Efnisyfirlit

• Front Matter
  • About the Author
  • About the Artist
    • Rising Tide
    • The Day Moon
    • Dark Night
    • Intuitive
    • Carolina Moon
    • Earthrise
    • Full Moon
  • Contributors
  • Reviewers
  • Preface
    • Student Learning Guide
    • Faculty Teaching Guide
• Interactive Review – Principles and Practice of Psychiatric Nursing
• Unit 1 Principles of Psychiatric Nursing Care
  • Interactive Review – Unit 1
  • Chapter 1 Roles and Functions of Psychiatric–Mental Health Nurses: Competent Caring
    • Learning Objectives
    • Historical Perspectives
      • TABLE 1-1 EVOLUTIONARY TIMELINE IN PSYCHIATRIC NURSING
      • BOX 1-1 A NURSE SPEAKS
      • Role Emergence
        • BOX 1-2 A PHYSICIAN SPEAKS
        • Critical Reasoning
        • BOX 1-3 INTERPERSONAL NURSING ROLES IDENTIFIED BY PEPLAU
        • Critical Reasoning
      • Evolving Functions
        • FIG 1-1 Hildegard E. Peplau.
        • Critical Reasoning
        • Critical Reasoning
    • Contemporary Practice
      • Nurse-Patient Partnership
      • Competent Caring
        • FIG 1-2 Elements of the psychiatric–mental health nursing role.
        • BOX 1-4 PHILOSOPHICAL BELIEFS OF PSYCHIATRIC–MENTAL HEALTH NURSING PRACTICE
        • FIG 1-3 Psychiatric–mental health nursing practice.
        • BOX 1-5 DOMAINS OF PSYCHIATRIC–MENTAL HEALTH NURSING PRACTICE
          • Direct Care Activities
          • Communication Activities
          • Management Activities
        • Critical Reasoning
    • Levels of Performance
      • Laws
      • Qualifications
      • Practice Setting
        • TABLE 1-2 PSYCHIATRIC NURSING SUPPORT GROUPS
        • Critical Reasoning
      • Personal Initiative
        • Critical Reasoning
    • Psychiatric Nursing Agenda
      • Outcome Evaluation
      • Leadership Skills
        • Critical Reasoning
      • Political Action
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 2 Therapeutic Nurse–Patient Relationship
    • Learning Objectives
    • Characteristics of the Relationship
      • BOX 2-1 CHARACTERISTICS THAT FACILITATE GROWTH IN HELPING RELATIONSHIPS
    • Personal Qualities of the Nurse
      • Awareness of Self
        • FIG 2-1 Elements affecting the nurse's ability to be therapeutic.
        • Increasing Self-Awareness
          • FIG 2-2 Johari window. Each quadrant, or windowpane, describes one aspect of the self.
          • Critical Reasoning
        • The Nurse and Self-Growth
          • FIG 2-3 A and B, Johari windows showing varying degrees of self-awareness.
          • Critical Reasoning
      • Clarification of Values
        • Value Systems
          • Critical Reasoning
        • Value Clarification Process
        • The Mature Valuing Process
          • TABLE 2-1 STEPS IN THE VALUE CLARIFICATION PROCESS
          • Critical Reasoning
      • Exploration of Feelings
      • Serving as Role Model
        • Critical Reasoning
      • Altruism
      • Ethics and Responsibility
        • Critical Reasoning
    • Phases of the Relationship
      • Preinteraction Phase
        • Concerns of New Nurses
          • BOX 2-2 COMMON CONCERNS OF PSYCHIATRIC NURSING STUDENTS
          • Clinical Example
          • Critical Reasoning
          • Self-Assessment
      • Introductory, or Orientation, Phase
        • Forming a Contract
          • Critical Reasoning
      • Working Phase
        • TABLE 2-2 ANALYSIS OF WHY PATIENTS SEEK PSYCHIATRIC HELP
        • BOX 2-3 REASONS PATIENTS HAVE DIFFICULTY SEEKING HELP
      • Termination Phase
        • BOX 2-4 ELEMENTS OF A NURSE-PATIENT CONTRACT
        • BOX 2-5 CRITERIA FOR DETERMINING PATIENT READINESS FOR TERMINATION
        • Critical Reasoning
    • Facilitative Communication
      • Verbal Communication
        • TABLE 2-3 NURSE'S TASKS IN EACH PHASE OF THE RELATIONSHIP PROCESS
        • Critical Reasoning
      • Nonverbal Communication
        • Types of Nonverbal Behaviors
          • Critical Reasoning
        • Interpreting Nonverbal Behavior
          • THERAPEUTIC DIALOGUE
            • Patient
            • Nurse Response No. 1
            • Nurse Response No. 2
            • Nurse Response No. 3
        • Implications for Nursing Care
          • Critical Reasoning
      • The Communication Process
        • Structural Model
          • FIG 2-4 Components of communication.
          • Sender
            • TABLE 2-4 PROBLEMS WITH THE STRUCTURAL ELEMENTS OF THE COMMUNICATION PROCESS
            • THERAPEUTIC DIALOGUE
              • Congruent Communication
                • Verbal Level
                • Nonverbal Level
              • Incongruent Communication
                • Verbal Level
                • Nonverbal Level
          • Message
          • Receiver
          • Feedback
          • Context
      • Therapeutic Communication Techniques
        • Listening
          • TABLE 2-5 PROCESS RECORDING
        • Broad Openings
        • Restating
        • Clarification
        • Reflection
          • THERAPEUTIC DIALOGUE
            • Patient
            • Nurse
          • THERAPEUTIC DIALOGUE
            • Patient
            • Nurse
            • Patient
        • Focusing
          • THERAPEUTIC DIALOGUE
            • Patient
            • Nurse
        • Sharing Perceptions
          • THERAPEUTIC DIALOGUE
            • Patient
            • Nurse
        • Theme Identification
        • Silence
        • Humor
          • BOX 2-6 POSITIVE FUNCTIONS OF HUMOR
        • Informing
        • Suggesting
          • Critical Reasoning
    • Motivational Interviewing
      • BOX 2-7 THERAPEUTIC COMMUNICATION TECHNIQUES
    • Responsive Dimensions
      • Genuineness
        • THERAPEUTIC DIALOGUE
          • Patient
          • Nurse
      • Respect
        • Critical Reasoning
      • Empathic Understanding
        • Development of Empathy
          • BOX 2-8 RESEARCH FINDINGS ABOUT EMPATHY
        • Empathic Responses
          • THERAPEUTIC DIALOGUE
            • Patient
            • Nurse
            • Patient
            • Nurse
            • Patient
            • Nurse
            • Patient
            • Nurse
            • Patient
          • Critical Reasoning
      • Concreteness
        • FIG 2-5 Levels of concreteness in the therapeutic relationship.
        • THERAPEUTIC DIALOGUE
          • Example 1
            • Patient
            • Nurse
            • Patient
            • Nurse
          • Example 2
            • Patient
            • Nurse
    • Action Dimensions
      • Confrontation
        • Timing in Relationships
          • FIG 2-6 Levels of confrontation in the therapeutic relationship.
          • THERAPEUTIC DIALOGUE
            • Example 1
              • Nurse
            • Example 2
              • Nurse
            • Example 3
              • Nurse
            • Example 4
              • Nurse
            • Example 5
              • Nurse
          • Critical Reasoning
      • Immediacy
        • THERAPEUTIC DIALOGUE
          • Example 1
            • Patient
            • Nurse
          • Example 2
            • Patient
            • Nurse
      • Nurse Self-Disclosure
        • BOX 2-9 GUIDELINES FOR SELF-DISCLOSURE
        • THERAPEUTIC DIALOGUE
          • Patient
          • Nurse
      • Emotional Catharsis
        • THERAPEUTIC DIALOGUE
          • Nurse
          • Patient
          • Nurse
          • Patient
          • Patient
      • Role Playing
        • Critical Reasoning
        • TABLE 2-6 RESPONSIVE AND ACTION DIMENSIONS FOR THERAPEUTIC NURSE–PATIENT RELATIONSHIPS
    • Therapeutic Impasses
      • BOX 2-10 FORMS OF RESISTANCE DISPLAYED BY PATIENTS
      • Resistance
      • Transference
        • Overcoming Resistance and Transference
          • BOX 2-11 FORMS OF COUNTERTRANSFERENCE DISPLAYED BY NURSES
      • Countertransference
        • Problem Patients
      • Boundary Violations
        • BOX 2-12 POSSIBLE BOUNDARY VIOLATIONS RELATED TO PSYCHIATRIC NURSES
        • Critical Reasoning
    • Therapeutic Outcome
    • CHAPTER IN REVIEW
    • References
  • Chapter 3 The Stuart Stress Adaptation Model of Psychiatric Nursing Care
    • Learning Objectives
    • Theoretical Assumptions
      • FIG 3-1 Levels of organization that comprise the social hierarchy.
      • BOX 3-1 ASSUMPTIONS OF THE STUART STRESS ADAPTATION MODEL
    • Describing Mental Health and Illness
      • FIG 3-2 Patterns of behavior.
      • Defining Mental Health
        • Critical Reasoning
        • Criteria of Mental Health.
      • Defining Mental Illness
        • BOX 3-2 KEY FACTS ABOUT MENTAL AND SUBSTANCE USE DISORDERS
          • Overall
          • Substance Use
          • Costs
          • Treatment
        • Critical Reasoning
    • Biopsychosocial Components
      • Predisposing Factors
      • Precipitating Stressors
        • Stressful Life Events.
          • FIG 3-3 Biopsychosocial components of the Stuart Stress Adaptation Model of psychiatric nursing care.
          • Critical Reasoning
        • Life Strains and Hassles.
      • Appraisal of Stressors
        • Cognitive Responses.
          • BOX 3-3 THE SOCIOCULTURAL CONTEXT OF CARE
          • Critical Reasoning
        • Affective Responses.
        • Physiological Responses.
        • Behavioral Responses.
        • Social Responses.
          • Critical Reasoning
      • Coping Resources
      • Coping Mechanisms
    • Patterns of Response
      • Nursing Diagnoses
      • Relationship to Medical Diagnoses
        • FIG 3-4 Comparison of nursing and medical models of care.
      • Classifying Mental Disorders
        • DSM-IV-TR.
          • BOX 3-4 OUTLINE FOR CULTURAL FORMULATION IN PSYCHIATRIC DIAGNOSIS
          • Cultural formulation
            • TABLE 3-1 COMMON CULTURE-BOUND SYNDROMES
    • Treatment Stages and Activities
      • Crisis Stage
      • Acute Stage
        • FIG 3-5 Psychiatric nursing treatment stages and activities.
      • Health Maintenance Stage
      • Health Promotion Stage
        • FIG 3-6 The Stuart Stress Adaptation Model of psychiatric nursing care.
        • TABLE 3-2 STAGES OF TREATMENT RELATED TO LEVELS OF PREVENTION AND CHAPTERS OF THE TEXT
        • TABLE 3-3 SUMMARY OF THE ELEMENTS OF THE STUART STRESS ADAPTATION MODEL
    • CHAPTER IN REVIEW
    • References
  • Chapter 4 Evidence-Based Psychiatric Nursing Practice
    • Learning Objectives
    • Evidence-Based Practice
      • FIG 4-1 Evidence-based behavioral practice.
      • Bases for Nursing Practice
        • Critical Reasoning
      • Developing Evidence-Based Care
        • FIG 4-2 Developing evidence-based care.
        • BOX 4-1 EVIDENCE-BASED PRACTICE RESOURCES
        • Critical Reasoning
    • Practice Guidelines
      • BOX 4-2 HIERARCHY OF RESEARCH EVIDENCE
      • BOX 4-3 QUESTIONS TO ASK WHEN EVALUATING A PRACTICE GUIDELINE
      • FIG 4-3 Taxonomy of building blocks for informed decision making in behavioral health assessment and treatment.
      • Critical Reasoning
      • Clinical Pathways
        • Critical Reasoning
        • BOX 4-4 CHARACTERISTICS OF GOOD BEHAVIORAL HEALTH PRACTICE GUIDELINES
      • Clinical Algorithms
        • Critical Reasoning
    • Outcome Measurement
      • BOX 4-5 CATEGORIES OF OUTCOME INDICATORS
        • Clinical Outcome Indicators
        • Functional Outcome Indicators
        • Satisfaction Outcome Indicators
        • Financial Outcome Indicators
      • Critical Reasoning
      • TABLE 4-1 Considerations in Selecting Outcome Measures in Psychiatric Nursing Practice
      • Patient Satisfaction
      • Quality Report Cards
        • Critical Reasoning
    • Evidence Base for Psychiatric Nursing Practice
      • Agenda for Psychiatric Nursing Research
      • Beyond Evidence-Based Practice
    • CHAPTER IN REVIEW
    • References
  • Chapter 5 Biological Context of Psychiatric Nursing Care
    • Learning Objectives
    • Structure and Function of the Brain
      • FIG 5-1 The field of neuroscience.
      • BOX 5-1 ABOUT THE BRAIN
      • FIG 5-2 Lateral view of the left cerebral hemisphere of the brain.
      • FIG 5-3 Superior view of the brain.
      • FIG 5-4 When the brain is cut between the two hemispheres down the middle (a midsagittal section), the main divisions can be seen clearly, as in A and C, which are schematic representations. B, A magnetic resonance imaging scan. C, Schematic representation of midsagittal section of the brain.
      • FIG 5-5 Structure and function of the brain.
      • FIG 5-6 Structures of the limbic system.
      • BOX 5-2 STRUCTURE AND FUNCTION OF THE BRAIN
        • Cerebrum
          • Dominant Hemisphere
          • Nondominant Hemisphere
          • Corpus Callosum
          • Cerebral Cortex
          • Frontal Lobes
          • Parietal Lobes
          • Central Sulcus
          • Temporal Lobes
          • Lateral Fissure
          • Occipital Lobes
        • Diencephalon
          • Thalamus
          • Pineal Gland
          • Hypothalamus
        • Brainstem
          • Midbrain
          • Pons
          • Medulla Oblongata
          • Reticular Formation
        • Basal Ganglia
        • Limbic System
          • Hippocampus
          • Amygdala
          • Fornix
        • Cerebellum
        • Ventricles
        • Spinal Fluid
        • Blood-Brain and Blood-CSF Barriers
      • Critical Reasoning
    • Neuroimaging
      • FIG 5-7 Neurotransmission. Bottom: 1, Neurotransmitter is released from presynaptic cell into synapse. 2, Neurotransmitter, recognized by receptor cell, causes channel to open, and ions are exchanged. 3, Exchange of ions causes impulse, which causes reaction in receptor cell. 4, Neurotransmission has taken place, receptor channel closes, and neurotransmitter returns to presynaptic membrane (reuptake).
      • FIG 5-8 Positron emission tomography (PET) scan shows varying patterns of glucose consumption during different tasks. The color scale ranges from 2 (violet) to 45 (red). A, Different kinds of tasks cause increased glucose consumption in distinct areas of the brain. A checkerboard visual stimulus activates the occipital lobes. An auditory stimulus causes increased glucose consumption in the temporal lobes. When an individual is engaged in an active, cognitive task rather than passive perception of stimuli, glucose consumption increases in the frontal lobes. Subjects trying to remember information from a verbal stimulus (a story) show increased glucose consumption in the temporal lobes. Sequential movements of the fingers of the right hand activate the motor cortex on the left and the supplementary motor arc (vertical arrows)B, Increasing complexity of a particular kind of task causes increased glucose consumption in progressively larger areas of the cortex. With the subject blindfolded (“eyes closed”), there is relatively little glucose consumption in the occipital lobes. With the eyes open, looking at a plain white light source activates the primary visual cortex of the occipital lobes. Looking at an outdoor scene (“complex scene”) activates the visual association cortex in additional areas of the occipital lobes. C, The left hemisphere usually plays a dominant role in language functions, and the right hemisphere is involved in musical and certain other functions. When a subject listens simultaneously to a Sherlock Holmes story and a Brandenburg concerto, both superior temporal lobes and both frontal lobes are activated. Listening to just the story activates predominantly the left hemisphere. Musical chords alone activate predominantly the right hemisphere.
      • TABLE 5-1 NEUROTRANSMITTERS AND NEUROMODULATORS IN THE BRAIN
      • TABLE 5-2 BRAIN-IMAGING TECHNIQUES
      • Critical Reasoning
    • Biological Rhythms
      • TABLE 5-3 TIME: AN INSTANT TO ETERNITY
      • Circadian Rhythms
      • Sleep
        • FIG 5-9 The day within: a sample of the body's daily rhythms.
        • FIG 5-10 From the sun to the brain.
        • Critical Reasoning
    • Psychoneuroimmunology
      • FIG 5-11 Normal sleep architecture. Green areas indicate REM sleep.
    • Genetics
      • BOX 5-3 INSIGHTS GAINED FROM THE HUMAN DNA SEQUENCE
      • FIG 5-12 A primer: from DNA to life. Cells contain DNA—the hereditary material of all living things. The genome is an organism's complete set of DNA and is organized into chromosomes. DNA contains genes whose sequence specifies how and when to build proteins. Proteins perform most essential life functions, often working together as molecular machines. Molecular machines interact through complex, interconnected pathways and networks to make the cell come alive. Communities of cells range from associations of microbes (each a single cell) to the hundred trillion cells in a human.
      • Critical Reasoning
      • Genetics of Mental Illness
        • TABLE 5-4 STUDY DESIGNS FOR INHERITANCE AND GENETIC RESEARCH ON MENTAL DISORDERS
      • Impact of the Human Genome Project
    • Biological Assessment of the Patient
      • Critical Reasoning
      • BOX 5-4 BIOLOGICAL ASSESSMENT OF THE PSYCHIATRIC PATIENT
        • Health Care History
          • General Health Care
          • Hospitalizations, Surgeries, and Medical Procedures
          • Brain Impairment
          • Cancer
          • Lung Problems
          • Cardiac Problems
          • Diabetes
          • Endocrine Disturbances
          • Menstrual History
          • Sexual History
          • Reproductive History
        • Lifestyle
          • Eating
          • Medications
          • Substance Use
          • Toxins
          • Occupation (Current and Past)
          • Injury
          • Impact of Culture, Race, Ethnicity, and Gender
            • Physical Examination
              • Review of Physiological Systems
        • Laboratory Values
        • Presenting Symptoms and Coping Responses
    • CHAPTER IN REVIEW
    • References
  • Chapter 6 Psychological Context of Psychiatric Nursing Care
    • Learning Objectives
    • Mental Status Examination
      • Critical Reasoning
      • Obtaining Clinical Information
        • BOX 6-1 CATEGORIES OF THE MENTAL STATUS EXAMINATION
          • General Description
          • Emotional State
          • Experiences
          • Thinking
          • Sensorium and Cognition
    • Content of the Examination
      • Appearance
        • CLINICAL EXAMPLE
        • BOX 6-2 SOCIOCULTURAL CONTEXT OF CARE
          • Clinical Judgment or Sociocultural Bias?
