Margins Study Assistant

Chapter 1

Foundations of Psychiatric-Mental Health Nursing

Summary

Nurses working in all settings must understand the difference between mental health and mental illness . Nurses will come across clients in various stages of the mental health continuum in every setting, age group, and community. Developing therapeutic nurse-client relationship s is a core element of the scope of the psychiatric-mental health nursing practice Familiarity with the many risk and protective factors for mental illness is an important part of the nursing process in caring for individuals with potential or diagnosed mental health disorders.

Key terms

mental health: state of well-being in which individuals realize their own abilities, cope with the normal stresses of life, work productively, and contribute to their community
mental illness: health condition involving changes in emotion, thinking, or behavior (or a combination of these) associated with emotional distress and problems functioning in social, work, or…
client: feeling in order to determine the effectiveness of the treatment plan
nursing assessment s: an important part of nursing practice
explicit bias: attitudes people are aware of, endorse, and communicate
psychosocial rehabilitation: helps individuals develop the social, emotional, and intellectual skills needed to live happily with the smallest amount of professional assistance manageable
stigma: cluster of negative attitudes and beliefs that motivates the general public to fear, reject, avoid, and discriminate against a group of people
traumatic brain injury (TBI): brain injury that can cause short- or long-term problems with a person being unable able to think, function, move, and communicate normally

Chapter 2

Fundamentals of Theories and Therapies

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Summary

The id, ego, and superego keep the person in balance between satisfying every primal want and bowing to societal pressures. And the two concepts of transference and countertransference reveal that all clients have a past and are attempting to frame their reality in ways that are safe and familiar. The use of defense mechanisms is necessary for all humans to emotionally adjust to their environment. The psychoanalytic theory from Sigmund Freud provides a foundation to understand psychiatric problems.

Key terms

transference: unconscious feeling the client has toward another or the health-care worker that is originally based on a past experience with an important person in their life
id: part of the mind that is the most primitive, it drives the instincts, reflexes, and needs
past and: attempting to frame their reality in ways that are safe and familiar
defense mechanism: thought, words, or behavior prompted by the unconscious mind; can reduce anxiety in the short-term; may result in ineffective coping if used longer term
ego: part of the psychic apparatus that experiences and reacts to the outside world and thus mediates between the primitive drives of the id and the demands of the social and physical…
superego: part of the personality representing the conscience, formed in early life by internalization of the standards of parents and other models of behavior
use of defense mechanisms: necessary for all humans to emotionally adjust to their environment
countertransference: unconscious feeling the health-care worker has toward the client

Chapter 3

Communication, Perception, and Assessment

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Summary

The nurse must also learn to reflect on the interactions with clients to improve their active listening skills and nonverbal communication and enhance their compassion Many clients have formed their beliefs from the cultures in which they were raised as children and from their adult experiences. When a client is experiencing a mental illness, the perceptions of mental health treatments can be the driving force behind whether or not the client seeks help and/or complies with treatment.

Key terms

nonverbal communication: type of communication where those involved are communicating without words
active listening: therapeutic technique in which the nurse listens to a client closely, asking questions as needed, to fully understand the content of the message and the depth of the client’s…
client: experiencing a mental illness, the perceptions of mental health treatments can be the driving force behind whether or not the client seeks help and/or complies with treat
therapeutic communication: when a nurse supports, draws out information for an assessment, or provokes deeper understanding on what a client is communicating
therapeutic relationship: healthy relationship that develops over time, is based on mutual trust and respect, and there is a nurturing of health, hope, wellness, empathy, and therapeutic interventions to…
psychosocial assessment: evaluation of a client’s mental health and social well-being; it assesses self-perception and the client’s ability to function in the community
self-awareness: where the nurse takes time to focus on self, their own words and actions, and reflects on the effectiveness of these in relation to a client interaction
self-disclosure: interactive communication process wherein one person shares information about themselves in an appropriate context, modeling the behavior for others in the therapeutic relationship

Chapter 4

Neurobiology and Pharmacological Standards

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Summary

It explained how neurotransmitters, like serotonin and dopamine, endocrine functioning, and hormones, affect human behavior. This section provided a review of the components and functions of the nervous system relative to mental health disorders nurses encounter in practice. Their presence/absence or proper functioning can heavily influence expressions of mental health disorders The nursing role when it comes to psychopharmaceuticals is to assess for mental health symptoms and medications, collaborate with the client to recognize medication barriers and engage in nursing interventions to…

