiritual Distressp. 463
Psychiatric and Psychosocial Therapiesp. 467
Cognitive Behavioral Therapyp. 467
Thought Stoppingp. 467
Thought Substitutionp. 468
Reframing/Relabelingp. 468
Rational-Emotive Therapy (RET)p. 468
Deep-Breathing Exercisesp. 468
Benson's Relaxation Responsep. 468
Progressive Relaxation Techniquep. 469
Visualization (Visual Imagery, Guided Imagery)p. 469
Strategic Therapyp. 469
Assertiveness Trainingp. 469
Systematic Desensitizationp. 470
Dialectical Behavior Therapyp. 470
Other Therapiesp. 471
Psychoanalytic Therapyp. 471
Gestalt Therapyp. 471
Client-Centered Therapyp. 471
Family Therapy, Family Systems Therapyp. 471
Group Therapyp. 471
Transactional Analysisp. 472
Psychodramap. 472
Eye Movement Desensitization and Reprocessingp. 472
Virtual Reality Exposure Therapyp. 472
Psychopharmacologyp. 473
Sedative-Hypnotic Drugsp. 473
Antianxiety Drugs: Benzodiazepinesp. 474
Antianxiety Drugs: Miscellaneousp. 477
Antipsychotic Drugs: Typicalp. 478
Antipsychotic Drugs: Atypicalp. 482
Antiparkinson/Anticholinergic Drugsp. 484
Antidepressant Drugs: Tricyclic (TCAs)p. 486
Antidepressant Drugs: Selective Serotonin Reuptake Inhibitors (SSRIs)p. 489
Antidepressant Drugs: Miscellaneousp. 491
Antidepressant Drugs: Monoamine Oxidase Inhibitors (MAOIs)p. 494
Antimanic Drugs: Mood Stabilizersp. 496
Central Nervous System Stimulants and Miscellaneous Drugs for Hyperkinesisp. 498
Alcohol and Drug Abuse Adjunct Treatment Drugsp. 499
Cholinesterase Inhibitors (Alzheimer Treatment)p. 503
Comparison of Developmental Theoriesp. 504
Freud's Psychosexual Theoryp. 504
Erikson's Psychosocial Theoryp. 504
Maslow's Theory of Human Needp. 505
Piaget's Theory of Cognitive Developmentp. 505
Kohlberg's Theory of Moral Reasoningp. 507
Defense Mechanisms and Strategiesp. 508
Standards of Care for Psychiatric-Mental Health Nursing Practicep. 510
DSM-IV-TR Classificationp. 512
Glossaryp. 522
Referencesp. 532
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