Psychiatric: Mental Health Nursing

Evidence-Based Concepts, Skills, and Practices by Wanda K. Mohr.

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discusionquestionchap21-31.docx

1) Type the definition of each of the KEY TERM from the 1st page of each of the 39 chapters from the Psychiatric—Mental Health Nursing: Evidence-Based Concepts, Skills, and Practices by Wanda K. Mohr.

2) Cite the page in the textbook each key term is found.

3) Submit all the Key Terms in one document.

Discussion Topics, Mohr

Chapter 21, Forensic Psychiatric Nursing

Discussion Topics	Learning Objective
1. You have just graduated from nursing school and you are considering working in forensic nursing. Psychiatric: Mental Health Nursing a. Explain the psychiatric nurse’s role in the forensic milieu. b. What are your fears in dealing with people in correctional facilities? c. What do you think would be most difficult about working with the forensic client? d. Have you ever witnessed acting-out behavior in a client? What happened? How did it make you feel? What do you think about this situation now? Were there any clues that this behavior was imminent? Looking at this situation now, could it have been prevented?	1
2. You are interviewing a forensic nurse who works in a correctional facility. The nurse begins to discuss the issues associated with special populations. a. Choose one of the special populations that forensic nurses may interact with (juvenile offenders, female offenders, older adult offenders, offenders with HIV/AIDS or hepatitis, or offenders with terminal illness). Discuss some of the issues that a forensic nurse faces when dealing with these special populations.	2
3. While performing a clinical rotation in a hospital, you are assigned to a client that has been admitted from a local correctional facility. He was admitted with severe chest pain and it was confirmed that the client had a myocardial infarction. When assessing the client, you must be accompanied by a police officer and he must un-cuff the client from the bed so that you can perform a complete assessment. When you read the client’s chart, you find out that he is incarcerated for the attempted murder of a child. a. Would you treat this client differently than any other client who was admitted with a myocardial infarction? b. How is security for the forensic nurse incorporated into client care and what type of challenges does this present?	1, 2
4. You have just graduated from nursing school and started a job at the local correctional facility in the health clinic. Your first client is a female who has just been transferred to the correctional facility today. She has a diagnosis of terminal cancer. You learn she has three children and a husband that are devastated about her incarceration. The client reports being extremely worried about her family. Psychiatric: Mental Health Nursing a. What are the potential blocks to the assessment process with this client? b. What are potential nursing diagnoses for this client? What interventions could be used for each diagnosis (use the textbook for support)? c. What strategies would you adopt when working with the client’s family? Provide examples of how you could implement these strategies.	3

Discussion Topics, Mohr

Chapter 22, Sleep Disorders

Discussion Topics	Learning Objective
1. After you’ve worked the 7 am to 7 pm day shift for three years, your place of employment requires that you work the night shift for one year. a. Define the term sleep. Have you ever experienced sleep deprivation? If so, how did you feel physically? Emotionally? b. How well do you feel you sleep at night? Do you feel rested when you awaken in the morning? c. Do you participate in any routines or rituals before going to bed? If so, why? d. Do you believe that your abilities as a nurse would be compromised if you were working with sleep deprivation? Why or why not?	1, 3, 4
2. Timothy is 52 years old and has just developed problems with sleeping. After conducting an interview with Timothy, it is determined that the use of alcohol, tobacco, and caffeine may be interfering with his sleep. a. List the changes in sleep patterns that occur from infancy through the elderly years. b. How does the use of alcohol, tobacco, and caffeine interfere with sleep?	2, 4
3. After feeling down for several months and having difficulty sleeping, Chris decided to seek help from a healthcare provider. Chris was diagnosed with major depression and was placed on an antidepressant. Psychiatric: Mental Health Nursing a. What effect does major depression have on sleep? b. How can the different types of medications used to treat depression effect sleep?	3, 6, 7
4. Your 69 year old female patient is admitted for a sleep study. She complains of sleep difficulty nightly. a. Explain the normal changes in sleep across the lifespan to the patient. b. What diagnostic testing would you anticipate this patient having? c. How can the nurse assess for sleep difficulty? d. What are some recommendations you can make for good sleep hygiene? e. What is an appropriate nursing diagnosis for this patient? What interventions would you use to assist the patient and why?	2, 5, 6, 8