Key terms

dopamine: monoamine neurotransmitter responsible for the management of mood states, attention and focus, motor control and regulation, sexual gratification, reward and motivation, and…
serotonin: neurotransmitter and a monoamine, responsible for the promotion of mood and sleep regulation, mitigation of pain, aggression and sexual behavior, stimulation of gastric…
hormones: group of molecules that function to send signals to other cellular organisms in the human body
nervous system: made up of the central nervous system and the peripheral nervous system
neurotransmitter: chemical messenger that carries messages from one neuron to another
amygdala: pair of small almond-shaped regions located anterior to the hippocampus and responsible for the formation and encoding of memories, especially those that are highly emotionally…
cortisol: released in the wake of adrenocorticotropic hormone, and part of the HPA axis, is responsible for mobilizing glucose for energy, increasing protein metabolism, immune effects…
histamine: monoamine neurotransmitter that is responsible for management of awake states, homeostasis, appetite, and smooth muscle contractions

Chapter 5

Therapeutic Settings

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Summary

Clinicians and clients should work together to choose the least restrictive environment that meets the client’s needs Building a rapport with clients is important in all types of treatment settings. Telehealth and teletherapy have become more viable treatment options since COVID-19. There are many types of psychiatric-mental health treatment settings, each with its own advantages and disadvantages.

Key terms

telehealth: use of digital technologies to deliver medical and psychiatric care, health education, and public health services by remotely connecting multiple users in separate locations
least restrictive environment: treatment setting that places the fewest restrictions on lives
rapport with clients: important in all types of treatment settings
milieu therapy: treatment in a structured, safe environment where participation in day-to-day routines, communities, and relationships is the method of therapy
authoritative leadership: type of group in which the leader is in complete control and dictates rules, goals, and norms
substance use rehabilitation: treatment of substance use disorder that is provided in a variety of settings
partial hospitalization: structured program of outpatient psychiatric services as an alternative to inpatient psychiatric care, allowing clients to return home at night
patient-centered medical home: (or medical home model) community center that provides comprehensive, coordinated, client-centered models of primary care

Chapter 6

Therapeutic Relationships

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Summary

These stages, as well as the boundaries placed and upheld by the nurse, help to build the rapport and trust between the client and the nurse Family dynamics have a large impact on a child’s emotional development. Some things that can affect family dynamics are being a single-parent family, divorce, poverty, addition of a stepparent, and parental mental health. Therapeutic nurse-client relationships vary in depth, length, and focus.

Key terms

boundaries: limits set as individuals that define levels of comfort when interacting with others
family dynamics: way that the family members interact, communicate, and problem-solve
differentiation of self: when an individual is able to feel autonomous and make decisions that help them function independently within the family group
re-traumatization: feeling like the past trauma is reoccurring or that the person is in an unsafe situation as they were when the trauma occurred
barrier: anything that blocks the ability of an individual to get the care that is appropriate for their needs
complex trauma: when an individual is exposed over time to multiple recurring traumatic events
engagement: describes the client and the health-care team collaborating on treatment and participating together in the services provided
subjective burden: feelings, such as stigma, fears about interactions, disturbing behaviors, feeling trapped, feeling resentful, and being anxious about the future

Chapter 7

Interprofessional Care

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Summary

The four evidence-based case management service models are the brokerage model, the intensive case management model, the clinical case management model, and the strengths-based case management model. The four dimensions of recovery are health, home, purpose, and community. Examples of rehabilitative resources, which also support recovery, include housing assistance, job coaching, educational assistance, and social support They differ in who serves as the case manager and in the degree of closeness and interaction between the case manager and client.

Key terms

case management: collaborative and organized approach that involves assessing, planning, coordinating, and monitoring services and resources to meet the needs of individuals or groups, often in…
rehabilitative resources: various programs, services, and interventions that aim to support people with mental health conditions in their recovery and return to their highest level of functioning
four dimensions of recovery: health, home, purpose, and community
care coordination: organization and distribution of health-care services across different providers and settings in order to ensure that clients receive the right care at the right time
confidentiality: ethical obligation to protect and keep private a client’s personal health information, preventing its disclosure to unauthorized individuals or entities
continuity of care: coordination of care and consistent care at regular intervals by mental health specialists and the primary care provider

Chapter 8

Cultural Considerations

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Summary

Certain cultures experience higher rates of disease due to genetics or health disparities caused by environmental factors. Various cultures have their own traditional healing practices and beliefs, and many people still use these practices either alongside or in place of Western medicine. Their culture informs how they view health and illness, how they view healthcare providers, and how receptive they are to treatment plans. Culture also determines who receives care and the quality of their care.