        • Observations.
        • Clinical Implications
      • Speech
        • Observations.
        • Clinical Implications
      • Motor Activity
        • Observations.
        • Clinical Implications
          • Critical Reasoning
      • Interaction During the Interview
        • CLINICAL EXAMPLE
        • Observations.
        • Clinical Implications
      • Mood
        • Observations.
          • CLINICAL EXAMPLE
        • Clinical Implications
      • Affect
        • Observations.
        • Clinical Implications
      • Perceptions
        • Observations.
        • Clinical Implications
          • Critical Reasoning
      • Thought Content
        • Observations.
          • BOX 6-3 THOUGHT CONTENT DESCRIPTORS
          • CLINICAL EXAMPLE
          • BOX 6-4 THOUGHT PROCESS DESCRIPTORS
        • Clinical Implications
      • Thought Process
        • Observations.
        • Clinical Implications
      • Level of Consciousness
        • BOX 6-5 QUESTIONS USEFUL IN DETERMINING ORIENTATION
          • Questions Related to Time
          • Questions Related to Place
          • Questions Related to Person
        • Observations.
        • Clinical Implications
      • Memory
        • Observations.
        • Clinical Implications
      • Level of Concentration and Calculation
        • Observations.
          • BOX 6-6 GENDER DIFFERENCES IN THE BRAIN
            • Problem-Solving Tasks Favoring Women
            • Problem-Solving Tasks Favoring Men
        • Clinical Implications
      • Information and Intelligence
        • Observations.
        • Clinical Implications
      • Judgment
        • Observations.
        • Clinical Implications
          • Critical Reasoning
      • Insight
        • Observations.
          • CLINICAL EXAMPLE
        • Clinical Implications
      • Documenting Clinical Information
      • Mini-Mental State Examination
    • Psychological Tests
      • BOX 6-7 CASE STUDY
      • Critical Reasoning
    • Behavioral Rating Scales
    • CHAPTER IN REVIEW
    • Mental Status Examination (read text)
    • References
  • Chapter 7 Social, Cultural, and Spiritual Context of Psychiatric Nursing Care
    • Learning Objectives
    • BOX 7-1 THE FUNCTIONS OF CULTURE
    • Cultural Competency
      • BOX 7-2 CULTURAL COMPETENCE SELF-ASSESSMENT
      • Critical Reasoning
    • Risk Factors and Protective Factors
      • Critical Reasoning
      • FIG 7-1 Sociocultural context of psychiatric care.
      • Age
        • BOX 7-3 SOCIOCULTURAL DIVERSITY AND THE HEALTH CARE SYSTEM
        • Critical Reasoning
      • Ethnicity
        • Critical Reasoning
      • Gender
        • CLINICAL EXAMPLE
        • Critical Reasoning
      • Education
        • CLINICAL EXAMPLE
      • Income
        • CLINICAL EXAMPLE
        • Critical Reasoning
      • Beliefs
        • Critical Reasoning
    • Nursing Assessment and Diagnosis
      • BOX 7-4 SOCIOCULTURAL STRESSORS
      • Critical Reasoning
      • BOX 7-5 QUESTIONS RELATED TO SOCIOCULTURAL RISK AND PROTECTIVE FACTORS
        • Age
          • Questions
          • Example
        • Ethnicity
          • Questions
          • Example
        • Gender
          • Questions
          • Example
        • Education
          • Questions
          • Example
        • Income
          • Questions
          • Example
        • Beliefs
          • Questions
          • Example
      • Critical Reasoning
      • Critical Reasoning
    • Treatment Implications
      • Service Utilization
        • Critical Reasoning
      • Therapeutic Nurse–Patient Interactions
      • Psychopharmacology
    • CHAPTER IN REVIEW
    • References
  • Chapter 8 Legal and Ethical Context of Psychiatric Nursing Care
    • Learning Objectives
    • Ethical Standards
      • BOX 8-1 ESSENTIAL ETHICS SKILLS IN PSYCHIATRIC PRACTICE
      • Ethical Decision Making
        • FIG 8-1 Model for ethical decision making.
        • Critical Reasoning
        • TABLE 8-1 STEPS AND QUESTIONS IN ETHICAL DECISION MAKING
      • Ethical Dilemmas
    • Hospitalizing the Patient
      • Critical Reasoning
      • Voluntary Admission
        • Critical Reasoning
      • Involuntary Admission (Commitment)
        • The Commitment Process.
          • TABLE 8-2 CHARACTERISTICS OF THE TWO TYPES OF ADMISSION TO PSYCHIATRIC HOSPITALS
          • Critical Reasoning
        • Emergency Hospitalization.
        • Short-Term or Observational Hospitalization.
          • FIG 8-2 Clinical algorithm for the involuntary commitment process.
        • Long-Term Hospitalization (Formal Commitment).
          • Critical Reasoning
        • Commitment Dilemma.
          • Critical Reasoning
          • Dangerousness
            • Critical Reasoning
          • Freedom of Choice
            • Critical Reasoning
      • Discharge
      • Ethical Considerations
    • Involuntary Community Treatment
      • Critical Reasoning
    • Patients’ Rights
      • Critical Reasoning
      • Right to Communicate With People Outside the Hospital
        • BOX 8-2 RIGHTS OF PSYCHIATRIC PATIENTS
      • Right to Keep Personal Effects
        • Critical Reasoning
      • Right to Enter into Contractual Relationships
        • Critical Reasoning
        • Incompetency.
          • Critical Reasoning
      • Right to Education
        • Critical Reasoning
      • Right to Habeas Corpus
      • Right to Privacy
        • Critical Reasoning
        • HIPAA.
        • Privileged Communication.
          • Critical Reasoning
        • Circle of Confidentiality.
          • FIG 8-3 The circle of confidentiality.
          • Critical Reasoning
        • Protecting a Third Party.
      • Right to Informed Consent
        • Critical Reasoning
      • Right to Treatment
        • BOX 8-3 EXCEPTIONS ALLOWING THE RELEASE OF INFORMATION WITHOUT THE PATIENT'S CONSENT
        • BOX 8-4 OBTAINING INFORMED CONSENT
          • Information to Disclose
            • Diagnosis
            • Treatment
            • Consequences
            • Alternatives
            • Prognosis
          • Principles of Informing
      • Right to Refuse Treatment
        • Forcing Medications.
          • Critical Reasoning
          • Critical Reasoning
      • Right to Treatment in the Least Restrictive Setting
        • Critical Reasoning
      • Ethical Considerations
        • BOX 8-5 HIERARCHY OF RESTRICTIVENESS
    • Psychiatry and Criminal Responsibility
      • Disposition of Mentally Ill Offenders
        • Critical Reasoning
    • Legal Role of the Nurse
      • FIG 8-4 Legal influences on psychiatric nursing practice.
      • TABLE 8-3 THREE SETS OF CRITERIA USED TO DETERMINE THE CRIMINAL RESPONSIBILITY OF A MENTALLY ILL OFFENDER
      • Nurse as Provider
        • Malpractice.
        • Litigation.
        • Legal Responsibilities.
          • BOX 8-6 COMMON AREAS OF LIABILITY IN PSYCHIATRIC SERVICES
          • BOX 8-7 SELECTED LITIGATION INVOLVING PSYCHIATRIC NURSES
            • Case 1: Valentine v Strange (597 F. SUPP. 1316-VA.)
            • Case 2: Delicata v Bourlesses (404 N.E. 2ND 667-MASS.)
            • Case 3: Vattimo v Lower Bucks Hospital (428 A. 2ND 765-PA.)
      • Nurse as Employee
        • Critical Reasoning
        • Critical Reasoning
      • Nurse as Citizen
        • CLINICAL EXAMPLE
    • CHAPTER IN REVIEW
    • References
  • Chapter 9 Policy and Advocacy in Mental Health Care
    • Learning Objectives
    • A Compelling Need
      • The Global View
      • The National View
        • Critical Reasoning
        • Critical Reasoning
        • FIG 9-1 Reasons for not seeking treatment.
        • BOX 9-1 HEALTHY PEOPLE 2020—OBJECTIVES RELATED TO MENTAL HEALTH AND MENTAL ILLNESS
          • Mental Health Status Improvement
          • Treatment Expansion
    • Policy and Legislation
      • Critical Reasoning
      • BOX 9-2 GOALS AND RECOMMENDATIONS IN A TRANSFORMED MENTAL HEALTH SYSTEM
        • Goal 1: Americans Understand that Mental Health Is Essential to Overall Health
          • Recommendations
        • Goal 2: Mental Health Care Is Consumer and Family Driven
          • Recommendations
        • Goal 3: Disparities in Mental Health Services Are Eliminated
          • Recommendations
        • Goal 4: Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice
          • Recommendations
        • Goal 5: Excellent Mental Health Care Is Delivered and Research Is Accelerated
          • Recommendations
        • Goal 6: Technology Is Used to Access Mental Health Care and Information
          • Recommendations
      • Critical Reasoning
      • FIG 9-2 Declining commitment of state dollars to mental health.
      • Mental Health Parity Act of 1996
        • Critical Reasoning
      • Mental Health and Addiction Equity Act of 2008 (Federal Mental Health Parity Law)
      • Patient Protection and Affordable Care Act of 2010 (Health Reform Law)
        • BOX 9-3 PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 (HEALTH REFORM LAW): IMPACT ON MENTAL HEALTH CARE
      • Protection and Advocacy Act
      • Americans with Disabilities Act
        • Critical Reasoning
        • Critical Reasoning
      • Advance Directives
        • Critical Reasoning
      • Mental Health Courts
    • Advocacy by Nurses
      • Patient Advocacy
        • CLINICAL EXAMPLE
      • Issues’ Advocacy
        • Critical Reasoning
      • Community and Public Health Advocacy
        • TABLE 9-1 COMMUNITY AND PUBLIC HEALTH ORGANIZATIONS AND AGENCIES WITH ADVOCACY ACTIVITIES
        • CLINICAL EXAMPLE
      • Professional Advocacy
        • TABLE 9-2 PROFESSIONAL NURSING ORGANIZATIONS WITH ADVOCACY ACTIVITIES
      • Advocacy Strategies
        • Advocacy Is a Personal and Professional Call to Action.
        • Fight the Stigma.
        • Share Your Personal Experience with Mental Illness.
        • Influence Public Opinion and the Legislature.
          • BOX 9-4 A PERSONAL STORY OF RECOVERY AND SELF-IDENTIFICATION
    • CHAPTER IN REVIEW
    • References
  • Chapter 10 Families as Resources, Caregivers, and Collaborators
    • Learning Objectives
    • Family Assessment
      • FIG 10-1 Parent status in the contemporary family.
      • FIG 10-2 America's changing households.
      • Critical Reasoning
      • Characteristics of the Functional Family
      • Culture
        • Critical Reasoning
        • BOX 10-1 SOCIOCULTURAL CONTEXT OF CARE
      • Family History
        • Critical Reasoning
      • Family APGAR
        • FIG 10-3 Example of a family genogram.
        • Critical Reasoning
    • Working with Families
      • TABLE 10-1 MODELS USED IN WORKING WITH FAMILIES
      • Competence Model
        • Critical Reasoning
      • Psychoeducational Programs
    • Benefits of Family Involvement
      • BOX 10-2 10-WEEK EDUCATIONAL PROGRAM FOR FAMILIES OF THE MENTALLY ILL
        • Nature and Purpose of Program
        • The Family Experience
        • Mental Illness I
        • Mental Illness II
        • Managing Symptoms and Problems
        • Stress, Coping, and Adaptation
        • Enhancing Personal and Family Effectiveness I
        • Enhancing Personal and Family Effectiveness II
        • Relationships Between Families and Professionals
        • Community Resources
      • Critical Reasoning
    • Barriers to Family Involvement
      • BOX 10-3 THE MEANING OF MENTAL ILLNESS TO THE FAMILY
      • Critical Reasoning
      • Critical Reasoning
    • Families as a Population at Risk
      • Critical Reasoning
    • Building Bridges
      • BOX 10-4 NAMI FAMILY-TO-FAMILY EDUCATION PROGRAM
      • BOX 10-5 FAMILY INVOLVEMENT COMPETENCIES FOR MENTAL HEALTH PROFESSIONALS
        • Developing a Collaboration with the Family
        • Offering Information on Mental Illness
        • Enhancing Family Communication and Problem Solving
        • Helping With Service System Use
        • Helping Family Members Meet Own Needs
        • Addressing Special Issues Concerning the Patient
        • Addressing Special Issues Concerning the Family
    • CHAPTER IN REVIEW
    • References
  • Chapter 11 Implementing the Nursing Process: Standards of Practice and Professional Performance
    • Learning Objectives
    • The Nursing Process
    • Standards of Practice
      • Critical Reasoning
    • Assessment
      • Standard 1: Assessment
        • Rationale
        • Key Elements
          • FIG 11-1 Nursing conditions and behaviors related to psychiatric nursing standards of practice.
          • Critical Reasoning
    • Diagnosis
      • Standard 2: Diagnosis
        • Rationale
        • Key Elements
          • Critical Reasoning
    • Outcomes Identification
      • Standard 3: Outcomes Identification
        • Rationale
          • BOX 11-1 PHENOMENA OF CONCERN FOR PSYCHIATRIC–MENTAL HEALTH NURSES
        • Key Elements
    • Planning
      • Standard 4: Planning
        • Rationale
        • Key Elements
    • Implementation
      • Standard 5: Implementation
        • Rationale
        • Key Elements
      • Standard 5A: Coordination of Care
      • Standard 5B: Health Teaching and Health Promotion
      • Standard 5C: Milieu Therapy
      • Standard 5D: Pharmacological, Biological, and Integrative Therapies
      • Advanced-Practice Interventions 5E to 5G
      • Standard 5E: Prescriptive Authority and Treatment
      • Standard 5F: Psychotherapy
      • Standard 5G: Consultation
        • Critical Reasoning
    • Evaluation
      • Standard 6: Evaluation
        • Rationale
        • Key Elements
    • Standards of Professional Performance
      • FIG 11-2 Nursing conditions and behaviors related to the psychiatric nursing standards of professional performance. Nursing conditions and behaviors related to the psychiatric nursing standards of professional performance.
    • Quality Of Practice
      • Standard 7: Quality of Practice
        • Rationale
        • Key Elements
          • Critical Reasoning
          • Critical Reasoning
    • Education
      • Standard 8: Education
        • Rationale
        • Key Elements
    • Professional Practice Evaluation
      • Standard 9: Professional Practice Evaluation
        • Rationale
        • Key Elements
    • Collegiality
      • Standard 10: Collegiality
        • Rationale
        • Key Element
          • Critical Reasoning
    • Collaboration
      • Standard 11: Collaboration
        • Rationale
        • Key Elements
          • Critical Reasoning
          • FIG 11-3 Collaborative relationships for psychiatric nurses.
          • TABLE 11-1 MENTAL HEALTH PERSONNEL, TRAINING, AND ROLES
    • Ethics
      • Standard 12: Ethics
        • Rationale
        • Key Elements
    • Research
      • Standard 13: Research
        • Rationale
        • Key Elements
    • Resource Utilization
      • Standard 14: Resource Utilization
        • Rationale
        • Key Elements
          • Critical Reasoning
    • Leadership
      • Standard 15: Leadership
        • Rationale
        • Key Elements
          • BOX 11-2 CASE STUDY
            • Assessment
            • Diagnosis
            • Outcomes Identification
            • Planning
            • Implementation
            • Evaluation
    • CHAPTER IN REVIEW
    • References
• Unit 2 Continuum of Care
  • Interactive Review – Unit 2
  • Chapter 12 Prevention and Mental Health Promotion
    • Learning Objectives
    • Promotion and Prevention
      • Mental Health Promotion
        • QUALITY AND SAFETY ALERT
      • Mental Illness Prevention
        • FIG 12-1 Preventive interventions by developmental stage.
        • BOX 12-1 U.S. MENTAL HEALTH PREVENTION RECOMMENDATIONS
          • Healthy People 2020 Recommendations
          • U.S. Preventive Services Task Force 2010-2011 Recommendations
        • Critical Reasoning
        • Models of Prevention
      • Public Health Prevention Model
        • Critical Reasoning
        • Community Needs Assessment
        • Identifying and Prioritizing High-Risk Groups
        • Interventions
          • Critical Reasoning
      • Medical Prevention Model
        • Critical Reasoning
      • Nursing Prevention Model
        • Critical Reasoning
    • Assessment
      • Risk Factors and Protective Factors
        • QUALITY AND SAFETY ALERT
      • Target Populations
        • Critical Reasoning
    • Planning and Implementation
      • Health Education
        • Self-Efficacy
          • Critical Reasoning
          • BOX 12-2 RESILIENCE STRENGTHS IN INDIVIDUALS, FAMILIES, AND COMMUNITIES
        • Types of Interventions
        • Programs and Activities
          • BOX 12-3 HEALTH EDUCATION ACTIVITIES
            • Definition
            • Activities
          • Critical Reasoning
      • Environmental Change
        • Organizations and Politics
          • Critical Reasoning
      • Social Support
        • BOX 12-4 NIC INTERVENTIONS RELATED TO SUPPORT SYSTEM ENHANCEMENT
          • Definition
          • Activities
        • Types of Interventions
          • BOX 12-5 CHARACTERISTICS OF SELF-HELP GROUPS
        • Informal Support Groups
          • BOX 12-6 ASSESSMENT GUIDELINES FOR RECOMMENDING SELF-HELP GROUPS
            • Questions for the Group
            • Questions for the Potential Member
      • Stigma Reduction
        • BOX 12-7 THE ROOTS OF STIGMA
        • QUALITY AND SAFETY ALERT
        • BOX 12-8 CULTURAL CONTEXT OF CARE: AMERICAN ATTITUDES ABOUT MENTAL ILLNESS
        • Critical Reasoning
        • BOX 12-9 A FUTURE FOUNDED ON PREVENTION
    • Evaluation
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 13 Crisis and Disaster Intervention
    • Learning Objectives
    • Crisis Characteristics
      • Crisis Responses
        • FIG 13-1 Paradigm: the effect of balancing factors in a stressful event.