Discussion Topics, Mohr

Chapter 23, Anxiety Disorders

Discussion Topics	Learning Objective
1. You are caring for a client who is experiencing severe anxiety. Think about a time in your life when you have experienced anxiety. a. Define anxiety. b. What are your common symptoms when anxious? Pay attention to your body response and connect the response to the feeling of anxiety. Classify these as cognitive, affective, physiologic, or behavioral. c. How is your response to anxiety similar and different when the anxiety is related to your personal life and to your experience as a nursing student? d. What techniques do you use to reduce your own anxiety? Do they work? Do you use several techniques or only a few? Do you smoke, drink, or use food to reduce your anxiety?	1, 5
2. Alex is a 54-year-old man who has been suffering from extreme anxiety after being robbed by a man at gun point. He does not understand how anxiety results from being robbed. a. Discuss the proposed etiology for Anxiety Disorders (PTSD) with Alex. b. Compare and contrast acute stress disorder and post-traumatic stress disorder. c. Describe the effects anxiety can have on sensation, cognition, and verbal ability.	4, 5, 6
3. Marsha is a 38-year-old woman who has been diagnosed with an anxiety disorder. She has little knowledge about anxiety and believes she is alone in her diagnosis. She is also curious about the different treatment options available to treat anxiety. a. Explain to Marsha what is meant by the term anxiety disorder. b. To help her understand she is not alone, discuss the prevalence of anxiety disorders with Marsha. c. Explain one of the cognitive-behavioral therapies used to treat anxiety. d. Marsha’s psychiatrist has decided to place her on medication. What types of medications can be used to treat anxiety? Choose one of these medications and list client education you would want to provide to a client.	2, 3, 7

Discussion Topics, Mohr

Chapter 24, Somatoform, Dissociative, and Sexual Disorders

Discussion Topics	Learning Objective
1. Mary is a 64-year-old woman who complains of chronic pain in her left arm, shoulder, and back. She has been through many diagnostic tests and no physical cause for the source of her pain can be found. a. How do you feel about clients who constantly complain about various physical symptoms? How do you react when a client constantly complains about such symptoms? Do you think that your reaction to the clients interferes with developing a therapeutic relationship? b. What do you believe about clients who have physical complaints but no demonstrated physiologic reason for them?	1, 2
2. Josephine is a 21-year-old woman who was sexual abused from the ages of 8 to 12. She has just been diagnosed with dissociative identity disorder. a. What kinds of feelings do you experience when you think about working with clients who have been victims of severe physical or sexual abuse? How might these feelings affect your nursing care? b. Reflect on times when you have been forgetful or not paying attention. How did these experiences make you feel when you realized they had occurred? c. What nursing diagnosis would be appropriate to use with this patient? What interventions do you believe are needed (use the textbook for support)?	5, 6, 7
3. During a patient interview, you are required to obtain information about a client’s sexual history. a. Have you experienced a situation in which a client shared concerns about sexual issues with you? How did you feel? Were you comfortable listening? Did you seek advice about how to respond to the client? b. What are your feelings about people who are homosexual or bisexual? How do your feelings influence your role as a professional nurse? c. Have you ever had a problem, concern, or question related to sexual behavior? If so, how did you resolve it? Did you talk with anyone? In whom did you choose to confide? What was it about that person that made you feel comfortable discussing your concerns?	8, 9

Discussion Topics, Mohr

Chapter 25, Personality Disorders

Discussion Topics	Learning Objective
1. After learning about the personality disorders in class, a classmate turns to you and says he has some of the symptoms of about three different personality disorders. a. Do you notice aspects of your own personality in the descriptions of some of the personality disorders? If yes, how does that make you feel? What is the difference between finding some characteristics of a disorder and an actual diagnosis?	1, 2
2. You are caring for a client that is showing manifestations of a personality disorder. Another nurse asks you if his symptoms fit into the A, B, or C cluster of personality disorders. Psychiatric: Mental Health Nursing a. What are the differences between cluster A, B, and C personality disorders? b. Provide a description and symptoms of one personality disorder that falls into each cluster.	5
3. While working in a psychiatric mental health facility, you are assigned to Kenny, a 34-year-old man who has just been diagnosed with a personality disorder. Kenny says to you, “can’t they just give me a pill so that I can feel better?” a. What are the different treatment options that are available for a client with a personality disorder? b. Identify what treatment modality is best for each personality disorder and how the treatment is believed to help the disorder.	6
4. You have been a psychiatric nurse for 10 years working with children. You are being transferred to the adult unit where you will be working with clients with Personality Disorders and you have no experience in this area. a. Why is self care important for the nurse when working with patients with this diagnosis? b. What self care activities will you employ and why?	8