Key terms

culture: set of beliefs, attitudes, and practices shared by a group of people or community that is accepted, followed, and passed down to other members of the group
health disparities: health outcomes impacted by social determinants of health that represent preventable differences experienced by underrepresented individuals
traditional healing: various medicines and healing practices around the world that differ from the modern, Western health-care system
cultural humility: respecting and learning about the cultures of others while exploring one’s own cultural biases
Ayurveda: traditional Hindu form of medicine from India that is based on the idea that disease is caused by an imbalance in the body
curanderismo: holistic practice traditional to Hispanic cultures that is rooted in beliefs that health is achieved through the right balance of mind, body, and spirit
racism: belief that races are distinct from one another, and that there is a hierarchy to race, implying that races are unequal
ethnocentrism: belief that one’s culture (or race, ethnicity, country) is better and preferable to another’s

Chapter 9

Social and Emotional Concerns

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Summary

Furthermore, it delves into the intricate emotional landscape, discussing grief, coping mechanisms, and the psychological intricacies involved in processing impending loss. Grief and loss are profound, deeply emotional experiences that occur in response to significant events, such as the death of a loved one, the ending of a relationship, the loss of a job, or a decline in health. The section delves into the multifaceted aspects surrounding death and dying, exploring social, emotional, and cultural dimensions. It emphasizes nursing responsibilities at the end of life, as well as the importance of nursing self-care to avoid burnout.

Key terms

section: cultural considerations, emphasizing the diverse beliefs, rituals, and practices related to death and dying across various cultures and religions
burnout: state of chronic physical and emotional exhaustion often associated with feelings of cynicism and detachment from work
loss: actual or perceived deprivation of someone or something valued, leading to an experience of grief
grief: natural emotional response to loss
restraint: technique where physical or mechanical means restrict a client’s movement
disenfranchised grief: type of grief that is not openly acknowledged or socially supported
anger: subjective, emotional state characterized by antagonism toward someone or something perceived as causing harm or offense
de-escalation: recognizing early signs of agitation or aggression, such as changes in a client’s body language, tone of voice, or behavior to prevent an escalating situation from becoming…

Chapter 10

Legal and Ethical Guidelines

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Summary

Maintaining understanding and compliance with the tenets of HIPAA is critical for client safety and trust. Under HIPAA, PHI cannot be used or shared without the client’s written permission. This is one of the client rights provided under federal law. Other client rights offered under federal statute include those in the Affordable Care Act.

Key terms

tenets of HIPAA: critical for client safety and trust
duty to warn: professional responsibility to warn another person if they are being threatened
mandatory reporting: obligation to report to stated authorities when neglect or abuse is suspected
right to privacy: belief that one’s personal information is protected from public access
informed consent: communication between a client and a health-care provider that results in agreement and permission by the client for treatment or services
protected health information (PHI): any information in the medical record that can be used to identify an individual and that was created, used, or disclosed while providing a health-care service
absconding: leaving an inpatient facility without permission, which can include failing to return from an authorized leave

Chapter 11

Court Involvement

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Summary

If a person is thought to be a danger to themselves or others, or has a grave incapacity, they may be treated on an involuntary basis. There are two types of processes to initiate involuntary commitment: (1) emergency and (2) judicial. The reasons for court-ordered treatment can be complex. This involves court recommendations and the continual monitoring of the client through the medical and court system.

Key terms

person: thought to be a danger to themselves or others, or has a grave incapacity, they may be treated on an involuntary basis
involuntary commitment: kept in custody without consent after a waiting period
advance directive: document that allows a person to make decisions when they are still capable of making them; includes the living will, power of attorney, and health-care proxy
emergency admission: hospital admission for persons reasonably determined to have mental illness and, due to this, are deemed to be dangerous to self or others
PRN: medical abbreviation for the Latin pro re nata meaning, “as it is needed”
ex parte: a court order where all of the parties are not yet involved
conditional release/discharge: person must adhere to prescribed treatment (medication, counseling, follow-up appointments) or be returned to the hospital
conservatorship: created through the courts due to the absence of responsible parties, such as for children with absent parents, and may focus more specifically on financial decisions

Chapter 12

Self-Determination and Advocacy

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Summary

Nurses play a role in client advocacy, particularly in circumstances where clients are unable to adequately represent themselves, or have the legal designation of diminished responsibility. Empowerment leads to self-reliance, participation in decisions, dignity and respect for us and others, and the knowledge of belonging and contribution to a wider community Autonomy and independence are not the same. Independence is the ability for self-care.