        • Critical Reasoning
        • Types of Crises
        • Maturational Crises
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Situational Crises
          • Critical Reasoning
          • BOX 13-1 CHARACTERISTICS OF DISASTERS
    • Crisis Intervention
      • TABLE 13-1 PHASES OF DISASTER RESPONSE
      • BOX 13-2 SOCIOCULTURAL CONTEXT OF CARE
        • Survivors of Katrina
      • BOX 13-3 BEHAVIORS COMMONLY EXHIBITED AFTER A CRISIS
      • Critical Reasoning
    • Assessment
      • QUALITY AND SAFETY ALERT
      • Precipitating Event
        • QUALITY AND SAFETY ALERT
      • Perception of the Event
      • Support Systems and Coping Resources
        • Critical Reasoning
      • Coping Mechanisms
    • Planning And Implementation
      • QUALITY AND SAFETY ALERT
      • Environmental Manipulation
        • FIG 13-2 Levels of crisis intervention.
        • TABLE 13-2 PATIENT EDUCATION PLAN Coping with Crisis
      • General Support
      • Generic Approach
        • QUALITY AND SAFETY ALERT
      • Individual Approach
        • Critical Reasoning
      • Techniques
        • BOX 13-4 TECHNIQUES OF CRISIS INTERVENTION
    • Evaluation
      • TABLE 13-3 NURSING INTERVENTIONS FOR CRISIS AND DISASTER EVENTS
      • Critical Reasoning
    • Settings for Crisis and Disaster Intervention
    • Modalities of Crisis Intervention
      • Disaster Responses
        • BOX 13-5 CASE STUDY
          • Assessment
          • Diagnosis
          • Outcomes Identification and Planning
          • Implementation
          • Evaluation
        • BOX 13-6 KEY CONCEPTS OF DISASTER—MENTAL HEALTH
        • BOX 13-7 COMMON PSYCHIATRIC RESPONSES TO DISASTER
          • Psychiatric Diagnoses
          • Psychological/Behavioral Responses
        • BOX 13-8 GUIDING PRINCIPLES FOR CULTURAL COMPETENCE IN DISASTER MENTAL HEALTH
        • Critical Reasoning
      • Mobile Crisis Programs
        • Critical Reasoning
      • Telephone Contacts
      • Group Work
      • Victim Outreach Programs
      • Health Education
        • Critical Reasoning
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse: Nurses Remember 9/11
          • A Student's View
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse: Nurses Remember 9/11
          • A Faculty's View
    • CHAPTER IN REVIEW
    • References
  • Chapter 14 Recovery Support
    • Learning Objectives
    • Recovery
      • BOX 14-1 COMPONENTS OF RECOVERY
      • Critical Reasoning
      • TABLE 14-1 COMPARISON OF PSYCHIATRIC REHABILITATION AND TRADITIONAL MEDICAL MODELS OF CARE
      • QUALITY AND SAFETY ALERT
    • Assessment
      • The Individual
        • Critical Reasoning
        • Characteristics of Serious Mental Illness.
        • Behaviors Related to Serious Mental Illness
          • BOX 14-2 MYTHS AND FACTS ABOUT MENTAL ILLNESS
          • Critical Reasoning
          • Activities of daily living
          • Interpersonal relations
            • QUALITY AND SAFETY ALERT
          • Low self-esteem
          • Motivation
          • Strengths
          • Nonadherence
            • Critical Reasoning
            • QUALITY AND SAFETY ALERT
          • Living Skills Assessment
            • TABLE 14-2 POTENTIAL SKILLS NEEDED IN RECOVERY SUPPORT
      • The Family
        • Components of Family Assessment.
          • QUALITY AND SAFETY ALERT
        • Family Burden
          • Critical Reasoning
        • Social Support Needs.
      • The Community
        • Critical Reasoning
    • Planning and Implementation
      • The Individual
        • Critical Reasoning
        • Developing Strengths and Potential.
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Learning Living Skills
          • QUALITY AND SAFETY ALERT
        • Illness Management and Recovery
          • QUALITY AND SAFETY ALERT
          • BOX 14-3 ELEMENTS OF A PSYCHOEDUCATION PLAN
        • Accessing Community Supports
          • Rehabilitation programs
            • Consumer-centered services
              • FIG 14-1 Components of a community support system.
              • Critical Reasoning
          • Residential services
            • BOX 14-4 PRINCIPLES OF PERSONAL ASSISTANCE IN COMMUNITY EXISTENCE (PACE)
            • TABLE 14-3 TYPE OF SOCIAL SUPPORT AND ASSOCIATED PEER RECOVERY SUPPORT SERVICES
            • Critical Reasoning
            • QUALITY AND SAFETY ALERT
          • Supported employment
            • QUALITY AND SAFETY ALERT
          • Educational services
            • Critical Reasoning
      • The Family
        • Empowerment
          • Critical Reasoning
        • Family Psychoeducation
          • Critical Reasoning
          • QUALITY AND SAFETY ALERT
      • The Community
        • Critical Reasoning
    • Evaluation
      • Patient and Family Evaluation
      • Program Evaluation
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
• Unit 3 Applying Principles in Nursing Practice
  • Interactive Review – Unit 3
  • Chapter 15 Anxiety Responses and Anxiety Disorders
    • Learning Objectives
    • Continuum of Anxiety Responses
      • Defining Characteristics
        • LEARNING FROM A CLINICAL CASE
          • Case Background
          • Case Critical Reasoning Questions
        • Critical Reasoning
      • Levels of Anxiety
        • FIG 15-1 Continuum of anxiety responses.
        • QUALITY AND SAFETY ALERT
    • Assessment
      • Behaviors
        • FIG 15-2 Mind modulation of the autonomic nervous system and its two branches, the parasympathetic (conserving) and the sympathetic (activating), down to the cellular level.
        • BOX 15-1 PHYSIOLOGICAL, BEHAVIORAL, COGNITIVE, AND AFFECTIVE RESPONSES TO ANXIETY
          • Physiological
            • Cardiovascular
            • Respiratory
            • Gastrointestinal
            • Neuromuscular
            • Urinary Tract
            • Skin
          • Behavioral
          • Cognitive
          • Affective
        • Critical Reasoning
      • Predisposing Factors
        • Biological
          • FIG 15-3 Effects of a benzodiazepine (BZ) drug at the gamma-aminobutyric acid (GABA) receptor. Cl, Chloride ion.
          • BOX 15-2 PHYSICAL DISORDERS ASSOCIATED WITH ANXIETY
            • Cardiovascular/Respiratory Disorders
            • Endocrinologic Disorders
            • Neurological Disorders
            • Substance-Related Disorders
              • Intoxications
              • Withdrawal Syndromes
        • Familial
        • Psychological
          • Critical Reasoning
        • Behavioral
          • Critical Reasoning
      • Precipitating Stressors
        • Threats to Physical Integrity
        • Threats to Self-System
          • BOX 15-3 PRIMARY CARE POSTTRAUMATIC STRESS DISORDER (PTSD) SCREEN*
      • Appraisal of Stressors
      • Coping Resources
        • Critical Reasoning
      • Coping Mechanisms
        • BOX 15-4 A PATIENT SPEAKS
        • QUALITY AND SAFETY ALERT
        • Problem- or Task-Focused Coping
          • Critical Reasoning
        • Emotion- or Ego-Focused Coping
          • TABLE 15-1 EGO DEFENSE MECHANISMS
          • FIG 15-4 The Stuart Stress Adaptation Model as related to anxiety responses.
    • Diagnosis
      • Nursing Diagnoses
        • TABLE 15-2 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Anxiety Responses
      • Medical Diagnoses
        • BOX 15-5 PANIC ATTACK
        • BOX 15-6 OBSESSIONS AND COMPULSIONS
          • Obsessions
          • Examples
          • Compulsions
          • Examples
        • QUALITY AND SAFETY ALERT
      • Outcomes Identification
        • TABLE 15-3 DIFFERENCES BETWEEN ANXIETY AND DEPRESSION
    • Planning
      • BOX 15-7 NOC OUTCOME INDICATORS FOR ANXIETY SELF-CONTROL
      • TABLE 15-4 SUMMARIZING EVIDENCE-BASED TREATMENT FOR Anxiety Disorders
    • Implementation
      • Severe and Panic Levels of Anxiety
        • Establishing a Trusting Relationship
        • Nurses’ Self-Awareness
          • CLINICAL EXAMPLE
          • Critical Reasoning
        • Protecting the Patient
        • Modifying the Environment
        • Encouraging Activity
        • Medication
          • TABLE 15-5 ANTIANXIETY DRUGS
          • BOX 15-8 A FAMILY SPEAKS
          • QUALITY AND SAFETY ALERT
      • Moderate Levels of Anxiety
        • TABLE 15-6 NURSING TREATMENT PLAN SUMMARY Severe and Panic Anxiety Responses
        • Psychoeducation
        • Recognition of Anxiety
        • Insight into the Anxiety
          • BOX 15-9 PATIENT RESISTANCES TO RECOGNIZING ANXIETY
        • Coping with the Threat
          • BOX 15-10 COGNITIVE BEHAVIORAL TREATMENT STRATEGIES FOR ANXIETY DISORDERS
            • Cognitive Restructuring
            • Learning New Behavior
        • Relaxation Training
          • BOX 15-11 INDICATORS OF RELAXATION
            • Physiological
            • Cognitive
            • Behavioral
          • BOX 15-12 SEQUENCE OF PROGRESSIVE MUSCLE RELAXATION
        • Biofeedback
          • TABLE 15-7 PATIENT EDUCATION PLAN The Relaxation Response
        • Systematic Desensitization
          • BOX 15-13 SAMPLE PATIENT HIERARCHY FOR PHOBIAS
            • Sample Hierarchy
          • Critical Reasoning
    • Evaluation
      • TABLE 15-8 NURSING TREATMENT PLAN SUMMARY Moderate Anxiety Responses
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1. What are the stressors that led to his current condition?
        • 2. What medical and nursing diagnoses do his symptoms suggest?
        • 3. What comorbidity has he developed?
        • 4. What neurotransmitters might be involved in his behavioral responses?
        • 5. Which medications do you think would be helpful to him? Which ones should be avoided and why?
        • 6. What types of education do he and his wife need?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Physical Accident Leading to Psychiatric Illness (Panic Attacks) (read text)
    • References
  • Chapter 16 Psychophysiological Responses and Somatoform and Sleep Disorders
    • Learning Objectives
    • Continuum of Psychophysiological Responses
      • FIG 16-1 Continuum of psychophysiological responses.
      • LEARNING FROM A CLINICAL CASE
        • Case Background
        • Case Critical Reasoning Questions
    • Assessment
      • Behaviors
        • QUALITY AND SAFETY ALERT
        • Physiological
          • BOX 16-1 PHYSICAL CONDITIONS AFFECTED BY PSYCHOLOGICAL FACTORS
            • Cardiovascular
            • Musculoskeletal
            • Respiratory
            • Gastrointestinal
            • Skin
            • Genitourinary
            • Endocrinologic
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Psychological
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Faking Illness
        • Pain
          • QUALITY AND SAFETY ALERT
        • Sleep
          • QUALITY AND SAFETY ALERT
          • Critical Reasoning
      • Predisposing Factors
        • Biological
        • Psychoneuroimmunology
        • Sleep
        • Psychological
          • FIG 16-2 Updated view of Selye's general adaptation syndrome emphasizing the mind-body-cell/gene communication loop of the immune system. ACTH, Adrenocorticotropic hormone.
          • Critical Reasoning
        • Sociocultural
          • BOX 16-2 SOCIOCULTURAL CONTEXT OF CARE Somatoform Syndromes of Various Cultures
          • Critical Reasoning
      • Precipitating Stressors
      • Appraisal of Stressors
      • Coping Resources
        • TABLE 16-1 PATIENT EDUCATION PLAN Coping with Stress
      • Coping Mechanisms
        • BOX 16-3 A FAMILY SPEAKS
    • Diagnosis
      • Nursing Diagnoses
        • FIG 16-3 The Stuart Stress Adaptation Model as related to psychophysiological responses.
      • Medical Diagnoses
        • TABLE 16-2 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Psychophysiological Responses
    • Outcomes Identification
    • Planning
      • Critical Reasoning
    • Implementation
      • TABLE 16-3 SUMMARIZING EVIDENCE-BASED TREATMENT FOR Psychophysiological Responses
      • QUALITY AND SAFETY ALERT
      • Psychological Approaches
        • CLINICAL EXAMPLE
          • Selected Nursing Diagnoses
        • BOX 16-4 A PATIENT SPEAKS
      • Patient Education
        • Critical Reasoning
      • Physiological Support
        • BOX 16-5 SLEEP HYGIENE BEHAVIOR STRATEGIES
        • QUALITY AND SAFETY ALERT
    • Evaluation
      • TABLE 16-4 MEDICATIONS FOR THE TREATMENT OF INSOMNIA
      • TABLE 16-5 NURSING TREATMENT PLAN SUMMARY Maladaptive Psychophysiological Responses
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Chronic Pain and Depression (read text)
    • References
  • Chapter 17 Self-Concept Responses and Dissociative Disorders
    • Learning Objectives
    • Continuum of Self-Concept Responses
      • Self-Concept
        • Developmental Influences
          • LEARNING FROM A CLINICAL CASE
            • Case Background
            • Case Critical Reasoning Questions
        • Significant Others
          • Critical Reasoning
        • Self-Perceptions
      • Body Image
        • FIG 17-1 Continuum of self-concept responses.
        • Critical Reasoning
      • Self-Ideal
        • FIG 17-2 A, Person with a low level of self-esteem caused by a large discrepancy between self-concept and self-ideal. B, Person with a greater conformity of self-concept and self-ideal and therefore a high level of self-esteem.
        • Critical Reasoning
      • Self-Esteem
        • Critical Reasoning
      • Role Performance
      • Personal Identity
        • Developmental Influences
          • TABLE 17-1 QUALITIES OF THE HEALTHY PERSONALITY
      • Healthy Personality
        • Critical Reasoning
    • Assessment
      • Behaviors
        • Behaviors Associated With Low Self-Esteem
          • Direct behaviors
            • Self-criticism
            • Self-diminution
            • Guilt and worry
            • Physical manifestations
            • Postponing decisions
            • Denying oneself pleasure
            • Disturbed relationships
            • Withdrawal from reality
            • Self-destructiveness
            • Other destructiveness
          • Indirect behaviors
            • Illusions and unrealistic goals
            • Exaggerated sense of self
            • Boredom
            • Polarizing view of life
              • CLINICAL EXAMPLE
                • Selected Nursing Diagnoses
              • BOX 17-1 BEHAVIORS ASSOCIATED WITH LOW SELF-ESTEEM
              • CLINICAL EXAMPLE
                • Selected Nursing Diagnoses
        • Behaviors Associated With Identity Diffusion
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Behaviors Associated With Dissociation and Depersonalization
          • BOX 17-2 BEHAVIORS ASSOCIATED WITH IDENTITY DIFFUSION
          • QUALITY AND SAFETY ALERT
          • BOX 17-3 A FAMILY SPEAKS
          • QUALITY AND SAFETY ALERT
          • BOX 17-4 BEHAVIORS ASSOCIATED WITH DISSOCIATION AND DEPERSONALIZATION
            • Affective
            • Perceptual
            • Cognitive
            • Behavioral
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
      • Predisposing Factors
        • Factors Affecting Self-Esteem
        • Unrealistic Self-Ideals
          • BOX 17-5 UNREALISTIC SELF-EXPECTATIONS: THE TYRANNY OF THE “SHOULDS”
        • Factors Affecting Role Performance
          • Gender roles
            • Critical Reasoning
          • Work roles
        • Factors Affecting Personal Identity
          • Critical Reasoning
      • Precipitating Stressors
        • Trauma.
          • QUALITY AND SAFETY ALERT
        • Role Strain
          • Developmental transitions
          • Health-illness transitions
        • Biological Stressors
      • Appraisal of Stressors
        • TABLE 17-2 FACTORS INFLUENCING SELF-CONCEPT BASED ON HEALTH-ILLNESS TRANSITIONS
        • Critical Reasoning
      • Coping Resources
      • Coping Mechanisms
        • Short-Term Defenses
        • Long-Term Defenses
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Ego Defense Mechanisms
    • Diagnosis
      • Nursing Diagnoses
      • Medical Diagnoses
        • FIG 17-3 Stuart Stress Adaptation Model as related to self-concept responses.
    • Outcomes Identification
      • Long-term goal
      • Short-term goals
        • After 1 week
          • TABLE 17-3 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Self-Concept Responses
        • After 2 weeks
        • After 3 weeks
    • Planning
    • Implementation
      • BOX 17-6 NOC OUTCOME INDICATORS FOR SELF-ESTEEM
      • TABLE 17-4 PATIENT EDUCATION PLAN Improving Family Relationships
      • Level 1: Expanded Self-Awareness
        • TABLE 17-5 NURSING INTERVENTIONS IN ALTERATIONS IN SELF-CONCEPT AT LEVEL 1 Goal: Expand the Patient's Self-Awareness
        • Critical Reasoning
      • Level 2: Self-Exploration
        • Critical Reasoning
      • Level 3: Self-Evaluation
        • TABLE 17-6 NURSING INTERVENTIONS IN ALTERATIONS IN SELF-CONCEPT AT LEVEL 2 Goal: Encourage the Patient's Self-Exploration
        • BOX 17-7 A PATIENT SPEAKS
        • TABLE 17-7 NURSING INTERVENTIONS IN ALTERATIONS IN SELF-CONCEPT AT LEVEL 3 Goal: Assist the Patient's Self-Evaluation
        • Critical Reasoning
      • Level 4: Realistic Planning
      • Level 5: Commitment to Action
        • QUALITY AND SAFETY ALERT
        • TABLE 17-8 NURSING INTERVENTIONS IN ALTERATIONS IN SELF-CONCEPT AT LEVEL 4 Goal: Help the Patient Formulate a Realistic Plan of Action
    • Evaluation
      • TABLE 17-9 NURSING TREATMENT PLAN SUMMARY Maladaptive Self-Concept Responses
      • LEARNING FROM A CLINICAL CASE outcome
        • 1. How has her childhood experience shaped her self-concept, body image, self-ideal, self-esteem, and personal identity?