Discussion Topics, Mohr

Chapter 27, Depressive Disorders

Discussion Topics	Learning Objective
1. Depression is often referred to as the common cold of mental illness because it affects so many individuals at some point in their lives. a. When was the last time you felt “down” or sad? What were the circumstances? Did you consciously do anything about this feeling, or did the feeling just “go away”? b. Have you noticed any particular events or circumstances in your life that are related to feelings of sadness or “feeling down”? c. What is the incidence and prevalence of depressive disorders in the United States population? d. What coping measures do you use to deal with feelings of sadness or depression?	1
2. While working in a local hospital, a client is admitted that you believe might be suffering from depression. a. What are the signs and symptoms of depression? b. Compare and contrast the different etiological theories of depression.	2, 3
3. Sandra has been suffering from severe depression for the past year and has just decided to seek help for her condition. Her healthcare provider is deciding upon appropriate treatment of her disorder. a. List information you would provide to a patient who is prescribed a Selective Serotonin Reuptake Inhibitor, Tricyclic Antidepressant, or a Monoamine Oxidase Inhibitor. b. Identify Somatic therapies that can be used to treat depression.	4

Discussion Topics, Mohr

Chapter 28, Bipolar Disorders

Discussion Topics	Learning Objective
1. While doing a clinical rotation through a psychiatric mental health facility, you are assigned to a client who is in the manic phase of bipolar disorder. a. How prevalent are bipolar disorders in the United States? b. What are the signs and symptoms of bipolar disorder? c. How do you think you would react to a client in a manic state? How would your approach to a manic client be different from your approach to other clients?	1, 2, 4
2. Eva is a 24-year-old woman who has just been diagnosed with bipolar disorder. She is upset by the diagnosis and asks you if she developed the condition because she drank alcohol before she turned 18. a. How would you respond to Eva? b. What are the different factors that are believed to play a role in bipolar disorder? How do they influence the disorder?	3
3. After diagnosing Adam with bipolar disorder, a physician decides to use combination therapy involving both medication and psychotherapy. a. What medication education would the nurse want to include in the plan of care for a patient prescribed Lithium or Lamotrigine (Lamictal)? b. How could you encourage medication compliance in a bipolar client?	5, 6

Discussion Topics, Mohr

Chapter 30, Substance Use Disorders

Discussion Topics	Learning Objective
1. While caring for a patient with substance abuse issues, you begin to evaluate your own opinions regarding abused substances. a. Do you have different attitudes about someone who is addicted to/dependent on prescription drugs compared with someone who is addicted to/dependent on alcohol or street drugs? b. Have you ever experienced any adverse consequences related to the use of a substance? c. Write about your feelings related to alcohol and substance abuse. Speculate how these feelings may influence your work as a nurse with clients who are substance-dependent? d. What is the incidence and prevalence of substance use disorders?	1, 2
2. Randy is a 43-year-old man who has been a heavy drinker since the age of 25. Because of his dependency on alcohol, he has a hard time keeping a job and has been divorced twice. He has decided to go to a treatment center to try and overcome his addiction. While in a group therapy session, Randy states, “I don’t know why I drink, my father did too. I guess I learned it from him.” a. What etiological factors are believed to be influential over substance abuse behaviors?	3
3. Shannon has suffered from Major Depressive Disorder for five years. She has used various types of controlled substances over the years and due to the amount she has used, she needs larger and larger doses in order to achieve a “high.” a. What are the effects of the different controlled substances and what are the symptoms of an overdose? b. What is a co-morbid disorder? What is the incidence of co-occurring disorders? What is the significance of recognizing Shannon has having a co-occurring disorder? c. What two main components of interdisciplinary treatment are you likely to see used with this patient and why?	5, 6, 8

Discussion Topics, Mohr

Chapter 31, Cognitive Disorders

Discussion Topics	Learning Objective
1. After discussing cognitive disorders in class, you begin thinking about experiences you have had with those who suffer from these conditions. a. What is a cognitive disorder? Have you ever had a family member who was diagnosed with a cognitive disorder? What feelings were evoked by the changes that result when someone has this kind of disorder? b. Think about any clients you may have cared for with a cognitive disorder. What were some of the difficulties involved in nursing care? How did you feel about caring for these clients? What did you learn about yourself? c. If a genetic marker or a diagnostic test became available for Alzheimer’s disease, would you want to be tested? Why or why not?	1
2. You are caring for a client who has been diagnosed with dementia. When speaking to the client’s family, it becomes evident that they are not very familiar with the disease process. a. The family of this client wishes to know more about the symptoms of dementia. Identify and explain a symptom that may be seen in clients with dementia. Psychiatric: Mental Health Nursing b. The family also tells you that there have been two other family members that have been diagnosed with Alzheimer’s disease and would like to know what causes the disease. What information would you provide about the etiology of Alzheimer’s disease?	3, 4
3. You are working in a doctor’s office and a 55-year-old man comes in with his 77-year-old father who is experiencing signs of dementia. He wishes to find out about potential treatments for his father’s condition. a. What are the recommended psychosocial and pharmacological treatments for delirium and dementia? b. The doctor is deciding between prescribing Rivastigmine (Exelon) or donepezil (Aricept). What information would you want to provide for these medications?