Key terms

advocacy: supporting a cause or proposal
diminished responsibility: reduces liability for a criminal act on the part of a defendant who has experienced certain alterations in thought processes
empowerment: assist individual to take action toward improving their own health
independence: ability to do things on one’s own
client representation: consulting with the client regarding the client’s objectives, how the client wants to proceed, and then take the action approved by the client
enablement: attempt to make life easier for an individual with negative consequences
self-advocacy: ability to speak for oneself, have full autonomy, and complete agency
mediating: speak for a client, settle a dispute, or create agreement

Chapter 13

Clinical Guidelines and Practice

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Summary

The scope of nursing practice is outlined by the Nurse Practice Act in each nurse’s state. Nurses should be familiar with federal insurance providers, like Medicare and Medicaid, safety protocols promulgated by OSHA, and programs like Healthy People 2030 and National Patient Safety Goals to help them focus… The DSM-5-TR provides a widely used diagnostic tool in the field of clinical psychology, PMH nursing, and psychiatry. Nurses must be aware of the many organizations and agencies that affect their role in the health-care field.

Key terms

Nurse Practice Act: set of state laws and regulations that govern the practice of nursing within a specific jurisdiction
DSM-5-TR: standard reference in clinical practice for the diagnosis of mental health disorders
Healthy People 2030: objectives and goals to improve the health of the nation
scope of nursing practice: outlined by the Nurse Practice Act in each nurse’s state
diagnostic overshadowing: phenomenon of clinical bias that may occur in mental health treatment when symptoms are attributed to the psychiatric diagnosis and medical comorbidities are missed, increasing…
American Psychiatric Nurses Association (APNA): professional organization that provides leadership in issues related to all nurses working in the mental health field in all practice settings
burnout: psychological phenomenon characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment related to one’s work
deinstitutionalization: policy, process, and movement that released thousands of mentally ill persons from state institutions back into the communities

Chapter 14

Neurocognitive Disorders

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Summary

While mild cognitive impairment (MCI) and mild neurocognitive disorder (MiND) are very similar, diagnosis for MiND includes the presence of one or more cognitive difficulties in the areas of complex attention, memory… All neurocognitive disorders, whether mild or major, share the following symptoms, with differences in their severity depending upon the person’s diagnosis: difficulty planning and making decisions, difficulty… Each year, more than seven million Americans experience delirium (American Delirium Society, 2023). Delirium is a mental state in which the client becomes temporarily confused, disoriented, and not able to think or remember clearly.

Key terms

neurocognitive disorder: brain function disorders that mark gradual or sudden diminishment in cognition, attention, memory, learning, social, and/or motor skills and often affect the ability to perform…
mild neurocognitive disorder (MiND): diminishment in an individual’s cognition, attention, memory, learning, and/or social and motor skills that is greater than expected from the regular aging process but that does…
delirium: mental state in which the client becomes temporarily confused, disoriented, and not able to think or remember clearly
Alzheimer disease: most common neurocognitive disorders; affects the brain by causing atrophy in the cortex and deposits of amyloid plaques and neurofibrillary tangles in the neurons, which cause…
Huntington disease: genetic mutation that causes both physical and cognitive declines; the disease attacks the neurons in the brain, causing them to die
major neurocognitive disorder: group of disorders that can affect younger and older individuals’ cognition with a gradual decline in at least one of the following domains of cognition: executive function…
Parkinson disease: similar to Lewy body dementia, involving Lewy bodies, insoluble deposits of alpha-synuclei protein that damage the brain
vascular dementia: stem from injuries to the brain caused by ischemia, such as a stroke, that block blood flow to the brain and lead to permanent neuron death

Chapter 15

Schizophrenia Spectrum Disorder and Other Psychotic Disorders

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Summary

There is no one characteristic for schizophrenia, but clients can experience symptoms such as delusions, hallucinations (usually auditory), incoherence, catatonic or hyperactive behavior, and flat effect. Schizophrenia is a disorder usually beginning when a person is in their late teens or early twenties. The etiology of the condition is unknown, although there are a range of theoretical perspectives, and it is thought to involve neurotransmitter signal disruption. Schizophrenia spectrum disorders include schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, medication and substance-induced psychotic disorder, catatonia, and psychotic disorder due to…

Key terms

schizophrenia: severe mental illness and disturbance involving a collection of cognitive, affective, and behavioral symptoms that negatively impact social, educational, or occupational…
etiology of the condition: unknown, although there are a range of theoretical perspectives, and it is thought to involve neurotransmitter signal disruption
hallucination: perception of sensory experiences without natural external stimuli, including auditory, visual, tactile, gustatory, and olfactory types
delusion: fixed false belief that cannot be changed in the mind of those who hold them despite evidence to the contrary
differences between these disorders: the timing and duration of symptoms and precipitating events
non-bizarre delusion: fixed false belief containing content that is plausible but inconsistent with evidence
bizarre delusion: fixed false beliefs with content that is not reasonably possible in this world
formication: hallucination that bugs are crawling on the skin