        • 2. How do the concepts of identity diffusion, dissociation, and depersonalization manifest in her behavior?
        • 3. What precipitating stressors does she describe and how do they threaten her “idealized self”?
        • 4. What medical and nursing diagnoses would be appropriate for helping her?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Stressors Affecting Self-Concept (read text)
    • References
  • Chapter 18 Emotional Responses and Mood Disorders
    • Learning Objectives
    • Continuum of Emotional Responses
      • LEARNING FROM A CLINICAL CASE
        • Case Background
        • Case Critical Reasoning Questions
      • FIG 18-1 Continuum of emotional responses.
      • Grief Reactions
      • Depression
        • BOX 18-1 SOCIOCULTURAL CONTEXT OF CARE
          • How Does Culture Impact Depression?
        • TABLE 18-1 COMORBIDITY OF DEPRESSION AND OTHER PSYCHIATRIC ILLNESSES
        • QUALITY AND SAFETY ALERT
        • Critical Reasoning
      • Bipolar Disorder
        • BOX 18-2 FACTS ABOUT MOOD DISORDERS
          • Major Depressive Disorder
          • Bipolar Disorder
        • QUALITY AND SAFETY ALERT
    • Assessment
      • Behaviors
        • Behaviors Associated With Delayed Grief Reaction
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnosis
        • Behaviors Associated With Depression
          • BOX 18-3 BEHAVIORS ASSOCIATED WITH DEPRESSION
            • Affective
            • Physiological
            • Cognitive
            • Behavioral
          • Postpartum onset
          • Seasonal pattern
            • Critical Reasoning
        • Suicide
          • QUALITY AND SAFETY ALERT
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Behaviors Associated With Bipolar Disorder
          • BOX 18-4 BEHAVIORS ASSOCIATED WITH BIPOLAR DISORDER
            • Affective
            • Physiological
            • Cognitive
            • Behavioral
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnosis
      • Predisposing Factors
        • Genetics
        • Object Loss Theory
          • QUALITY AND SAFETY ALERT
        • Personality Organization Theory
        • Cognitive Model
          • Critical Reasoning
        • Learned Helplessness-Hopelessness Model
        • Behavioral Model
          • Critical Reasoning
        • Biological Model
          • Endocrine system
          • Cortisol
          • Neurotransmission
            • Behavior
            • Biochemistry
            • Neuroendocrine
            • Treatment
            • Brain imaging
              • FIG 18-2 The serotonin neurotransmitter system implicated in depression.
              • FIG 18-3 Positron emission tomography (PET) scan of glucose use in depressed subject (figure on left) showing frontal hypometabolism (left side of figure). This improves after treatment with antidepressant medication (figure on right); note increased glucose metabolism in frontal lobe (left side of figure).
          • Biological rhythms
            • TABLE 18-2 PREFRONTAL CORTEX AND SEROTONIN INTERCONNECTIONS: IMPLICATIONS IN DEPRESSION
            • QUALITY AND SAFETY ALERT
            • FIG 18-4 A, Normal sleep architecture. B, Depressed sleep architecture. Yellow areas indicate rapid eye movement (REM) sleep.
          • Kindling
            • FIG 18-5 Biological factors related to depression. DST, dexamethasone suppression test; EEGs, electroencephalograms; TRH, thyroid-releasing hormone.
            • QUALITY AND SAFETY ALERT
            • Critical Reasoning
      • Precipitating Stressors
        • Loss of Attachment
          • Inhibiting factors
            • BOX 18-5 FACTORS THAT INFLUENCE THE MOURNING PROCESS
        • Life Events
        • Role Strain
          • Critical Reasoning
        • Physiological Changes
          • TABLE 18-3 PHYSICAL ILLNESS AND MEDICATIONS ASSOCIATED WITH DEPRESSIVE AND BIPOLAR DISORDERS
          • QUALITY AND SAFETY ALERT
      • Appraisal of Stressors
      • Coping Resources
      • Coping Mechanisms
        • TABLE 18-4 SUMMARY OF CAUSATIVE MODELS OF MOOD DISORDERS
        • BOX 18-6 A FAMILY SPEAKS
        • BOX 18-7 RISK FACTORS FOR DEPRESSION
    • Diagnosis
      • FIG 18-6 The Stuart Stress Adaptation Model as related to emotional responses.
      • TABLE 18-5 NURSING DIAGNOSES AND TERMS RELATED TO Emotional Responses
      • Nursing Diagnoses
        • Critical Reasoning
      • Medical Diagnoses
    • Outcomes Identification
    • Planning
      • Acute Treatment Phase
      • Continuation Treatment Phase
        • FIG 18-7 The phases of treatment for mood disorders.
        • BOX 18-8 NOC OUTCOME INDICATORS FOR GRIEF RESOLUTION
      • Maintenance Treatment Phase
        • QUALITY AND SAFETY ALERT
        • Critical Reasoning
    • Implementation
      • BOX 18-9 NIC INTERVENTIONS RELATED TO GRIEF WORK FACILITATION
        • Definition
        • Activities
      • TABLE 18-6 SUMMARIZING THE EVIDENCE ON Mood Disorders
      • Patient Safety
        • QUALITY AND SAFETY ALERT
      • Intervening in Depressive Disorder
        • Nurse-Patient Relationship
        • Physiological Treatments
          • Psychopharmacology
            • QUALITY AND SAFETY ALERT
            • Critical Reasoning
          • Somatic and alternative therapies
            • TABLE 18-7 ANTIDEPRESSANT DRUGS
            • BOX 18-10 A PATIENT SPEAKS
        • Expressing Feelings
        • Cognitive Strategies
      • Intervening in Bipolar Disorder
        • Nurse-Patient Relationship
        • Physiological Treatments
          • Psychopharmacology
            • QUALITY AND SAFETY ALERT
            • Critical Reasoning
          • Somatic therapy
        • Expressing Feelings
          • TABLE 18-8 MOOD-STABILIZING DRUGS
        • Cognitive Strategies
      • Common Interventions for Both Depressive and Bipolar Disorders
        • Behavioral Change
          • BOX 18-11 LIST OF POTENTIALLY REWARDING ACTIVITIES FOR PATIENTS WITH MOOD DISORDERS
          • Critical Reasoning
        • Social Skill Building
        • Family and Group Involvement
          • TABLE 18-9 PATIENT EDUCATION PLAN Enhancing Social Skills
        • Education
    • Evaluation
      • TABLE 18-10 NURSING TREATMENT PLAN SUMMARY Maladaptive Emotional Responses
      • LEARNING FROM A CLINICAL CASE outcome
        • 1. What behaviors would you include in your assessment?
        • 2. What medical and nursing diagnoses should be considered?
        • 3. What medications might be prescribed for this patient?
        • 4. What interventions would be implemented in the acute, continuation, and maintenance phases of treatment?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Depression (read text)
    • Grief: Losing a Child (read text)
    • Manic State: Bipolar Disorder (read text)
    • References
  • Chapter 19 Self-Protective Responses and Suicidal Behavior
    • Learning Objectives
    • Continuum of Self-Protective Responses
      • LEARNING FROM A CLINICAL CASE
        • Case Background
        • Case Critical Reasoning Questions
      • Critical Reasoning
      • Epidemiology of Suicide
        • FIG 19-1 Continuum of self-protective responses.
        • BOX 19-1 SOCIOCULTURAL CONTEXT OF CARE
          • Suicide Among Minority Groups
        • Critical Reasoning
    • Assessment
      • Behaviors
        • Noncompliance/Nonadherence
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnosis
          • Critical Reasoning
        • Self-Injury
        • Suicidal Behavior
          • QUALITY AND SAFETY ALERT
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • TABLE 19-1 CHARACTERISTICS OF SUICIDE COMPLETERS AND ATTEMPTERS
      • Nature of the Assessment
        • BOX 19-2 A FAMILY SPEAKS
        • QUALITY AND SAFETY ALERT
      • Predisposing Factors
        • Psychiatric Diagnosis
          • FIG 19-2 Inpatient suicide/self-harm assessment tool and safety plan.
        • Personality Traits and Disorders
          • Critical Reasoning
        • Psychosocial Factors and Physical Illness
        • Genetic and Familial Variables
          • QUALITY AND SAFETY ALERT
          • FIG 19-3 Levels of postsynaptic serotonin (5-HT) receptors. More receptors are present when there is too little 5-HT (upregulation), and fewer receptors when there is too much 5-HT (down-regulation).
        • Biochemical Factors
          • BOX 19-3 RISK FACTORS IN THE ASSESSMENT OF THE SELF-DESTRUCTIVE PATIENT
            • Assessing Circumstances of an Attempt
            • Presenting Symptoms
            • Suicidal Behavior
            • Psychiatric Illness
            • Psychosocial History
            • Personality Factors
            • Family History
          • Critical Reasoning
      • Precipitating Stressors
      • Appraisal of Stressors
        • BOX 19-4 RISK FACTORS FOR SUICIDE IN SPECIAL POPULATIONS
          • Hospitalized Depressed Patients
          • Elderly Patients
          • Patients with Alcoholism
          • Depressed Adolescents
        • QUALITY AND SAFETY ALERT
      • Coping Resources
      • Coping Mechanisms
        • BOX 19-5 A PATIENT SPEAKS
        • BOX 19-6 PROTECTIVE FACTORS AGAINST SUICIDE
        • FIG 19-4 The Stuart Stress Adaptation Model as related to self-protective responses.
    • Diagnosis
      • Nursing Diagnoses
        • QUALITY AND SAFETY ALERT
      • Medical Diagnoses
        • TABLE 19-2 NURSING DIAGNOSES RELATED TO Self-Protective Responses
    • Outcomes Identification
      • BOX 19-7 NOC OUTCOME INDICATORS FOR SUICIDE SELF-RESTRAINT
    • Planning
      • FIG 19-5 Clinical algorithm for planning treatment for the suicidal patient.
    • Implementation
      • Critical Reasoning
      • Protection and Safety
        • QUALITY AND SAFETY ALERT
        • QUALITY AND SAFETY ALERT
        • Critical Reasoning
      • Increasing Self-Esteem
      • Regulating Emotions and Behaviors
        • TABLE 19-3 PATIENT EDUCATION PLAN Compliance Counseling
      • Mobilizing Social Support
      • Patient Education
        • BOX 19-8 GOALS OF THE NATIONAL STRATEGY FOR SUICIDE PREVENTION (NSSP)
      • Suicide Prevention
        • BOX 19-9 SUICIDE PREVENTION STRATEGIES
    • Evaluation
      • TABLE 19-4 NURSING TREATMENT PLAN SUMMARY Maladaptive Self-Protective Responses
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1. What are Kara's predisposing risk and protective factors?
        • 2. What behaviors suggest changes in her neurotransmitters?
        • 3. What is her precipitating stressor and maladaptive coping mechanism?
        • 4. What would be the goals of her treatment?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Suicide and Hospitalization (read text)
    • References
  • Chapter 20 Neurobiological Responses and Schizophrenia and Psychotic Disorders
    • Learning Objectives
    • Critical Reasoning
    • LEARNING FROM A CLINICAL CASE
      • Case Background
      • Case Critical Reasoning Questions
    • BOX 20-1 A PATIENT SPEAKS
    • FIG 20-1 Continuum of neurobiological responses.
    • BOX 20-2 IMPACT OF SCHIZOPHRENIA ON THE INDIVIDUAL AND SOCIETY
    • Continuum of Neurobiological Responses
    • Assessment
      • QUALITY AND SAFETY ALERT
      • Behaviors
        • Cognition
          • FIG 20-2 Core symptom clusters in schizophrenia.
          • BOX 20-3 POSITIVE AND NEGATIVE SYMPTOMS OF SCHIZOPHRENIA
            • Positive Symptoms
              • Psychotic Disorders of Thinking
              • Disorganization of Speech and Behavior
            • Negative Symptoms
              • Problems of Emotion
              • Impaired Decision Making
          • Critical Reasoning
          • FIG 20-3 Brain information processing model.
          • Memory
            • BOX 20-4 PROBLEMS IN COGNITIVE FUNCTIONING
              • Memory
              • Attention
              • Form and Organization of Speech (Formal Thought Disorder)
              • Decision Making
              • Thought Content
          • Attention
            • Critical Reasoning
          • Form and organization of speech
          • Decision making
            • BOX 20-5 FORM AND CONTENT OF SPEECH RELATED TO PSYCHOTIC DISORDERS
              • Loose Associations
              • Incoherence
              • Tangentiality
              • Illogical Speech
              • Distractible Speech
              • Clang Associations
              • Poverty of Content of Speech
            • Critical Reasoning
          • Thought content
        • Perception
          • Critical Reasoning
          • TABLE 20-1 SENSORY MODALITIES INVOLVED IN HALLUCINATIONS
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnosis
          • CLINICAL EXAMPLE
          • BOX 20-6 PREFRONTAL CORTICAL DYSFUNCTION IN SCHIZOPHRENIA
            • Neurological Soft Signs
            • Neurological Hard Signs
        • Emotion
          • QUALITY AND SAFETY ALERT
        • Behavior and Movement
          • Critical Reasoning
          • BOX 20-7 ABNORMAL BEHAVIORS AND MOVEMENTS IN PATIENTS WITH SCHIZOPHRENIA
            • Behaviors
            • Movements
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnosis
        • Socialization
          • Critical Reasoning
      • Physical Health
        • QUALITY AND SAFETY ALERT
      • Predisposing Factors
        • Genetics
        • Neurobiology
          • Imaging studies
            • FIG 20-4 Magnetic resonance imaging scans through the bodies of the lateral ventricles in a pair of monozygotic twins who are discordant for schizophrenia. Note the increase in the cerebrospinal fluid spaces in the twin with schizophrenia (right) compared with the unaffected twin (left).
          • Neurotransmitter studies.
            • FIG 20-5 Blood flow demonstrated by positron emission tomography during the performance of the Wisconsin Card Sort Task (a task that activates the prefrontal cortex in normal subjects) in a twin with schizophrenia (right column) and an unaffected twin (left column). The arrows indicate the relatively focused failure of activation in the affected twin compared with the unaffected twin.
            • FIG 20-6 A, A midsagittal section shows the approximate anatomical routes of the four dopamine tracts. B, A coronal section shows the sites of origin and the targets of all four tracts. DA, Dopamine.
          • Neurodevelopment
        • Viral and Infection Theories
      • Precipitating Stressors
        • Biological
          • BOX 20-8 NEUROBIOLOGICAL RESPONSE SYMPTOM TRIGGERS
            • Health
            • Environment
            • Attitudes/Behaviors
        • Symptom Triggers
      • Appraisal of Stressors
        • Stress Diathesis Model
      • Coping Resources
        • FIG 20-7 The Stuart Stress Adaptation Model as related to neurobiological responses.
      • Coping Mechanisms
    • Diagnosis
      • Nursing Diagnoses
      • Medical Diagnoses
    • Outcomes Identification
      • TABLE 20-2 POSTPSYCHOTIC ADJUSTMENT: PROCESS COMPONENTS AND PATIENT CARE THEMES
    • Planning
      • TABLE 20-3 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Maladaptive Neurobiological Responses
    • Implementation
      • FIG 20-8 Optimizing treatment outcomes.
      • TABLE 20-4 BEHAVIORAL STRATEGIES FOR PEOPLE WITH PSYCHOSIS
      • QUALITY AND SAFETY ALERT
      • Interventions in the Crisis and Acute Phases
        • Patient Safety
          • TABLE 20-5 SUMMARIZING EVIDENCE-BASED TREATMENTS FOR Neurobiological Responses
          • QUALITY AND SAFETY ALERT
        • Managing Delusions
          • Critical Reasoning
        • Managing Hallucinations
          • TABLE 20-6 LEVELS OF INTENSITY OF HALLUCINATIONS
          • BOX 20-9 STRATEGIES FOR WORKING WITH PATIENTS WHO HAVE DELUSIONS
            • Place the Delusion in a Time Frame and Identify Triggers
            • Assess the Intensity, Frequency, and Duration of the Delusion
            • Identify Emotional Components of the Delusion
            • Observe for Evidence of Concrete Thinking
            • Observe Speech for Symptoms of a Thought Disorder
            • Observe for the Ability to Accurately Use Cause-and-Effect Reasoning
            • Distinguish Between the Description of the Experience and the Facts of the Situation
            • Carefully Question the Facts as They Are Presented and Their Meaning
            • Discuss Consequences of the Delusion When the Person Is Ready
            • Promote Distraction as a Way to Stop Focusing on the Delusion
          • BOX 20-10 BARRIERS TO SUCCESSFUL INTERVENTION FOR DELUSIONS
            • Becoming Anxious and Avoiding the Person
            • Reinforcing the Delusion
            • Attempting to Prove the Person Is Wrong
            • Setting Unrealistic Goals
            • Becoming Incorporated into the Delusional System
            • Failing to Clarify Confusion Surrounding the Delusion
            • Being Inconsistent in Intervention
            • Seeing the Delusion First and the Person Second
          • QUALITY AND SAFETY ALERT
        • Psychopharmacology
          • BOX 20-11 STRATEGIES FOR WORKING WITH PATIENTS WHO HAVE HALLUCINATIONS
            • Establish a Trusting Interpersonal Relationship
            • Assess for Symptoms of Hallucinations, Including Duration, Intensity, and Frequency
            • Focus on the Symptom and Ask the Patient to Describe What Is Happening
            • Help the Patient Manage the Hallucinations
            • Identify Whether Drugs or Alcohol Have Been Used
            • If Asked, Point Out Simply That You Are Not Experiencing the Same Stimuli
            • Suggest and Reinforce the Use of Interpersonal Relationships as a Symptom Management Technique
            • Help the Patient Describe and Compare Current and Past Hallucinations
            • Help the Patient Identify Needs That May Be Reflected in the Content of the Hallucination
            • Determine the Impact of the Patient's Symptoms on Activities of Daily Living
        • Cognitive Behavioral Therapy
          • TABLE 20-7 ANTIPSYCHOTIC DRUGS
      • Interventions in the Maintenance Phase
        • Stages of Relapse
          • Stage 1: Overextension
            • BOX 20-12 A FAMILY SPEAKS
          • Stage 2: Restricted consciousness
          • Stage 3: Disinhibition
          • Stage 4: Psychotic disorganization
            • TABLE 20-8 FAMILY EDUCATION PLAN Understanding Psychosis
          • Stage 5: Psychotic resolution
            • Critical Reasoning
            • CLINICAL EXAMPLE
        • Managing Relapse
          • QUALITY AND SAFETY ALERT
          • Critical Reasoning
          • BOX 20-13 A PATIENT'S GUIDE FOR HANDLING POTENTIAL RELAPSE
          • CLINICAL EXAMPLE
          • Selected Nursing Diagnoses
          • BOX 20-14 SYMPTOM MANAGEMENT TECHNIQUES
            • Category 1: Distraction
            • Category 2: Fighting Back
            • Category 3: Isolation
            • Category 4: Attempts to Feel Better
            • Category 5: Help Seeking
        • Relapse and Medications
          • QUALITY AND SAFETY ALERT
          • QUALITY AND SAFETY ALERT
      • Interventions in the Health Promotion Phase
        • BOX 20-15 NURSING INTERVENTIONS TO PREVENT RELAPSE
        • QUALITY AND SAFETY ALERT
    • Evaluation
      • TABLE 20-9 NURSING TREATMENT PLAN SUMMARY Maladaptive Neurobiological Responses
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1. What positive and negative symptoms of schizophrenia did he exhibit?
