2993_FM_i-xvi 14/01/14 5:31 PM Page i 4TH EDITION Neeb’s Fundamentals of Mental Health Nursing Linda M. Gorman, RN, MN, PMHCNS-BC, FPCN Clinical Nurse Specialist/Nursing Consultant Private Practice Studio City, California Robynn F. Anwar, MST, MSN, Ed Nursing Faculty/CNA and Multi-Skilled Coordinator Camden County College, Camden Campus Camden, New Jersey 2993_FM_i-xvi 14/01/14 5:31 PM Page ii F.A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2014 by F. A. Davis Company Copyright © 1997, 2001, 2006, by F.A. Davis Company. All rights reserved. This book is protected by copy- right. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Lisa B. Houck Director of Content Development: Darlene D. Pedersen Project Editor: Jacalyn C. Clay Electronic Project Editor: Sandra A. Glennie Illustration and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), edi- tors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Gorman, Linda M., author. Neeb’s fundamentals of mental health nursing / Linda M. Gorman, Robynn F. Anwar. — Fourth edition. p. ; cm. Fundamentals of mental health nursing Preceded by: Fundamentals of mental health nursing / Kathy Neeb. 3rd ed. c2006. Includes bibliographical references and index. ISBN 978-0-8036-2993-6 (pbk. : alk. paper) I. Anwar, Robynn F., author. II. Neeb, Kathy, 1952- Fundamentals of mental health nursing. Preceded by (work): III. Title. IV. Title: Fundamentals of mental health nursing. [DNLM: 1. Mental Disorders—nursing. 2. Nursing, Practical. 3. Psychiatric Nursing—methods. WY 160] RC440 616.89’0231—dc23 2013021696 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of pay- ment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1169-2/04 0 + $.25. 2993_FM_i-xvi 14/01/14 5:31 PM Page iii To Corie, who saw me as an author many years ago. (LG) To Mayme, I realize how much easier this journey would have been if you were here. Wasim and Andrea, I appreciate your belief in my abilities. “Mom Bessie,” who renewed her practical nurse license at age 94. Linda, thank you for being my mentor through this process. Shirley, Toni, and Ted—Thank you. (RA) 2993_FM_i-xvi 14/01/14 5:31 PM Page iv 2993_FM_i-xvi 14/01/14 5:31 PM Page v Preface eeb’s Fundamentals of Mental Health Chapters 1 to 9 provide the basics of Nursing is a psychiatric nursing text mental health nursing concepts, with an N tailored specifically to the needs of emphasis on communication. Chapters 10 the LVN/LPN student. We understand that to 22 are “clinical” chapters in that they many students at this level of preparation cover specific diagnoses and/or populations. do not have the opportunity for clinical ex- Many of the chapters include the following perience in a psychiatric setting, but they will new or enhanced key features: encounter patients with mental health issues in their rotations. Students will encounter • Neeb’s Tip will give a “clinical pearl” that patients and their families with psychiatric succinctly describes a key take-away from diagnoses as well as a variety of psychosocial the chapter. issues and behaviors that challenge them. This • Critical Thinking Questions are expanded text will provide the basic knowledge and and interspersed in the chapters to empha- skills to address many of these challenges, size a concept and challenge the student to with an emphasis on communication. This apply the concept just covered. Many of new edition also brings enhancements via the these include case-based scenarios. Internet through DavisPlus. • Toolbox provides additional resources for Our goal with this text is to provide basic students who want more information. information about mental health theories, These can be further explored on the personality development, coping and com- book’s Web site. munication styles, psychiatric diagnoses, and • Pharmacology Corner in Chapters 10 to 20 nursing actions, all as they pertain to the prac- and 22 covers important current informa- tice of the LVN/LPN. tion about medications used for the spe- The impact of psychiatric disorders con- cific population that will pertain to the tinues to be a concern in the United States. LVN/LPN scope of practice. Depression, anxiety, eating disorders, and • Clinical Activities are suggestions for the substance abuse continue to be major health student to utilize when caring for patients problems. How society responds to debilitat- with a particular disorder. ing mental illness has been the subject of • Classroom Activities include suggestions much debate. Clearly the need for nurses to for projects or actions that students have education in caring for people with and faculty can use in the classroom mental health issues is essential. to enhance learning. The Fourth Edition of Neeb’s Fundamentals • Case Studies are in-depth, with questions of Mental Health Nursing brings new authors to help the student apply knowledge who have expanded on the foundations that learned in the chapter. Kathy Neeb created so successfully in the first • Multiple Choice Questions—At least three editions. The new authors bring broad 10 questions are provided at the end of experience in psychiatric nursing, education, the chapters, with the answers/rationales and clinical practice. New chapters in this in Appendix A. Additional NCLEX Fourth Edition include postpartum issues questions are on the book’s Web site. as well as separate chapters on depressive • Sample Care Plans are provided in the and bipolar disorders. We have added more clinical chapters. features to enhance the concepts and make • Appendix E, which is new, matches com- them more meaningful and current. mon behaviors with nursing diagnoses. v 2993_FM_i-xvi 14/01/14 5:31 PM Page vi vi Preface Internet-based enhancements include pod- LVN/LPN student will not be using the casts, updated references, and other resources Manual routinely, a familiarity with the such as drug monographs and Neeb’s blog. terminology that is used by other health-care Neeb’s blog will provide an opportunity for professionals is essential. The chapter titles the student to reflect on learning and experi- reflect the new terminology where changes ences that can be shared with others. For have been made. the instructor, this Fourth Edition provides We, as practitioners and educators in the access to PowerPoint presentations, test bank field of mental health, have seen the impact questions, and other expanded features. of mental health issues on our patients and This edition coincides with the publica- society. We hope that the students who tion of the DSM-5, Diagnostic and Statistical utilize this book will gain a new perspective Manual for Mental Disorders by the American that includes up-to-date knowledge as well Psychiatric Association that was published as empathy for the suffering these disorders in 2013. The terminology used throughout can cause. We hope this book will con- this edition reflect the changes in this tribute to knowledgeable and compassion- major psychiatric reference. Although the ate LVNs/LPNs. 2993_FM_i-xvi 14/01/14 5:31 PM Page vii Reviewers PATTI ALFORD, RN, BSBM DEBORAH B. HARRIS, BSN, MSN, RN Instructor Director, Practical Nursing Program Kilgore College Valley Vocational Technical Center Longview, Texas Fishersville, Virginia RUTH FEE BLACKMORE, MSN, RN, CNOR EULA JACKSON, ADN, BS, MSN, CNE, PHD Faculty of Nursing Nursing Facilitator/Clinical Instructor Isabella Graham Hart School of Practical Reid State College and University of Phoenix Nursing Evergreen, Alabama Rochester, New York LINDA JOHNSON, RN, PHN, MSN, DHA RENEÉ T. BURWELL, AASN, BSN, MSED, EDD Assistant Director Vocational Nursing Program Coordinator of Health Science Programs Los Medanos College Charlotte Technical Center Pittsburg, California Port Charlotte, Florida ETHEL JONES, EDS, DSN, RN, CNE JOYCE CANAVAN, BS ED, MSN, RN Nursing Instructor Mental Health, Lead Instructor H. Councill Trenholm State Technical College