Chapter 16

Mood Disorders and Suicide

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Summary

Depressive disorders, a category of mood disorders, are characterized by persistent feelings of sadness, loss of interest or pleasure in activities, and various physical and cognitive symptoms that cause significant… The etiology of mood disorders involves genetic, biological, environmental, and psychological factors. Managing mood disorders typically involves a combination of pharmacological and psychotherapeutic interventions. Early detection and appropriate management are critical to improving outcomes and enhancing the quality of life for individuals with mood disorders (Sekhon & Gupta, 2020)

Key terms

mood disorder: disturbances in a person’s emotional state that are intense, long-lasting, and not necessarily tied to any specific event or situation
depressive disorders: mental health conditions characterized by persistent feelings of sadness, loss of interest in activities, and difficulties in carrying out daily activities
manic elation: symptom of a manic episode, as seen in bipolar I disorder, that is more severe and disruptive than hypomanic elation
nonsuicidal self-injury (NSSI): (also, self-harm ) behavior involving deliberate self-inflicted harm that is not intended to result in suicide
mania: when a person’s mood is abnormally elevated and accompanied by high energy or activity
bipolar disorder: recurrent illness that involves changes in mood and energy that may be severe and involves both depression and mania, or hypomania
lethality assessment: structured evaluation of the risk factors associated with a person’s potential for engaging in a life-threatening behavior, such as suicide
persistent depressive disorder: (formerly called dysthymia ) type of depression less severe than major depression but chronic, lasting for at least two years

Chapter 17

Anxiety, OCD, and Trauma-Stressor Disorders

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Summary

Individuals often experience stress, both emotional and physical, during their lifetime. Chronic stress has been linked to adverse health outcomes, such as weakened immune systems, slow wound healing, and an increased risk of chronic diseases (Ford et al., 2023). As such, nursing professionals must recognize signs of stress in their clients and employ effective stress-reduction techniques. Effective strategies to alleviate client stress include clear communication, creating a comfortable environment, involving clients in decision-making, and providing psychological support (Chesak et al., 2019)

Key terms

stress: body’s response to external pressures or threats, often resulting in physiological and emotional reactions
anxiety: heightened state of arousal and worry that may not always have a clear external cause
phobia: excessive and irrational fear of a specific object, situation, or activity that is typically harmless
body dysmorphic disorder (BDD): mental disorder in which a person is preoccupied with perceived defects or flaws in their appearance
attachment disorders: group of psychiatric conditions resulting from a disruption in the normal attachment process between a child and a caregiver
depersonalization: alteration in the perception or experience of oneself, where an individual may feel detached or estranged from their thoughts, feelings, body, or actions
desensitization: exposure therapy that involves gradually exposing the individual to the feared stimulus or situation until they no longer experience anxiety in response to it
dissociative disorder: group of mental conditions characterized by a disconnection between thoughts, memories, feelings, actions, or sense of identity

Chapter 18

Personality Disorders

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Summary

While everyone has unique personality traits, a personality disorder is diagnosed when these traits cause significant distress, disrupt daily life, and lead to difficulties in relationships, work, or other areas of… There are multiple types of personality disorders, but they tend to have certain symptoms in common that lead to diagnosis. A personality disorder may exist when a personality exhibits enduring patterns of thoughts, emotions, and behaviors that deviate significantly from cultural norms and cause significant distress and impairment in… A personality disorder is diagnosed through a thorough assessment by a trained professional, such as a psychiatrist.

Key terms

personality: unique and enduring patterns of thoughts, emotions, and behaviors that characterize an individual and distinguish them from others
personality disorder: when a personality exhibits enduring patterns of thoughts, emotions, and behaviors that deviate significantly from cultural norms and cause significant distress and impairment in…
personality traits: characteristics, whether considered positive or negative, that make up one’s personality
body illusion: discrepancy between the actual physical characteristics of the body and the way it is perceived by an individual
maladaptive behavior: patterns of thoughts, emotions, and actions that are ineffective or counterproductive to normal everyday life
de-escalation: use of strategies and communication techniques to calm and reduce agitation or aggression in individuals experiencing heightened emotional distress or crisis
grandiosity: exaggerated sense of self-importance, with beliefs of being unique, superior, and deserving of special treatment, associated with narcissistic personality disorder
magical thinking: idea that one can influence the outcome of specific events by doing something that has no bearing on the circumstances