        • 2. How did his illness affect his social and occupational functioning?
        • 3. What problems in cognitive functioning did he exhibit?
        • 4. What impact did his illness have on his family?
        • 5. How was his physical health affected?
        • 6. What behavioral strategies would help this patient and his family?
        • 7. Make a plan for each treatment phase of the Stuart Stress Adaptation Model
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Impact of a Psychiatric Psychotic Disorder (read text)
    • References
  • Chapter 21 Social Responses and Personality Disorders
    • Learning Objectives
    • Continuum of Social Responses
      • LEARNING FROM A CLINICAL CASE
        • Case Background
        • Case Critical Reasoning Questions
      • FIG 21-1 States of relatedness.
      • Adaptive and Maladaptive Responses
        • Critical Reasoning
        • FIG 21-2 Continuum of social responses.
      • Development Through the Life Cycle
        • Infancy
        • Preschool Years
        • Childhood
        • Preadolescence
        • Adolescence
        • Young Adulthood
        • Middle Adulthood
        • Late Adulthood
    • Assessment
      • Behaviors
        • QUALITY AND SAFETY ALERT
        • Manipulation
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • Clinical Example
            • Selected Nursing Diagnoses
          • Critical Reasoning
        • Narcissism
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
      • Predisposing Factors
        • Critical Reasoning
        • TABLE 21-1 BEHAVIORS RELATED TO MALADAPTIVE SOCIAL RESPONSES
        • Biological Factors
        • Developmental Factors
          • Critical Reasoning
        • Sociocultural Factors
          • BOX 21-1 SOCIOCULTURAL CONTEXT OF CARE
            • Social Sensitivity
      • Precipitating Stressors
        • Sociocultural Stressors
        • Psychological Stressors
      • Appraisal of Stressors
        • Critical Reasoning
      • Coping Resources
      • Coping Mechanisms
        • FIG 21-3 Projective identification and splitting affect patient-to-nurse and nurse-to-nurse communication.
        • CLINICAL EXAMPLE
          • Selected Nursing Diagnosis
        • Critical Reasoning
    • Diagnosis
      • Nursing Diagnoses
        • FIG 21-4 The Stuart Stress Adaptation Model as related to social responses.
      • Medical Diagnoses
    • Outcomes identification
      • TABLE 21-2 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Maladaptive Social Responses
    • Planning
      • BOX 21-2 NOC OUTCOME INDICATORS FOR SOCIAL INTERACTION SKILLS
    • Implementation
      • TABLE 21-3 PATIENT EDUCATION PLAN Modifying Impulsive Behavior
      • Protection from Self-Harm
        • TABLE 21-4 SUMMARIZING EVIDENCE-BASED TREATMENTS FOR Borderline Personality Disorder
        • QUALITY AND SAFETY ALERT
      • Establishing a Therapeutic Relationship
      • Family Involvement
        • BOX 21-3 A PATIENT SPEAKS
        • QUALITY AND SAFETY ALERT
        • Critical Reasoning
      • Milieu Therapy
        • BOX 21-4 A FAMILY SPEAKS
        • QUALITY AND SAFETY ALERT
      • Limit Setting and Structure
        • Critical Reasoning
      • Focusing on Strengths
      • Behavioral Strategies
        • TABLE 21-5 NURSING TREATMENT PLAN SUMMARY Maladaptive Social Responses
      • Medications
    • Evaluation
      • TABLE 21-6 NURSING TREATMENT PLAN SUMMARY Maladaptive Social Responses
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1. What are the features of his and her personality disorders?
        • 2. What would each diagnosis be?
        • 3. What are the predisposing factors of personality, temperament, and character that make their personalities problematic in this relationship?
        • 4. What were the precipitating stressors that created the conflict?
        • 5. What maladaptive coping made it difficult for them to communicate and accept each other's needs?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Antisocial Personality Disorder (read text)
    • References
  • Chapter 22 Cognitive Responses and Organic Mental Disorders
    • Learning Objectives
    • Continuum of Cognitive Responses
      • FIG 22-1 Continuum of cognitive responses.
      • LEARNING FROM A CLINICAL CASE
        • Case Background
        • Case Critical Reasoning Questions
    • Assessment
      • Behaviors
        • Behaviors Associated With Delirium
          • QUALITY AND SAFETY ALERT
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Behaviors Associated With Dementia
          • TABLE 22-1 TYPES AND OCCURRENCE RATES OF DEMENTIA
          • BOX 22-1 REVERSIBLE CAUSES OF DEMENTIA
          • QUALITY AND SAFETY ALERT
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • TABLE 22-2 ASSOCIATION OF AREAS OF BRAIN PATHOLOGY WITH BEHAVIORAL CHANGES IN DEMENTIA
          • TABLE 22-3 COMPARISON OF DELIRIUM, DEPRESSION, AND DEMENTIA
          • BOX 22-2 ALZHEIMER DISEASE FACTS AND FIGURES
          • BOX 22-3 THREE STAGES OF ALZHEIMER DISEASE
            • Stage I: Mild—2 to 4 average years duration
            • Stage II: Moderate—2 to 10 average years duration
            • Stage III: Severe—1 to 3 average years duration
          • Critical Reasoning
          • Critical Reasoning
          • QUALITY AND SAFETY ALERT
          • TABLE 22-4 DISTURBING BEHAVIORS CHARACTERISTIC OF DEMENTIA
        • Behaviors Associated with Traumatic Brain Injury
          • BOX 22-4 COMMON EFFECTS OF TRAUMATIC BRAIN INJURY (TBI)
            • Physical Problems
            • Cognitive Problems
            • Affective Problems
            • Behavioral Problems
          • QUALITY AND SAFETY ALERT
      • Predisposing Factors
        • Aging
        • Neurobiological
          • TABLE 22-5 RELATIONSHIPS BETWEEN NEUROTRANSMITTERS AND BEHAVIOR IN DEMENTIA
          • TABLE 22-6 HIV SYMPTOMS RELATED TO BRAIN STRUCTURES AND FUNCTIONS
          • Brain imaging
        • Genetic
          • QUALITY AND SAFETY ALERT
          • FIG 22-2 Pathological spread of Alzheimer disease (AD) as shown by positron emission tomography scans. A, Normal brain. B, Brain in stage I AD. C, Brain in stage II AD. D, Brain in stage III AD. E, Diagrams show the spread of the pathology in AD.
        • Underlying Psychiatric and Medical Disorders
      • Precipitating Stressors
        • Precipitating Stressors Associated With Delirium
          • BOX 22-5 MEDICATIONS ASSOCIATED WITH DELIRIUM
            • Narcotic
            • Sedative-Hypnotics
            • Cardiac Medications
            • Anticholinergics
            • Miscellaneous
          • Central nervous system disorder
          • Metabolic disorder
            • BOX 22-6 UNDERLYING CONDITIONS COMMONLY ASSOCIATED WITH DELIRIUM
              • Central Nervous System Disorders
              • Metabolic Disorders
              • Cardiopulmonary Disorders
              • Systemic Illnesses
              • Sensory Deprivation or Stimulation
            • Critical Reasoning
          • Cardiopulmonary disorder
          • Systemic illness
          • Sensory deprivation or stimulation
            • Critical Reasoning
        • Precipitating Stressors Associated with Dementia
          • BOX 22-7 UNDERLYING CONDITIONS COMMONLY ASSOCIATED WITH DEMENTIA ACROSS THE LIFE SPAN
            • Children
            • Adolescents
            • Adults/Elderly
              • Degenerative Brain Disorders
              • Toxic-Metabolic Disturbances
              • Central Nervous System Infections
              • Miscellaneous
          • BOX 22-8 RISK FACTORS AND PROPOSED PROTECTIVE FACTORS FOR ALZHEIMER DISEASE
            • Risk Factors
              • Definite
              • Possible
            • Proposed Protective Factors
        • Precipitating Stressors Associated with Traumatic Brain Injury
          • QUALITY AND SAFETY ALERT
          • Critical Reasoning
      • Appraisal of Stressors
      • Coping Resources
        • BOX 22-9 A FAMILY SPEAKS
      • Coping Mechanisms
        • Coping Mechanisms Associated With Delirium
        • Coping Mechanisms Associated With Dementia
        • Coping Mechanisms Associated With Traumatic Brain Injury
    • Diagnosis
      • Nursing Diagnoses
      • Medical Diagnoses
    • Outcomes Identification
      • FIG 22-3 The Stuart Stress Adaptation Model as related to cognitive responses.
    • Planning
    • Implementation
      • TABLE 22-7 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Maladaptive Cognitive Responses
      • Intervening in Delirium
        • Physiological Needs
          • QUALITY AND SAFETY ALERT
          • TABLE 22-8 family education plan Helping a Family with a Cognitively Impaired Member
          • Critical Reasoning
        • Hallucinations
        • Communication
          • TABLE 22-9 Cholinesterase Inhibitor Therapy for Alzheimer Disease
        • Patient Education
      • Intervening in Dementia
        • Pharmacological Approaches
          • TABLE 22-10 Antipsychotic Agents Used in Elderly Patients with Behavioral Disturbances and Dementia
          • QUALITY AND SAFETY ALERT
          • TABLE 22-11 PHARMACOLOGICAL TREATMENTS USED IN ALZHEIMER DISEASE
        • Orientation
        • Communication
        • Socialization and Structured Activities
        • Sensory Enhancement
        • Reinforcement of Adaptive Coping Mechanisms
        • Wandering
        • Decreasing Agitation
        • Family and Community Interventions
          • BOX 22-10 PRACTICAL RECOMMENDATIONS FOR CAREGIVERS OF AGITATED AND AGGRESSIVE PATIENTS WITH DEMENTIA
            • Decrease Escalation
            • Communicate Effectively
            • Review the Basics
      • Intervening in Traumatic Brain Injury
        • TABLE 22-12 SIX-PHASE MODEL FOR HELPING FAMILIES WITH ALZHEIMER DISEASE
    • Evaluation
      • TABLE 22-13 NURSING TREATMENT PLAN SUMMARY Maladaptive Cognitive Responses
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1. How was his dementia different from depression or delirium?
        • 2. Which neurotransmitters would be affecting his dementia as evidenced by what specific behaviors?
        • 3. What would be the nursing diagnoses?
        • 4. What interventions would be helpful for this patient?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Impact of a Head Injury on Cognitive/Emotional Functioning (read text)
    • References
  • Chapter 23 Chemically Mediated Responses and Substance-Related Disorders
    • Learning Objectives
    • LEARNING FROM A CLINICAL CASE
      • Case Background
      • Case Critical Reasoning Questions
    • FIG 23-1 Continuum of chemically mediated responses.
    • Continuum of Chemically Mediated Responses
      • Definition of Terms
        • TABLE 23-1 PROFILING COMMON ADDICTIONS IN THE UNITED STATES
      • Attitudes About Substance Abuse
        • Critical Reasoning
      • Prevalence
        • QUALITY AND SAFETY ALERT
        • BOX 23-1 KEY FACTS ABOUT SUBSTANCE USE AND ABUSE
          • Excessive Alcohol Use
          • Drug Abuse
        • QUALITY AND SAFETY ALERT
        • Multiple Substance Use
        • Dual Diagnosis
        • Substance-Related Disorders in Nurses
    • Assessment
      • Screening for Substance Abuse
        • QUALITY AND SAFETY ALERT
        • AUDIT-C
          • Critical Reasoning
        • B-DAST
        • SBIRT
        • Breathalyzer
          • BOX 23-2 AUDIT-C: ALCOHOL USE DISORDERS IDENTIFICATION TEST
            • Scoring
        • Blood and Urine Screening
          • TABLE 23-2 SBIRT: SCREEN, BRIEF INTERVENTION, REFER TO TREATMENT
          • TABLE 23-3 COMPARISON OF BLOOD ALCOHOL CONCENTRATIONS WITH BEHAVIORAL MANIFESTATIONS OF INTOXICATION
          • BOX 23-3 B-DAST: BRIEF DRUG ABUSE SCREENING TEST
      • Behaviors of Abuse and Dependence
        • Central Nervous System Depressants
          • Alcohol
            • CLINICAL EXAMPLE
              • Selected Nursing Diagnoses
            • TABLE 23-4 CHARACTERISTICS OF SUBSTANCES OF ABUSE
          • Barbiturates
          • Benzodiazepines
        • Stimulants
          • Amphetamines
            • QUALITY AND SAFETY ALERT
            • QUALITY AND SAFETY ALERT
            • BOX 23-4 METHAMPHETAMINE
          • Cocaine
            • QUALITY AND SAFETY ALERT
            • CLINICAL EXAMPLE
              • Selected Nursing Diagnoses
        • Opiates
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • BOX 23-5 MISUSE OF PRESCRIPTION DRUGS
          • Natural opiates
        • Marijuana
          • Critical Reasoning
        • Hallucinogens
          • Critical Reasoning
        • MDMA (Ecstasy)
        • Phencyclidine (PCP)
          • QUALITY AND SAFETY ALERT
        • Inhalants
          • Critical Reasoning
        • Nicotine
        • Caffeine
        • Date Rape Drugs
        • Codependence
      • Dual Diagnosis
        • BOX 23-6 RELATIONSHIPS BETWEEN SUBSTANCE USE AND PSYCHIATRIC DISORDERS
        • CLINICAL EXAMPLE
      • Predisposing Factors
        • Biological
          • Critical Reasoning
        • Psychological
        • Sociocultural
          • Critical Reasoning
      • Precipitating Stressors
        • Withdrawal
          • General depressant drug withdrawal.
          • Prescribed depressants and sedative-hypnotics withdrawal.
          • Alcohol withdrawal
        • Neurobiology
          • FIG 23-2 Alcohol withdrawal syndrome. BP, Blood pressure; HR, heart rate; T, temperature.
      • Appraisal of Stressors
      • Coping Resources
      • Coping Mechanisms
    • Diagnosis
      • Nursing Diagnoses
      • Medical Diagnoses
        • Critical Reasoning
        • FIG 23-3 The Stuart Stress Adaptation Model as related to substance abuse.
    • Outcomes Identification
      • TABLE 23-5 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Chemically Mediated Responses
    • Planning
      • QUALITY AND SAFETY ALERT
    • Implementation
      • Intervening in Withdrawal
        • QUALITY AND SAFETY ALERT
        • TABLE 23-6 SUMMARY OF EVIDENCE-BASED TREATMENT FOR Chemically Mediated Responses
        • Management of Alcohol Withdrawal
        • Management of Benzodiazepines, Barbiturates, and Other Sedative-Hypnotics Withdrawal
          • BOX 23-7 MANAGEMENT OF ALCOHOL WITHDRAWAL
            • Symptom-Triggered Regimen
            • Fixed-Schedule Regimen
        • Management of Opiate Withdrawal
        • Management of Nicotine Withdrawal
          • Nicotine gum and the nicotine patch
          • Bupropion
          • Varenicline
        • Management of Caffeine Withdrawal
        • Intervening in Toxic Psychosis
          • BOX 23-8 A PATIENT SPEAKS
      • Intervening to Maintain Abstinence
        • Alcohol
          • Naltrexone
          • Disulfiram
            • QUALITY AND SAFETY ALERT
            • Critical Reasoning
          • Nalmefene
          • Acamprosate
          • Citalopram
          • Ondansetron
        • Opiates
          • l-α-Acetylmethadol
          • Methadone
            • Critical Reasoning
          • Buprenorphine
        • Cocaine
          • Vaccine in development
      • Effects of Drug Use During Pregnancy
        • QUALITY AND SAFETY ALERT
        • Critical Reasoning
      • Psychological Interventions
        • BOX 23-9 A FAMILY SPEAKS
        • Motivational Approaches
        • Cognitive Behavioral Strategies
          • Critical Reasoning
        • Working With Codependency
        • Relapse Prevention
          • QUALITY AND SAFETY ALERT
      • Social Interventions
        • Couples and Family Counseling
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Group Therapy
          • Critical Reasoning
          • Self-help groups
            • BOX 23-10 THE 12 STEPS OF ALCOHOLICS ANONYMOUS
        • Community Treatment Programs
        • Employee Assistance Programs
      • Working With Dually Diagnosed Patients
        • TABLE 23-7 NURSING TREATMENT PLAN SUMMARY Chemically Mediated Responses
        • TABLE 23-8 NURSING TREATMENT PLAN SUMMARY Chemically Mediated Responses
        • QUALITY AND SAFETY ALERT
        • TABLE 23-9 Treatment Stages, Goals, and Interventions for Dually Diagnosed Patients
        • CLINICAL EXAMPLE
          • Selected Nursing Diagnoses
      • Intervening With Impaired Colleagues
        • QUALITY AND SAFETY ALERT
        • BOX 23-11 SIGNS OF IMPAIRED NURSING PRACTICE
          • Job Performance Changes
            • Controlled Drug Handling and Records (Potential Drug Diversion)
            • General Performance
          • Behavior and Personality Changes
          • Signs of Use
          • Signs of Withdrawal
        • Critical Reasoning
      • Preventive Interventions
        • Primary Prevention
        • Secondary Prevention
        • Tertiary Prevention
          • TABLE 23-10 PATIENT EDUCATION PLAN Promoting Adaptive Chemically Mediated Responses
    • Evaluation
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1 What is the prevalence of substance abuse, and could she be at risk for suicide?