Chapter 19

Substance Use and Misuse

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Summary

Three regions of the brain are the key components in the development and persistence of substance use disorders: the basal ganglia, the extended amygdala, and the prefrontal cortex. Prolonged, repeated misuse of substances can produce changes to the brain that can lead to a substance use disorder. Chronic substance use disorders significantly impact individuals, families, communities, and society. Substance use disorders (SUD) occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work…

Key terms

substance: psychoactive compound with the potential to cause health and social problems, including substance use disorder
brain: the key components in the development and persistence of substance use disorders: the basal ganglia, the extended amygdala, and the prefrontal cortex
alcohol use disorder (AUD): chronic medical condition that is categorized by difficulty stopping or controlling alcohol use, and by using alcohol to relieve or avoid withdrawal symptoms, even when it is…
drug diversion: when medication is redirected from its intended destination for personal use, sale, or distribution to others; includes drug theft, use, or tampering (adulteration or substitution)
harm reduction: focuses on meeting the client where they are and helping to prevent overdose, reduce transmission of infectious diseases, and improve the overall health of the client
stabilization: assisting a client through a period of acute detoxification and withdrawal so that they are medically stable and substance-free
stimulant: type of drug that causes the release of dopamine in the brain and is highly addictive because the flood of dopamine in the brain’s reward circuit strongly reinforces drug-taking…
withdrawal: when the reward control center begins to take over and the person begins to feel physical or emotional upset when they are not using a substance

Chapter 20

Eating Disorders

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Summary

Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, pica, and rumination are all eating disorders influenced by many psychological, behavioral, genetic, social, and… Anorexia nervosa is an eating disorder characterized by extreme restriction of food intake below the daily requirements, causing very low body weight that can be fatal. Anorexia is divided into two categories—restricting type and binge eating/purging type—and can involve cognitive distortions like thought-shape fusion. Eating disorders are a growing concern in nursing that can affect individuals of all ages and backgrounds.

Key terms

eating disorder: illness where there is an abnormal disturbance in attitudes and behaviors related to food
thought-shape fusion: type of distortion seen with eating disorders like anorexia where there are altered beliefs about food, weight, and shape
rumination: when gastrointestinal related, is when ingested food is repeatedly regurgitated and rechewed or spat out
bulimia nervosa: recurrent episodes of binge eating that are followed by behaviors to prevent weight gain like purging
anorexia nervosa: self-induced restriction of food due to fear of weight gain that results in weight being below the normal parameters for age and height
binge eating disorder: repeated episodes of excessive eating in shorter amounts of time than most people would eat in that situation, accompanied by significant lack of control over eating
pica: eating disorder where an individual repeatedly consumes nonfood items that lack nutritional benefits
cognitive distortion: irrational or exaggerated thinking patterns

Chapter 21

Somatic Symptom Disorders

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Summary

Somatic symptom disorder (SSD) is a condition that occurs when a client is focused on physical symptoms to the point of significant distress and disruption of normal functioning. Functional neurological disorder (FND) is a condition where an individual experiences one or more altered motor or sensory neurological symptoms that cannot be attributed to a specific medical or neurological condition. Risk factors include a history of childhood trauma, family history of SSD or mental health disorders, certain personality traits, and sociocultural traits affecting views on illness. Examples of behaviors commonly associated with SSD include excessive preoccupation with physical symptoms, high utilization of health-care services, disproportionate distress and anxiety, and impairment in daily…

Key terms

somatic: relating to or affecting the body
somatic symptom disorder (SSD): condition that occurs when a client is focused on physical symptoms to the point of significant distress and disruption of normal functioning
functional neurological disorder (FND): condition in which a person experiences neurological symptoms in the form of one or more altered motor or sensory symptoms that cannot be attributed to a specific medical or…
factitious disorder: mental health condition in which individuals feign illness or intentionally make others believe they are sick, characterized by a desire for attention and validation
illness anxiety disorder (IAD): mental health condition characterized by excessive worry and fear about having a serious medical condition, despite having little or no medical evidence to support the belief and…
pseudoseizures: seizure-like episodes without the characteristic electrical abnormalities observed in epilepsy on an electroencephalogram (EEG)
secondary gain: inadvertent advantages derived from adopting a sick role, such as receiving attention, sympathy, or support from others, or avoiding responsibilities or stressful situations

Chapter 22

Sexual Dysfunction and Gender Dysphoria

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Summary

The paraphilias are a type of sexual interest (i.e., urges, fantasies, behaviors) that are not limited to genital stimulation or fondling between mature, consenting human partners (APA, 2022). Paraphilias may be limited to private thoughts and feelings, or they may involve acting out the urges and fantasies that involve other, nonconsenting individuals Psychiatric care settings may provide the greatest opportunity for nurses to view and respond to the symptoms and distress of human sexual dysfunction; nurses and nursing students must first become aware of their own… This classification of sexual interest is controversial as a psychiatric disorder, but when the urges or fantasies are enacted by an individual on another, nonconsenting individual, they may have dire legal consequences.

Key terms

sexual dysfunction: person’s inability to respond sexually to mental or physical stimulation or to experience sexual pleasure
gender dysphoria: personal, distressing disconnect between one’s gender identity and their sex assigned at birth
paraphilias: a type of sexual interest (i.e., urges, fantasies, behaviors) that are not limited to genital stimulation or fondling between mature, consenting human partners (APA, 2022
paraphilia: sexual desire or behavior involving inanimate objects or nonconsenting other persons, or including subjugation
urges or fantasies: enacted by an individual on another, nonconsenting individual, they may have dire legal consequences
pedophilic disorder: paraphilia in which an individual, age sixteen years or older, is intensely attracted to a child or children and may engage in actual sexual behavior, including vaginal or rectal…
cisnormative: person who has a gender identity that is congruent with their biological sex, or sex assigned at birth
erectile disorder: difficulty in obtaining or maintaining a penile erection or experiencing a significant decrease in the rigidity of the erection during sexual activity

Chapter 23

Children and Adolescents

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Summary

Treatments are based on the type of intellectual disability that has been diagnosed and any comorbidities that exist. Approximately one in ten American children have a communication disorder, one of a group of neurodevelopmental disorders that affect speech and language development (Psychology Today, 2022). Intellectual disabilities are diagnosed in the developmental years but continue to affect individuals across the life span. Intellectual disabilities affect about 1 percent of the world’s population.

Key terms

intellectual disability: preferred term for intellectual functioning that falls below an IQ of 70 and starts before age eighteen
communication disorder: persistent difficulty with language and/or speech
intellectual developmental disorder: child is not meeting age-appropriate developmental guidelines for speech, language, socialization, motor skills, and behavior
learning disorder: occurs when a person has a difficult time in an area of learning, but it is not related to motivation or IQ level, emotional problems, cultural differences, or level of…
Tourette syndrome: disorder that is diagnosed with the presence of two or more motor tics and at least one vocal tic that have lasted for at least a year, began before age eighteen, and are not due…
Rett syndrome: disorder that affects mostly girls and often displays symptoms that are similar to autism
Down syndrome: intellectual disability where a baby is born with an extra chromosome 21
Asperger syndrome: disorder that has been reclassified as under ASD and has no requirement for onset by age three or language delay, and no criteria for communication or cognitive deficit

Chapter 24

Older Adults

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Summary

As older adults live longer, there are key factors that nurses can address to make sure that this population has the tools available for healthy aging. Chronic disease management and the ability to self-manage are two factors to consider. When self-management no longer seems possible, nurses should review options regarding care and advance directives with families and caregivers. Nurses must consider healthy aging and quality of life to be the overriding goals when offering education and other interventions.

Key terms

self-management: person’s active involvement in their own health-care decisions and intervention to promote their own best possible wellness with the help of the medical team
healthy aging: supporting the body and well-being, including functional ability through aging
acute pain: caused by injury, surgery, illness, trauma, or by a medical procedure that is short term in duration
opioids: compound drug that is derived from or synthetically resembles opium and has addictive properties
quality of life (QOL): extent to which life is comfortable or satisfying
cognitive impairment: alteration in cognition that causes a decline in memory and thinking that happens with age and many medical and inherited factors
nonsteroidal anti-inflammatory drugs (NSAIDs): medications that provide mild to moderate pain relief and also reduce fever and inflammation by inhibiting the production of prostaglandins

Chapter 25

Community Mental Health Treatment

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Summary

Social-emotional needs are important as well and include emotional support, social belonging, empowerment, and coping and emotional regulation skills. Community mental health offers services that vary according to the needs of the individual client. Community-based mental health services help to improve the overall mental health and well-being of communities. These needs can be affected by such factors as age, socioeconomic status, or severity of illness and include counseling, therapy, medication management, day programs, residential services, crisis programs, and more.