        • 2 Could her sexual orientation and distancing herself from her family be stressors?
        • 3 What are some of her external and internal triggers?
        • 4 What model of change did she use in her substance abuse treatment?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Alcohol and Substance Abuse (read text)
    • References
  • Chapter 24 Eating Regulation Responses and Eating Disorders
    • Learning Objectives
    • Continuum of Eating Regulation Responses
      • FIG 24-1 Continuum of eating regulation responses.
      • LEARNING FROM A CLINICAL CASE
        • Case Background
        • Case Critical Reasoning Questions
      • QUALITY AND SAFETY ALERT
      • Critical Reasoning
      • Prevalence of Eating Disorders
        • Anorexia Nervosa
        • Bulimia Nervosa
        • Binge Eating Disorder
        • Night Eating Syndrome
          • QUALITY AND SAFETY ALERT
    • Assessment
      • FIG 24-2 The overlapping relationships among eating disorders.
      • Behaviors
        • Binge Eating
        • Fasting or Restricting
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
        • Purging
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • Critical Reasoning
      • Medical Complications
        • QUALITY AND SAFETY ALERT
        • BOX 24-1 MEDICAL COMPLICATIONS ASSOCIATED WITH EATING DISORDERS
          • Central Nervous System
          • Renal
          • Hematological
          • Gastrointestinal
          • Metabolic
          • Endocrine
          • Cardiovascular
        • CLINICAL EXAMPLE
          • Selected Nursing Diagnoses
      • Psychiatric Complications
      • Predisposing Factors
        • Biological
          • FIG 24-3 Major factors influencing food intake.
          • Critical Reasoning
        • Psychological
        • Environmental
          • TABLE 24-1 FAMILY EDUCATION PLAN Preventing Childhood Eating Problems
        • Sociocultural
          • Critical Reasoning
      • Precipitating Stressors
        • BOX 24-2 PSYCHOSOCIAL PREDISPOSING FACTORS FOR THE DEVELOPMENT OF EATING DISORDERS
          • Personal Factors
          • Family Factors
          • Peers
          • Culture
          • Activities
      • Appraisal of Stressors
        • CLINICAL EXAMPLE
          • Selected Nursing Diagnoses
      • Coping Resources
      • Coping Mechanisms
    • Diagnosis
      • Nursing Diagnoses
      • Medical Diagnoses
    • Outcomes Identification
      • FIG 24-4 The Stuart Stress Adaptation Model as related to eating regulation responses.
    • Planning
      • Choice of Treatment Setting
        • QUALITY AND SAFETY ALERT
        • TABLE 24-2 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Eating Regulation Responses
        • TABLE 24-3 KEY FEATURES OF ANOREXIA NERVOSA AND BULIMIA NERVOSA
        • BOX 24-3 CLINICAL CRITERIA FOR HOSPITALIZATION OF PATIENTS WITH AN EATING DISORDER
          • Medical
          • Psychiatric
      • Nurse-Patient Contract
        • Critical Reasoning
        • TABLE 24-4 SUMMARIZING EVIDENCE-BASED TREATMENT FOR Eating Disorders
    • Implementation
      • Nutritional Stabilization
        • QUALITY AND SAFETY ALERT
      • Exercise
      • Cognitive Behavioral Interventions
        • BOX 24-4 COGNITIVE DISTORTIONS RELATED TO MALADAPTIVE EATING REGULATION RESPONSES
        • Cues
        • Thoughts, Feelings, and Assumptions
          • BOX 24-5 A PATIENT SPEAKS
        • Eating Regulation Responses
        • Consequences
          • TABLE 24-5 Consequences of Maladaptive Eating Regulation Responses
          • Critical Reasoning
      • Body Image Interventions
        • FIG 24-5 The perception of body shape and size can be evaluated through the use of special computer drawing programs that allow a subject to distort the width of an actual picture of a person's body by as much as 20%, larger or smaller. Both anorectic and normal subjects adjusted the figures of other people's bodies to normal dimension. However, anorectic subjects consistently adjusted their own body picture to a size 20% larger than its true form, which suggests they have a major problem with the perception of self-image.
      • Family Involvement
      • Group Therapies
        • BOX 24-6 A FAMILY SPEAKS
      • Medications
        • TABLE 24-6 NURSING TREATMENT PLAN SUMMARY Eating Regulation Reponses
        • TABLE 24-7 NURSING TREATMENT PLAN SUMMARY Eating Regulation Reponses
    • Evaluation
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1. How would you assess this woman's illness?
        • 2. What eating disorder does she have?
        • 3. What predisposing factors contribute to her illness?
        • 4. What nursing diagnoses would guide your interventions for this patient?
        • 5. What are the health consequences and medical complications of disordered eating?
        • 6. What treatment setting and interventions would you choose for this patient?
        • Case Outcome
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Eating Disorders (read text)
    • References
  • Chapter 25 Sexual Responses and Sexual Disorders
    • Learning Objectives
    • LEARNING FROM A CLINICAL CASE
      • Case Background
      • Case Critical Reasoning Questions
    • Continuum of Sexual Responses
      • Adaptive and Maladaptive Sexual Responses
        • FIG 25-1 Continuum of sexual responses.
        • FIG 25-2 Phases of the nurse's growth in developing awareness of human sexuality.
        • Critical Reasoning
      • Self-Awareness of the Nurse
        • Cognitive Dissonance
        • Anxiety
        • Anger
        • Action
          • CLINICAL EXAMPLE
          • Critical Reasoning
    • Assessment
      • Behaviors
        • QUALITY AND SAFETY ALERT
        • Heterosexuality
        • Homosexuality
          • Critical Reasoning
        • Bisexuality
        • Transvestism
        • Transsexualism
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • BOX 25-1 STAGES OF THE SEXUAL RESPONSE CYCLE
            • Stage 1: Desire
            • Stage 2: Excitement
            • Stage 3: Orgasm
            • Stage 4: Resolution
          • Critical Reasoning
        • The Sexual Response Cycle
      • Predisposing Factors
        • Biological Factors
        • Behavioral Factors
          • QUALITY AND SAFETY ALERT
      • Precipitating Stressors
        • Physical Illness and Injury
        • Psychiatric Illness
          • BOX 25-2 A FAMILY SPEAKS
        • Medications
          • Critical Reasoning
        • HIV/AIDS
        • The Aging Process
          • Critical Reasoning
      • Appraisal of Stressors
      • Coping Resources
      • Coping Mechanisms
    • Diagnosis
      • Nursing Diagnoses
      • Medical Diagnoses
    • Outcomes Identification
      • FIG 25-3 The Stuart Stress Adaptation Model as related to sexual responses.
      • Critical Reasoning
    • Planning
    • Implementation
      • Health Education
        • TABLE 25-1 NURSING DIAGNOSES AND MEDICAL TERMS RELATED TO Sexual Responses
        • TABLE 25-2 SUMMARIZING EVIDENCE BASED TREATMENTS FOR Sexual Responses
        • BOX 25-3 NOC OUTCOME INDICATORS FOR SEXUAL IDENTITY
        • TABLE 25-3 TEN COMMON MYTHS AND FACTS ABOUT HUMAN SEXUALITY
        • Critical Reasoning
      • Sexual Responses Within the Nurse-Patient Relationship
        • Sexual Responses of Nurses to Patients
          • QUALITY AND SAFETY ALERT
        • Sexual Responses of Patients to Nurses
          • CLINICAL EXAMPLE
      • Maladaptive Sexual Responses
        • Resulting from Illness
          • TABLE 25-4 SUMMARY OF NURSING CONSIDERATIONS IN SEXUAL RESPONSES OF PATIENTS TO NURSES
          • BOX 25-4 A PATIENT SPEAKS
          • Critical Reasoning
        • Difficulties With Sexual Orientation
          • TABLE 25-5 PATIENT EDUCATION PLAN Sexual Responses After an Organic Illness
          • QUALITY AND SAFETY ALERT
          • CLINICAL EXAMPLE
            • Selected Nursing Diagnoses
          • QUALITY AND SAFETY ALERT
        • Difficulties With Gender Identity
        • Pedophilia
          • Critical Reasoning
      • Dysfunctions of the Sexual Response Cycle
        • Masters and Johnson Model
        • Helen Singer Kaplan Model
          • TABLE 25-6 NURSING TREATMENT PLAN SUMMARY Maladaptive Sexual Responses
        • Pharmacological Treatment
    • Evaluation
      • LEARNING FROM A CLINICAL CASE OUTCOME
        • 1. How has the stigma of homosexuality affected the mental health of this young man?
        • 2. Why is it important for the nurse to examine one's own beliefs about homosexuality before providing care to this patient?
        • 3. Do public barriers, such as employment, exist related to sexual orientation?
        • 4. How would you intervene to assist this patient to “obtain the maximum level of adaptive sexual responses to enhance or maintain health”?
        • 5. What health education would you provide?
        • 6. What are your nursing actions in relation to this patient's concern about “coming out”?
        • Case Outcomes
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • Sexual Orientation, Health Care Providers, and Health Care Delivery (read text)
    • References
• Unit 4 Treatment Modalities
  • Interactive Review – Unit 4
  • Chapter 26 Psychopharmacology
    • LEARNING OBJECTIVES
    • Role of the Nurse in Psychopharmacology
      • Patient Assessment
      • Coordination of Treatment Modalities
      • Drug Administration
        • BOX 26-1 MEDICATION ASSESSMENT TOOL
          • Prescribed and Over-the-Counter Medications
          • Other Substances
      • Monitoring Drug Effects
      • Medication Education
      • Drug Maintenance Programs
      • Clinical Research Drug Trials
      • Prescriptive Authority
        • Critical Reasoning
    • Pharmacological Principles
      • Pharmacokinetics
        • Bioavailability
        • Half-life
        • Drug Interactions
      • Pharmacodynamics
        • Receptor Mechanisms
        • Dose-Response Curve
        • Therapeutic Index
        • Tolerance, Dependence, and Withdrawal Symptoms
      • Drug Co-Administration
        • BOX 26-2 GUIDELINES FOR DRUG CO-ADMINISTRATION
        • BOX 26-3 INCREASED RISK FACTORS FOR DEVELOPMENT OF DRUG INTERACTIONS
        • Primary Medication
        • Combination Drug Therapy
        • Augmentation or Adjunctive Therapy
          • TABLE 26-1 INTERACTIONS OF PSYCHOTROPIC DRUGS AND OTHER SUBSTANCES
        • Concurrent Pharmacology
        • Polypharmacy
          • Critical Reasoning
      • Special Populations
        • Youth
        • Elderly Patients
        • Pregnant and Lactating Women
        • Cross-Cultural Perspectives, Ethnopsychopharmacology, and Gender
        • Medically Ill Patients
          • FIG 26-1 Neurotransmission and drug effects at the synapse. ChE, Cholinesterase; GABA, gamma-aminobutyric acid; MAO, monoamine oxidase.
      • Biological Basis for Psychopharmacology
    • Antianxiety and Sedative-Hypnotic Drugs
      • Critical Reasoning
      • Benzodiazepines
        • BOX 26-4 TARGET SYMPTOMS FOR ANTIANXIETY AND SEDATIVE-HYPNOTIC BENZODIAZEPINES
          • Psychological
          • Physical
        • Clinical Use
        • Side Effects and Adverse Reactions
          • TABLE 26-2 ANTIANXIETY AND SEDATIVE-HYPNOTIC DRUGS: BENZODIAZEPINES
          • TABLE 26-3 BENZODIAZEPINE SIDE EFFECTS AND NURSING CONSIDERATIONS
          • BOX 26-5 BENZODIAZEPINE WITHDRAWAL SYMPTOMS
      • Nonbenzodiazepine Antianxiety Agents
        • TABLE 26-4 NONBENZODIAZEPINE ANTIANXIETY AND SEDATIVE-HYPNOTIC AGENTS
      • Nonbenzodiazepine Sedative-Hypnotic Agents
      • Barbiturates and Older Antianxiety and Sedative-Hypnotic Drugs
    • Antidepressant Drugs
      • TABLE 26-5 INDICATIONS FOR ANTIDEPRESSANT DRUGS
      • BOX 26-6 TARGET SYMPTOMS FOR ANTIDEPRESSANT DRUGS
      • Critical Reasoning
      • Selective Serotonin Reuptake Inhibitors
        • TABLE 26-6 ANTIDEPRESSANT DRUG SYNAPTIC ACTIVITY
        • TABLE 26-7 POSSIBLE CLINICAL EFFECTS OF SYNAPTIC ACTIVITY BY PSYCHOTROPIC DRUGS
        • TABLE 26-8 ANTIDEPRESSANT DRUGS
        • TABLE 26-9 COMPARATIVE SIDE EFFECT PROFILES OF SOME ANTIDEPRESSANT MEDICATIONS
        • TABLE 26-10 ANTIDEPRESSANT DRUG SIDE EFFECTS
        • TABLE 26-11 NURSING CONSIDERATIONS FOR ANTIDEPRESSANT DRUG SIDE EFFECTS
        • TABLE 26-12 ADJUNCTIVE AGENTS FOR ANTIDEPRESSANT-INDUCED SEXUAL DYSFUNCTION
      • Other Antidepressant Drugs
        • BOX 26-7 SEROTONIN SYNDROME
          • Overview
          • Symptoms Occur Within Minutes to Hours
          • Treatment
      • Tricyclic Antidepressants
      • Monoamine Oxidase Inhibitors
        • TABLE 26-13 DRUGS TO AVOID IN COMBINATION WITH MAOIs
        • BOX 26-8 FOOD CAUTIONS FOR PATIENTS TAKING MONOAMINE OXIDASE INHIBITORS (MAOIs)
          • Foods to Be Avoided
          • Foods to Be Eaten in Moderation and With Caution
        • BOX 26-9 SIGNS AND TREATMENT OF MAOI-INDUCED HYPERTENSIVE CRISIS
          • Warning Signs
          • Symptoms of Hypertensive Crisis
          • Treatment
    • Mood-Stabilizing Drugs
      • Lithium
        • TABLE 26-14 MOOD-STABILIZING DRUGS
        • BOX 26-10 TARGET SYMPTOMS FOR MOOD-STABILIZING DRUG THERAPY
          • Mania
          • Depression
        • Critical Reasoning
      • Anticonvulsants
        • BOX 26-11 PRELITHIUM WORK-UP
          • Maintenance Lithium Considerations
        • BOX 26-12 LITHIUM SIDE EFFECTS AND TOXICITY
          • Body Image
          • Cardiac
          • Central Nervous System
          • Dermatological
          • Endocrine
          • Gastrointestinal
          • Renal
          • Lithium Toxicity/Usually Dose Related
        • BOX 26-13 STABILIZING LITHIUM LEVELS
          • Common Causes for an Increase in Lithium Levels
          • Ways to Maintain a Stable Lithium Level
        • BOX 26-14 MANAGEMENT OF SERIOUS LITHIUM TOXICITY
      • Atypical Antipsychotics
      • Benzodiazepines
      • Calcium Channel Blockers
    • Antipsychotic Drugs
      • Atypical Antipsychotics
        • TABLE 26-15 ATYPICAL ANTIPSYCHOTIC AND TYPICAL ANTIPSYCHOTIC DRUGS
        • BOX 26-15 TARGET SYMPTOMS FOR ANTIPSYCHOTIC DRUGS
          • Typical and Atypical Antipsychotics
            • Positive Symptoms: An Excess or Distortion of Normal Function*
          • Atypical Antipsychotics
            • Negative Symptoms: A Diminution or Loss of Normal Function†
            • Mood Symptoms, Cognitive Impairment, and Difficulty with Socialization
        • Critical Reasoning
      • Typical Antipsychotics
      • General Pharmacological Principles
        • TABLE 26-16 COMPARISON OF TYPICAL AND ATYPICAL ANTIPSYCHOTIC DRUGS
        • TABLE 26-17 ACUTE SIDE EFFECT PROFILE: ANTIPSYCHOTIC DRUGS
        • TABLE 26-18 NURSING CONSIDERATIONS FOR ANTIPSYCHOTIC DRUG SIDE EFFECTS
        • TABLE 26-19 DRUGS TO TREAT EXTRAPYRAMIDAL SIDE EFFECTS
        • BOX 26-16 EPS AND TARDIVE DYSKINESIA
        • BOX 26-17 NEUROLEPTIC MALIGNANT SYNDROME (NMS)
          • Symptoms
          • Treatment
        • FIG 26-2 Medicines in development for mental illnesses. Some medicines are in development for more than one disorder.
    • Future Developments
      • New Psychopharmacological Agents
      • Genomics
        • FIG 26-3 Gene discovery: new avenues to prevention and treatment.
    • Psychiatric Nursing Practice
      • Documentation
      • Patient Education
        • Critical Reasoning
      • Patient Assistance Programs
        • TABLE 26-20 INTERVENTIONS TO IMPROVE PATIENT MEDICATION ADHERENCE
        • BOX 26-18 RISK FACTORS FOR PATIENT MEDICATION NONADHERENCE
      • Promoting Patient Adherence and Compliance
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 27 Behavior Change and Cognitive Interventions
    • Learning Objectives
    • Behavior
      • Critical Reasoning
    • Behavior Change Strategies
      • Readiness to Change
      • Motivational Interviewing
        • FIG 27-1 A model of change in substance use disorders.
        • TABLE 27-1 STAGES OF CHANGE MODEL
      • Motivational Interventions
        • FIG 27-2 Decisional balance grid.
    • Cognitive Strategies
      • Critical Reasoning
    • Cognitive Behavioral Interventions
      • TABLE 27-2 COGNITIVE DISTORTIONS
      • BOX 27-1 CHARACTERISTICS OF COGNITIVE BEHAVIORAL INTERVENTIONS
      • Cognitive Behavioral Assessment
        • Critical Reasoning
        • FIG 27-3 Phases of behavior.
        • FIG 27-4 Interacting systems in human behavior.