Key terms

community mental health: mental health treatment and activities that occur outside of an institution
emotional regulation: ability to recognize, understand, and regulate one’s emotions in a healthy and adaptive way
social belonging: feeling of being connected to and valued by others
home visiting service: providing mental health care that is personalized, convenient, and tailored to the client’s needs within the comfort of their own home environment, promoting early intervention…
Assertive Community Treatment (ACT): model of care that provides individualized support for clients in the community to help prevent relapse and recidivism and support recovery
community mental health center: health-care center that targets medically underserved populations in specific communities, also known as Federally Qualified Health Centers
group housing: type of small-scale living facility that, in addition to housing, provides support, supervision, and other types of assistance
intensive outpatient program (IOP): type of community care that provides structure and support for clients in a community setting, allowing them to receive intensive treatment without the disruption of…

Chapter 26

Adjuncts to Treatments

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Summary

Adjunctive treatments are complementary therapies used alongside traditional mental health treatments to enhance recovery outcomes. Nurses play a vital role in the implementation of adjunctive treatments for mental illness. Recovery from mental illness is often hindered by several barriers, including stigma and discrimination, lack of access to care, financial constraints, and limited social support. Stigma can lead to shame and reluctance to seek help, while financial and geographical barriers can prevent access to necessary treatments.

Key terms

adjunctive treatments: range of alternative treatments designed to enhance the impact of primary treatments, improving overall mental health outcomes
residual symptoms: such as fatigue, anxiety, and sleep disturbances that are commonly left over after treatment and are associated with relapse and disability
medicalization: process by which mental health issues are framed and treated primarily as medical conditions
anti-psychiatry movement: political/social and intellectual phenomenon that emerged in the 1960s as a response to perceived injustices and inadequacies within the traditional psychiatric system
validation therapy: empathetic and holistic approach to care that emphasizes understanding and respect for the client’s subjective experiences
user group: structured gatherings of individuals who share common experiences, in this case related to mental health issues
internet interventions: therapies delivered via web-based services, flexible and adapted to suit adult lifestyles and responsibilities
nursing informatics: integration of nursing science, computer science, and information science to manage and communicate data

Chapter 27

Current Trends and Growing Needs

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Summary

Human trafficking is the illegal trade of vulnerable people, typically for forced labor or commercial sexual exploitation, using coercion, fraud, or force. The COVID-19 pandemic has had a profound and lasting effect on mental health and care delivery. Many people reported increased anxiety and depression during the pandemic, but had problems accessing services due to lockdowns and other issues causing problems with access to care. Nurses became crucial in assisting clients with accessing care by providing education and services to connect them with providers, including therapists, nurse practitioners, and physicians.

Key terms

human trafficking: illegal trade of people, typically for forced labor or commercial sexual exploitation, using coercion, fraud, or force
exploitation: different ways in which traffickers financially benefit from their victims’ labor or sexual services
force: physical or psychological violence used to control victims, including threats, abuse, or confinement
assigned sex: category, typically male or female, that is assigned to an individual at birth based on physical and biological characteristics, such as genitalia and chromosomes
diversity, equity, and inclusion (DEI): commitment to recognizing and embracing differences, ensuring fairness, and fostering a sense of belonging for all individuals in order to create a more equitable and enriched…
flattening the curve: public health strategy aimed at slowing the spread of a contagious disease, like COVID-19, to ensure that the health-care system can manage the capacity
housing instability: state of uncertainty or vulnerability in one’s housing situation, characterized by frequent moves, risk of eviction, difficulty paying rent or mortgage, or a lack of stable…
nonbinary: people, also known as genderqueer, genderfluid, or agender, who do not exclusively identify as male or female and may have a gender identity that falls outside the traditional…

Chapter 28

Critical Thinking in Psychiatric-Mental Health Nursing

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Summary

This section addresses the nursing process in PMH nursing and the critical thinking involved. The plan of care is adapted to stated outcomes of care and client needs. The nurse engages in personal reflection as the plan of care unfolds. The nurse’s clinical judgment guides the process through all phases of the therapeutic relationship

Key terms

critical thinking: metacognitive process that is learned academically and experientially on the continuum of nursing education and practice
clinical judgment: decision-making from use of critical thinking in the nursing process
outcomes of care: measurable responses to interventions; results of goal-setting
plan of care: adapted to stated outcomes of care and client needs
nursing process: decision-making method in nursing practice
person-centered care: client is the focused recipient of nursing care
evidence-based practice (EBP): interventions formed by a combination of formal research findings, nursing competency, and the preferences of the client and family
planning: cognitive process of generating solutions to identified problems, setting goals of treatment, and developing nursing interventions to accomplish these objectives