        • Critical Reasoning
      • Cognitive Behavioral Implementation
      • Cognitive Restructuring
        • Monitoring Thoughts and Feelings
          • BOX 27-2 COGNITIVE BEHAVIORAL STRATEGIES
            • Cognitive Restructuring
            • Learning New Behavior
        • Questioning the Evidence
        • Examining Alternatives
        • Decatastrophizing
          • FIG 27-5 Daily Record of Dysfunctional Thoughts Form.
        • Reframing
          • Critical Reasoning
        • Thought Stopping
      • Learning New Behavior
        • Behavioral Activation
        • Modeling
        • Shaping
        • Token Economy
        • Role Playing
        • Social Skills Training
        • Aversion Therapy
        • Contingency Contracting
    • Role of the Nurse
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 28 Preventing and Managing Aggressive Behavior
    • Learning Objectives
    • Critical Reasoning
    • Behavioral Responses
      • Passive Behavior
        • Clinical Example
      • Aggressive Behavior
        • Clinical Example
      • Assertive Behavior
        • Critical Reasoning
    • Theories on Aggression
      • TABLE 28-1 COMPARISON OF PASSIVE, ASSERTIVE, AND AGGRESSIVE BEHAVIORS
      • Psychological
        • BOX 28-1 DEVELOPMENTAL FACTORS LIMITING USE OF NONVIOLENT COPING TECHNIQUES
        • FIG 28-1 Intergenerational transmission of violence.
      • Sociocultural
        • BOX 28-2 BACKGROUND INFORMATION ASSOCIATED WITH VIOLENT BEHAVIOR
      • Biological
        • FIG 28-2 Structures of the brain that are implicated in aggression.
    • Predicting Aggressive Behavior
      • Critical Reasoning
    • Nursing Assessment
      • FIG 28-3 Model of inpatient aggression.
      • FIG 28-4 Hierarchy of aggressive and violent patient behaviors.
      • FIG 28-5 Assault and violence assessment tool.
      • BOX 28-3 BEHAVIORS ASSOCIATED WITH AGGRESSION
        • Motor Agitation
        • Verbalizations
        • Affect
        • Level of Consciousness
      • FIG 28-6 Continuum of nursing interventions in managing aggressive behavior.
    • Nursing Interventions
      • Self-Awareness
      • Patient Education
      • Assertiveness Training
        • TABLE 28-2 PATIENT EDUCATION PLAN Appropriate Expression of Anger
        • BOX 28-4 WAYS TO MANAGE ANGER
        • Critical Reasoning
      • Communication Strategies
        • Critical Reasoning
      • Environmental Strategies
        • BOX 28-5 COMMUNICATION STRATEGIES USED TO PREVENT AGGRESSIVE BEHAVIOR
        • Clinical Example
        • Room Program
        • Cathartic Activities
      • Behavioral Strategies
        • Limit Setting
        • Behavioral Contracts
        • Time-Out
        • Token Economy
          • Clinical Example
      • Psychopharmacology
        • Antianxiety and Sedative-Hypnotic Medications
        • Antidepressants
        • Mood Stabilizers
        • Antipsychotics
        • Other Medications
          • Critical Reasoning
    • Crisis Management Techniques
      • Team Response
        • BOX 28-6 PROCEDURE FOR MANAGING PSYCHIATRIC EMERGENCIES
      • Seclusion and Restraints
        • Seclusion
          • Critical Reasoning
        • Restraints
          • BOX 28-7 NIC INTERVENTIONS RELATED TO SECLUSION
            • Definition
            • Activities
      • Terminating the Intervention
        • Critical Reasoning
    • Prevention
      • Lateral Violence
        • BOX 28-8 NIC INTERVENTIONS RELATED TO PHYSICAL RESTRAINT
          • Definition
          • Activities
      • Workplace Guidelines
        • BOX 28-9 HOW TO PREVENT AGGRESSIVE WORKPLACE BEHAVIOR
      • Staff Development
      • Staff Support
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 29 Somatic Therapies
    • Learning Objectives
    • Convulsive Therapies
      • Critical Reasoning
      • Indications
        • FIG 29-1 Electrode placement in electroconvulsive therapy.
        • Critical Reasoning
        • BOX 29-1 CRITERIA FOR THE USE OF ELECTROCONVULSIVE THERAPY (ECT)
          • Primary Use
          • Secondary Use
        • BOX 29-2 TARGET BEHAVIORS FOR ELECTROCONVULSIVE THERAPY (ECT)
          • ECT Proved Effective
          • ECT Proved Ineffective
      • Mechanism of Action
      • Adverse Effects
      • Nursing Care
        • Emotional Support and Education
          • Critical Reasoning
        • Pretreatment Nursing Care
          • BOX 29-3 EQUIPMENT FOR ELECTROCONVULSIVE THERAPY
        • Nursing Care During the Procedure
          • FIG 29-2 Electroencephalogram (EEG) electrode placement.
        • Posttreatment Nursing Care
          • Critical Reasoning
        • Interdisciplinary Collaboration
          • TABLE 29-1 COMMON PATIENT PROBLEMS AND NURSING INTERVENTIONS RELATED TO ELECTROCONVULSIVE THERAPY (ECT)
          • Critical Reasoning
        • Nursing Staff Education
          • Critical Reasoning
    • Chronotherapy
      • TABLE 29-2 NURSING INTERVENTIONS FOR THE PATIENT RECEIVING ELECTROCONVULSIVE THERAPY (ECT)
      • Indications
        • FIG 29-3 Broad-spectrum fluorescent lamps such as this one are used in daily therapy sessions from autumn until spring for people with seasonal affective disorder (SAD), who report feeling less depressed within 3 to 7 days after treatment begins.
      • Mechanism of Action
      • Adverse Effects
        • Critical Reasoning
    • Transcranial Magnetic Stimulation
      • Indications
      • Mechanism of Action
        • FIG 29-4 The physics of repetitive transcranial magnetic stimulation (rTMS).
      • Adverse Effects
        • Critical Reasoning
    • Cranial Electrotherapy Stimulation (CES)
      • Mechanism of Action
      • Adverse Effects
    • Implantable Brain Stimulation Device—Vagus Nerve Stimulation
      • Indications
      • Mechanism of Action
      • Adverse Effects
        • Critical Reasoning
    • Deep Brain Stimulation
      • Indications
      • Mechanism of Action
      • Adverse Effects
        • FIG 29-5 Vagus nerve stimulation (VNS) implantation.
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 30 Complementary and Alternative Therapies
    • LEARNING OBJECTIVES
    • Overview of Complementary and Alternative Medicine
      • TABLE 30-1 MAJOR DOMAINS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE
      • Evidence-Based Practice
      • Ethical Issues
        • BOX 30-1 PATIENT GUIDELINES FOR CONSIDERING COMPLEMENTARY AND ALTERNATIVE THERAPIES
    • Depression
      • Acupuncture
      • Meditation
      • Yoga
      • Herbal Products
        • Critical Reasoning
      • Exercise
      • Massage
        • Critical Reasoning
      • Light Therapy
      • Guided Imagery
    • Anxiety
      • Progressive Muscle Relaxation
      • Energy Therapies
        • Critical Reasoning
      • Yoga and Meditation
      • Acupuncture
      • Herbal Products
    • Substance Use Disorders
      • Acupuncture
        • FIG 30–1 Auricular acupuncture points.
      • Yoga and Meditation
      • Biofeedback
      • Herbal Products
    • Eating Disorders
      • Yoga and Meditation
    • Attention Deficit Hyperactivity Disorder
      • Neurofeedback
    • Dementias
      • Herbal Products
      • Energy Therapies
    • Nursing Implications
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 31 Therapeutic Groups
    • LEARNING OBJECTIVES
    • Critical Reasoning
    • Overview of Group Therapy
    • Components of Small Groups
      • Structure
        • TABLE 31-1 COMPONENTS OF SMALL GROUPS
      • Size
      • Length of Sessions
      • Communication
      • Roles
        • TABLE 31-2 GROUP ROLES AND FUNCTIONS
        • Critical Reasoning
      • Power
      • Norms
        • Critical Reasoning
      • Cohesion
    • Group Development
      • BOX 31-1 GROUP PROPOSAL GUIDELINES
      • Pregroup Phase
        • Critical Reasoning
      • Initial Phase
        • Orientation Stage
          • TABLE 31-3 DEVELOPMENTAL PHASES IN SMALL GROUPS
        • Conflict Stage
        • Cohesive Stage
          • TABLE 31-4 YALOM'S CURATIVE FACTORS
          • Critical Reasoning
      • Working Phase
      • Termination Phase
        • Critical Reasoning
    • Evaluation of the Group
      • BOX 31-2 GROUP SESSION NOTE OUTLINE
    • Nurses as Group Leaders
      • Groups with Co-Leaders
      • Nurse-Led Groups
        • Task Groups
        • Self-Help Groups
        • Educational Groups
        • Supportive Therapy Groups
        • Psychotherapy Groups
        • Brief Therapy Groups
        • Intensive Problem-Solving Groups
        • Peer Support Groups
          • Critical Reasoning
          • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 32 Family Interventions
    • Learning Objectives
    • The Context of Family Interventions
      • The Family Movement
        • BOX 32-1 ADVOCACY
        • Critical Reasoning
      • Cultural Competence
        • BOX 32-2 ACTIVITIES FOR PROMOTING PARTNERSHIPS WITH PATIENTS AND FAMILIES
        • Critical Reasoning
      • Professional Training
        • Critical Reasoning
      • Framework for Family Work
        • BOX 32-3 FAMILY RISK AND PROTECTIVE FACTORS IMPACTING CHILDREN AND ADOLESCENTS
          • Risk Factors
          • Protective Factors
        • Critical Reasoning
        • Critical Reasoning
    • Assessment and Planning
      • Critical Reasoning
      • Family Relational Problems
    • implementation
      • Critical Reasoning
      • Psychotherapy
    • Outcomes identification
    • Research on Family Interventions
      • Youth
        • Youth With Conduct Disorders
        • Youth With Mood, Attention, and Behavioral Disorders
        • Prevention of Youth Substance Abuse
        • Prevention of Youth Suicide
          • Critical Reasoning
          • BOX 32-4 THREE-STEP INTERVENTIONS: 10 MINUTES OF YOUR TIME CAN MEAN A LIFETIME FOR AN ADOLESCENT
            • Program Description
            • Program Content
      • Family Psychoeducation
      • Couples Therapy
    • The Role of the Nurse
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
• Unit 5 Treatment Settings
  • Interactive Review – Unit 5
  • Chapter 33 Hospital-Based Psychiatric Nursing Care
    • Learning Objectives
    • Inpatient Psychiatric Care
      • BOX 33-1 INDICATIONS AND TREATMENT OBJECTIVES FOR PSYCHIATRIC HOSPITALIZATION
        • Indications for Inpatient Hospitalization
        • Treatment Objectives
      • Critical Reasoning
      • FIG 33-1 Hospital stays for psychiatric patients.
      • TABLE 33-1 FIRST-LISTED DIAGNOSIS FOR PATIENTS DISCHARGED FROM SHORT-STAY HOSPITALS
      • State Hospitals
        • Critical Reasoning
      • Partial Hospitalization Programs
        • Critical Reasoning
      • The Role of the Nurse
    • Managing the Milieu
      • The Therapeutic Community
        • Critical Reasoning
      • The Therapeutic Milieu
        • Critical Reasoning
        • TABLE 33-2 MANAGING DISTURBING BEHAVIORS IN THE MILIEU
        • Containment
        • Support
        • Structure
        • Involvement
        • Validation
          • Critical Reasoning
      • Nursing Implications
        • Critical Reasoning
    • Implementing Caregiving Activities
      • Patient Safety and Risk Reduction
        • TABLE 33-3 SIX PROCESSES AND OUTCOMES OF INPATIENT PSYCHIATRIC TREATMENT
      • Meeting Physical Needs
      • Patient and Family Education
        • Critical Reasoning
      • Activities, Groups, and Programs
        • Critical Reasoning
      • Discharge Planning
        • BOX 33-2 EXAMPLES OF NURSING GROUPS OR PROGRAMS
          • Medication Education Groups
          • Community Resource Groups
          • Nutrition Groups
          • Sleep Improvement Programs
    • Integrating Care Delivery
      • Teamwork and Coordinated Care
        • Critical Reasoning
      • Resource Allocation
        • Critical Reasoning
      • Professional, Regulatory, and Accreditation Standards
        • Critical Reasoning
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 34 Community-Based Psychiatric Nursing Care
    • Learning Objectives
    • Critical Reasoning
    • Treatment Settings
      • Primary Care Settings
        • TABLE 34-1 BRIEF SCREENING TOOLS
        • Critical Reasoning
      • Emergency Department Psychiatric Care
        • Critical Reasoning
      • Employee Assistance Programs
      • Home Psychiatric Care
        • BOX 34-1 BENEFICIARIES OF IN-HOME PSYCHIATRIC NURSING SERVICES
        • BOX 34-2 HOME VISITING AND MATERNAL DEPRESSION
        • Critical Reasoning
        • Critical Reasoning
        • BOX 34-3 CONDITIONS THAT MIGHT MAKE A PATIENT PSYCHIATRICALLY HOMEBOUND
        • BOX 34-4 MEDICARE REQUIREMENTS FOR PSYCHIATRIC NURSES IN HOME CARE
        • Cultural Competence
          • Critical Reasoning
        • Safety
        • Nursing Activities
          • CLINICAL EXAMPLE
          • Critical Reasoning
      • Virtual Mental Health Care
        • BOX 34-5 TXT 4 HELP
        • Critical Reasoning
    • Models of Care
      • Patient-Centered Health Care Homes
        • Critical Reasoning
      • Collaborative Care and Care Management
        • BOX 34-6 ELEMENTS OF PATIENT-CENTERED HEALTH CARE HOMES
      • Case Management
        • Critical Reasoning
        • CLINICAL EXAMPLE
        • FIG 34-1 Components of a community support system.
      • Assertive Community Treatment
        • TABLE 34-2 ASPECTS AND INTERVENTIONS OF CLINICAL CASE MANAGEMENT
        • BOX 34-7 SERVICES PROVIDED BY ASSERTIVE COMMUNITY TREATMENT (ACT) TEAM MEMBERS
          • Rehabilitative Approach to Daily Living Skills
          • Family Involvement
          • Work Opportunities
          • Entitlements
          • Health Promotion
          • Medication Support
          • Housing Assistance
          • Financial Management
          • Counseling
        • Critical Reasoning
    • Vulnerable Populations in the Community
      • Deinstitutionalization
        • BOX 34-8 REFLECTING ON HOMELESSNESS BY TYRONE GARRETT
        • Critical Reasoning
      • Homeless People With Mental Illness
        • Critical Reasoning
        • CLINICAL EXAMPLE
      • Rural People With Mental Illness
        • Critical Reasoning
      • Incarcerated People With Mental Illness
        • TABLE 34-3 STATE PRISON INMATES IDENTIFIED AS MENTALLY III
        • FIG 34-2 Community model for services.
        • Critical Reasoning
        • Forensic Psychiatric Nursing
          • Critical Reasoning
          • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
• Unit 6 Special Populations in Psychiatry
  • Interactive Review – Unit 6
  • Chapter 35 Child Psychiatric Nursing
    • Learning Objectives
    • Child Psychiatric Care
      • Causative Factors
        • Critical Reasoning
      • Resilience
        • Critical Reasoning
    • A Framework for Nursing Practice
      • BOX 35-1 STRATEGIES FOR COMMUNICATING WITH CHILDREN
      • Communication
        • Critical Reasoning
      • Cultural Competence
    • Assessment
      • Key Areas
        • BOX 35-2 CHILD PSYCHIATRIC ASSESSMENT
          • Family Interview
          • Interview With the Child
          • Other Investigations
      • Ego Competency Skills
        • Establishing Closeness and Trusting Relationships
        • Handling Separation and Independent Decision Making
        • Handling Joint Decision Making and Interpersonal Conflict.
          • Critical Reasoning
        • Dealing With Frustration and Unfavorable Events.
          • Critical Reasoning
        • Celebrating Good Feelings and Feeling Pleasure.
          • Critical Reasoning
        • Working for Delayed Gratification.
        • Relaxing and Playing.
        • Cognitive Processing Through Words, Symbols, and Images.
        • Adaptive Sense of Direction and Purpose.
          • Critical Reasoning
      • Brain Imaging
    • Diagnosis
      • Psychiatric Diagnoses
        • TABLE 35-1 PSYCHIATRIC DISORDERS OF CHILDREN
        • Attention Deficit Hyperactivity Disorder.
          • TABLE 35-2 SUMMARIZING THE EVIDENCE ON ATTENTION DEFICIT HYPERACTIVITY DISORDER AND CONDUCT DISORDER
        • Depression
          • Critical Reasoning
        • Bipolar Disorder
        • Anxiety Disorders
        • Conduct Disorder
          • Critical Reasoning
        • Autism
        • Tourette Disorder
      • Nursing Diagnoses
        • Critical Reasoning
        • Risk for Self-Directed Violence
        • Chronic or Situational Low Self-Esteem
        • Ineffective Coping
          • TABLE 35-3 ENHANCING A CHILD'S SELF-ESTEEM
        • Anxiety
        • Risk for Other-Directed Violence
          • Critical Reasoning
        • Readiness for Enhanced Family Processes
          • BOX 35-3 STRATEGIES FOR BEHAVIOR MANAGEMENT OF CHILDREN
          • Critical Reasoning
    • Planning
      • Settings
    • Implementation
      • Therapeutic Play
        • TABLE 35-4 TREATMENT OPTIONS FOR CHILDREN AND ADOLESCENTS
        • TABLE 35-5 EGO COMPETENCY SKILLS SUMMARY
        • Critical Reasoning
      • Pharmacotherapy
        • TABLE 35-6 THERAPEUTIC ASPECTS OF PLAY
      • Expressive Therapies
      • Bibliotherapy
        • Critical Reasoning
      • Games
      • Storytelling
      • Cognitive Behavioral Therapy
      • Milieu Management
    • Outcomes Evaluation
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 36 Adolescent Psychiatric Nursing
    • Learning Objectives
    • Developmental Stage
    • Biological View of Adolescence
      • TABLE 36-1 THEORETICAL VIEWS OF ADOLESCENCE
      • BOX 36-1 COMPONENTS OF AN ADOLESCENT ASSESSMENT
    • Assessing the Adolescent
      • FIG 36-1 Profile of the high-risk adolescent.
      • BOX 36-2 2009 NATIONAL YOUTH RISK BEHAVIOR SURVEY OVERVIEW
      • Critical Reasoning
      • Body Image
      • Identity
        • CLINICAL EXAMPLE
      • Independence
        • Critical Reasoning
      • Social Role
        • Critical Reasoning
      • Sexual Behavior
    • Maladaptive Responses
      • Inappropriate Sexual Activity
        • BOX 36-3 ADOLESCENT NEGATIVE SEXUAL HEALTH OUTCOMES
        • CLINICAL EXAMPLE
      • Teen Pregnancy
        • CLINICAL EXAMPLE
        • Critical Reasoning
      • Mood Disorders
        • Depression
          • BOX 36-4 FACTS ABOUT DEPRESSION IN ADOLESCENTS
          • BOX 36-5 SYMPTOMS OF ADOLESCENT DEPRESSION
        • Bipolar Disorder
      • Suicide
        • BOX 36-6 RISK FACTORS FOR ADOLESCENT SUICIDE
          • Psychological Factors
          • Family and Genetic Factors
          • Environmental Factors
          • Biological Factors
          • Previous Suicidal Behavior
          • Sexual Orientation
        • CLINICAL EXAMPLE
        • CLINICAL EXAMPLE
        • CLINICAL EXAMPLE
      • Self-Injury
      • Conduct Disorder
        • CLINICAL EXAMPLE
        • BOX 36-7 TAKING THE BARK OUT OF BULLIES
        • CLINICAL EXAMPLE
      • Bullying
        • BOX 36-8 WAYS ADULTS CAN PROTECT TEENS FROM CYBER-BULLIES
      • Violence
        • BOX 36-9 BEHAVIOR CHECKLIST FOR POTENTIALLY VIOLENT YOUTH
        • CLINICAL EXAMPLE
        • Critical Reasoning
      • Substance Use
        • TABLE 36-2 THE FIVE STAGES OF ADOLESCENT SUBSTANCE ABUSE
        • CLINICAL EXAMPLE
        • Critical Reasoning
      • Weight and Body Image Problems
        • CLINICAL EXAMPLE
    • Working with Adolescents
      • Health Education
        • BOX 36-10 STRESS MANAGEMENT SKILLS FOR ADOLESCENTS
        • CLINICAL EXAMPLE
        • CLINICAL EXAMPLE
        • Critical Reasoning
      • Family Therapy
      • Group Therapy
        • Critical Reasoning
      • Individual Therapy
        • Therapeutic Alliance
        • Termination
      • Pharmacotherapy
      • Talking With Adolescents
        • Silence
        • Confidentiality
          • Critical Reasoning
        • Resistance
        • Arguing
        • Testing
        • Embarrassment About Being in Therapy
          • Critical Reasoning
      • Parents of the Adolescent
    • Evaluating Nursing Care
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 37 Geropsychiatric Nursing
    • Learning Objectives
    • Mental Illness in the Elderly Population
      • Role of the Geropsychiatric Nurse
        • BOX 37-1 GEROPSYCHIATRIC NURSING ONLINE RESOURCES*
    • Theories of Aging
      • Biological Theories
        • Critical Reasoning
        • Critical Reasoning
      • Psychological Theories
        • Critical Reasoning
      • Sociocultural Theories
        • Critical Reasoning
    • Assessment
      • The Interview
        • TABLE 37-1 KEY COMPONENTS OF GEROPSYCHIATRIC NURSING ASSESSMENT
        • Therapeutic Communication Skills
          • Critical Reasoning
        • The Interview Setting
      • Mental Status Examination
        • Depression
        • Anxiety
        • Psychosis
      • Behavioral Responses
        • Critical Reasoning
      • Functional Abilities
        • BOX 37-2 CHALLENGING BEHAVIORS OBSERVED IN GEROPSYCHIATRIC PATIENTS
        • Mobility
        • Activities of Daily Living
          • TABLE 37-2 ASSESSMENT OF RISK FOR FALLS
      • Physiological Functioning
        • General Health
        • Nutrition
        • Substance Abuse
      • Social Support
        • Family-Patient Interaction
          • Critical Reasoning
    • Diagnosis
      • Cognitive Responses
        • Impaired Memory
        • Confusion
          • Critical Reasoning
        • Paranoia
      • Affective Responses
        • Dysfunctional Grieving and Hopelessness
        • Risk for Self-Directed Violence
          • BOX 37-3 RISK FACTORS FOR SUICIDE IN THE ELDERLY
          • Critical Reasoning
        • Situational Low Self-Esteem
      • Somatic Responses
        • Disturbed Sleep Pattern
        • Imbalanced Nutrition: Less than Body Requirements
      • Stress Responses
        • Progressively Lowered Stress Threshold
        • Relocation Stress Syndrome
          • BOX 37-4 BEHAVIORS ASSOCIATED WITH RELOCATION STRESS SYNDROME
        • Risk for Caregiver Role Strain
          • TABLE 37-3 RISK FACTORS FOR CAREGIVER ROLE STRAIN
      • Behavioral Responses
        • Social Isolation
        • Self-Care Deficit/Behavioral Deficit
        • Challenging Behaviors and Behavioral Excess
    • Planning and Implementation
      • Therapeutic Milieu
        • Cognitive Stimulation
          • TABLE 37-4 SUMMARIZING EVIDENCE-BASED TREATMENT FOR Practice on Depression in the Aged
        • Promotion of a Sense of Calm and Quiet
        • Consistent Physical Layout
        • Structured Routine
        • Focus on Strengths and Abilities
        • Minimization of Challenging Behavior
        • Minimal Demands for Compliant Behavior
          • Critical Reasoning
        • Provision of Safety
      • Somatic Therapies
        • Electroconvulsive Therapy
          • TABLE 37-5 MYTHS AND REALITIES ABOUT PHYSICAL RESTRAINT
        • Psychotropic Medications
          • Age
          • Polypharmacy
          • Adherence
          • Co-morbidity
            • TABLE 37-6 PSYCHOTROPIC MEDICATIONS
      • Interpersonal Interventions
        • Psychotherapy
        • Life Review Therapy
        • Cognitive Approaches
        • Validation Therapy
        • Stimulation Approaches
        • Relaxation Therapy
        • Supportive and Counseling Groups
        • Patient Education
          • Critical Reasoning
        • Family Education and Support
    • Evaluation
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 38 Care of Survivors of Abuse and Violence
    • Learning Objectives
    • Critical Reasoning
    • Dimensions of Family Violence
      • Critical Reasoning
      • Characteristics of Violent Families
        • Multigenerational Transmission
          • FIG 38-1 Genogram demonstrates the multigenerational transmission of family violence.
        • Social Isolation
        • Use and Abuse of Power
          • BOX 38-1 FORMS OF ABUSE IN INTIMATE PARTNER RELATIONSHIPS
            • Definition
            • Physical Abuse
            • Sexual Abuse
            • Emotional Abuse
            • Economic Abuse
            • Psychological Abuse
        • Alcohol and Drug Abuse
      • Nursing Attitudes Toward Survivors of Violence
        • Creating Positive Attitudes
          • TABLE 38-1 BEYOND THE MYTHS: RECOGNIZING ABUSE SURVIVORS
          • TABLE 38-2 COMPARISON OF THE PATERNALISTIC AND EMPOWERMENT MODELS OF INTERVENTION WITH BATTERED WOMEN
          • Critical Reasoning
      • Health Effects of Family Abuse and Violence
        • Physical Health Effects
        • Psychological Effects
        • Behavioral Health Effects
          • Critical Reasoning
      • Preventive Nursing Interventions
        • Primary Prevention
          • Critical Reasoning
        • Secondary Prevention
        • Tertiary Prevention
          • BOX 38-2 INDICATORS OF ACTUAL OR POTENTIAL ABUSE
            • Nursing History
              • Primary Reason for Contact
              • Information from Family Genogram
              • Health History
              • Sexual History
              • Personal/Social History
            • Psychological History
              • Financial History
              • Family Beliefs/Values
              • Family Relations
            • Physical Examination
              • General Appearance
              • Vital Statistics
              • Skin
              • Head
              • Eyes
              • Ears
              • Mouth
              • Abdomen
              • Extremities
              • Neurological System
              • Genital/Urinary System
              • Rectum
            • Nursing Observations
              • General Observations
              • Home Environment
              • Family Communication Pattern
              • Emotional Climate
          • BOX 38-3 SAFETY PLAN TIPS
            • Steps to Take If You Are Planning to Leave Your Situation
            • Things To Take With You
            • More Safety Steps After You Have Left
          • Critical Reasoning
    • Special Populations
      • Child Abuse
        • Sexual Abuse of Children and Adolescents
          • Critical Reasoning
        • Abduction of Children
          • BOX 38-4 EFFECTS OF WITNESSING VIOLENCE IN CHILDHOOD
            • Infant
            • Preschool
            • School Age
            • Adolescent
        • Nursing Assessment
        • Nursing Interventions
      • Intimate Partner Violence
        • BOX 38-5 FACT SHEET ON DOMESTIC VIOLENCE
        • Critical Reasoning
        • Nursing Assessment
        • Nursing Interventions
          • BOX 38-6 INTERVENTIONS FOR SURVIVORS OF INTIMATE PARTNER VIOLENCE
      • Elder Abuse
        • Nursing Assessment
          • Critical Reasoning
        • Nursing Interventions
    • Rape and Sexual Assault
      • Critical Reasoning
      • Definition of Sexual Assault
      • Marital Rape
        • BOX 38-7 SEXUAL BEHAVIOR: THE FORCE CONTINUUM
      • Nursing Care of the Sexual Assault Survivor
        • Nursing Assessment
        • Nursing Interventions
          • Critical Reasoning
          • TABLE 38-3 NURSING TREATMENT PLAN SUMMARYSURVIVORS OF ABUSE AND VIOLENCE
          • BOX 38-8 INFORMATION SOURCES FOR SURVIVORS OF ABUSE AND VIOLENCE*
            • National Sexual Violence Resource Center
            • National Domestic Violence Hotline
            • U.S. Administration for Children and Families
            • National Center on Elder Abuse
            • Futures Without Violence (formerly the Family Violence Prevention Fund)
            • National Center for Victims of Crime
            • National Organization for Victim Assistance (NOVA)
          • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 39 The Military and Their Families
    • Learning Objectives
    • Critical Reasoning
    • Medical Disorders of Veterans
      • TABLE 39-1 U.S. MILITARY TROOP DEPLOYMENT
      • Traumatic Brain Injury
        • TABLE 39-2 HEALTH RISKS AND ILLNESSES FROM THE VIETNAM WAR TO THE PRESENT WAR ON TERROR
        • Critical Reasoning
    • Psychiatric Disorders of Veterans
      • Posttraumatic Stress Disorder
        • FIG 39-1 Defense and Veterans Brain Center Traumatic Brain Injury (TBI) screening tool.
        • Critical Reasoning
        • Pharmacological Treatment of PTSD
          • FIG 39-2 PTSD Checklist: Military Version (PCL-M).
        • Nonpharmacological Treatment of PTSD
      • Suicide
      • Substance Use Disorders
      • Military Sexual Trauma
        • Critical Reasoning
    • Women Veterans
      • Critical Reasoning
    • Challenges to Care
      • Impact on Families
      • Impact on Clinicians
    • Nursing Implications
      • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
  • Chapter 40 Psychological Care of Patients With a Life-Threatening Illness
    • Learning Objectives
    • Working With Patients and Families with Life-Threatening Diagnoses
      • Time of Uncertainty
        • BOX 40-1 COMMON LIFE-THREATENING ILLNESSES AND CONDITIONS
        • Critical Reasoning
      • Concerns of Patients and Family Members
        • BOX 40-2 QUESTIONS TO ASK AT TIME OF DIAGNOSIS
        • Critical Reasoning
    • Psychosocial and Mental Health Care
      • Anxiety
      • Depression
      • Caregiver Stress, Anger, and Sleep Deprivation
        • BOX 40-3 HELPING PATIENTS AND FAMILY MEMBERS
        • Critical Reasoning
    • Symptom Management and Palliative Care
      • Pain
        • Critical Reasoning
      • Constipation and Diarrhea
      • Nausea and Vomiting
      • Hiccups and Other Troublesome Symptoms
    • Transitioning to End-of-Life Care
      • Advocating for the Patient
      • The Changing Focus of Hope
        • Critical Reasoning
      • Decision Making and Health Care Ethics
        • Critical Reasoning
      • Withholding and Withdrawing Life-Sustaining Treatment
      • Medically Ineffective Treatment
      • Hospice
        • Critical Reasoning
    • Preparing for Death
      • Anticipatory Grief
      • The Dying Process
    • Concerns of Nurses Working with Patients with Life-Threatening Illness
      • Deaths of Infants and Children
      • Identifying With the Patient or Family
      • Medically Provided Nutrition and Hydration
      • Professional Integrity
        • TABLE 40-1 ASPECTS OF CARE FOR PATIENTS WITH LIFE-THREATENING ILLNESS
        • COMPETENT CARING A Clinical Exemplar of a Psychiatric Nurse
    • CHAPTER IN REVIEW
    • References
• Appendixes
  • Appendix A Nanda-I Nursing Diagnoses 2012-2014
    • 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 415
    • Domain 12: Comfort
    • Domain 13: Growth/Development
  • Appendix B DSM-IV-TR Diagnostic Criteria for Mental Disorders
    • DSM-IV-TR Classification
    • Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
      • Mental Retardation
      • Learning Disorders
      • Motor Skills Disorder
      • Communication Disorders
      • Pervasive Developmental Disorders
      • Attention-Deficit and Disruptive Behavior Disorders
      • Feeding and Eating Disorders of Infancy or Early Childhood
      • Tic Disorders
      • Elimination Disorders
      • Other Disorders of Infancy, Childhood, or Adolescence
    • Delirium, Dementia, and Amnestic and Other Cognitive Disorders
      • Delirium
      • Dementia
      • Amnestic Disorders
      • Other Cognitive Disorders
    • Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
    • Substance-Related Disorders
      • Alcohol-Related Disorders
        • Alcohol Use Disorders
        • Alcohol-Induced Disorders
      • Amphetamine- (or Amphetamine-like-) Related Disorders
        • Amphetamine Use Disorders
        • Amphetamine-Induced Disorders
      • Caffeine-Related Disorders
        • Caffeine-Induced Disorders
      • Cannabis-Related Disorders
        • Cannabis Use Disorders
        • Cannabis-Induced Disorders, cont'd
      • Cocaine-Related Disorders
        • Cocaine Use Disorders
        • Cocaine-Induced Disorders
      • Hallucinogen-Related Disorders
        • Hallucinogen Use Disorders
        • Hallucinogen-Induced Disorders
      • Inhalant-Related Disorders
        • Inhalant Use Disorders
        • Inhalant-Induced Disorders
        • Inhalant-Related Disorders, cont'd
      • Nicotine-Related Disorders
        • Nicotine Use Disorder
        • Nicotine-Induced Disorder
      • Opioid-Related Disorders
        • Opioid Use Disorders
        • Opioid-Induced Disorders
      • Phencyclidine-Related or Phencyclidine-like Disorders
        • Phencyclidine Use Disorders
        • Phencyclidine-Induced Disorders
      • Sedative-, Hypnotic-, or Anxiolytic-Related Disorders
        • Sedative, Hypnotic, or Anxiolytic Use Disorders
        • Sedative-, Hypnotic-, or Anxiolytic-Induced Disorders
      • Polysubstance-Related Disorder
      • Other (or Unknown) Substance-Related Disorders
        • Other (or Unknown) Substance Use Disorders
        • Other (or Unknown) Substance-Induced Disorders
    • Schizophrenia and Other Psychotic Disorders
    • Mood Disorders
      • Depressive Disorders
      • Bipolar Disorders
    • Anxiety Disorders
    • Somatoform Disorders
    • Factitious Disorders
    • Dissociative Disorders
    • Sexual and Gender Identity Disorders
      • Sexual Dysfunctions
        • Sexual Desire Disorders
        • Sexual Arousal Disorders
        • Orgasmic Disorders
        • Sexual Pain Disorders
        • Sexual Dysfunction Due to a General Medical Condition
      • Paraphilias
      • Gender Identity Disorders
    • Eating Disorders
    • Sleep Disorders
      • Primary Sleep Disorders
        • Dyssomnias
        • Parasomnias
      • Sleep Disorders Related to Another Mental Disorder
      • Other Sleep Disorders
    • Impulse-Control Disorders Not Elsewhere Classified
    • Adjustment Disorders
    • Personality Disorders
    • Other Conditions that May Be a Focus Of Clinical Attention
      • Psychological Factors Affecting Medical Condition
      • Medication-Induced Movement Disorders
      • Other Medication-Induced Disorder
      • Relational Problems
      • Problems Related to Abuse or Neglect
      • Additional Conditions That May Be a Focus of Clinical Attention
    • Additional Codes
    • Axis II: Personality Disorders
    • Axis III: Icd-9-Cm General Medical Conditions
    • Axis IV: Psychosocial And Environmental Problems
    • Axis V: Global Assessment Of Functioning (Gaf) Scale*
      • Code
      • Outline for Cultural Formulation
• Index
  • Index
  • A
  • B
  • C
  • D
  • E
  • F
  • G
  • H
  • I
  • J
  • K
  • L
  • M
  • N
  • O
  • P
  • Q
  • R
  • S
  • T
  • U
  • V
  • W
  • X
  • Y
  • Z

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  Glósur og yfirstrikanir
  Þú getur auðkennt textabrot með mismunandi litum og skrifað glósur að vild í rafbókina. Þú getur jafnvel séð glósur og yfirstrikanir hjá bekkjarsystkinum og kennara ef þeir leyfa það. Allt á einum stað.
  
  Hvað viltu sjá? / Þú ræður hvernig síðan lítur út
  Þú lagar síðuna að þínum þörfum. Stækkaðu eða minnkaðu myndir og texta með multi-level zoom til að sjá síðuna eins og þér hentar best í þínu námi.
  
  
  
  Fleiri góðir kostir
  - Þú getur prentað síður úr bókinni (innan þeirra marka sem útgefandinn setur)
  - Möguleiki á tengingu við annað stafrænt og gagnvirkt efni, svo sem myndbönd eða spurningar úr efninu
  - Auðvelt að afrita og líma efni/texta fyrir t.d. heimaverkefni eða ritgerðir
  - Styður tækni sem hjálpar nemendum með sjón- eða heyrnarskerðingu