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#### Cultural Perspectives on Suicide
Cultural norms and beliefs significantly influence attitudes toward mental health and suicide. Different cultures may interpret suicide differently, with some viewing it as a sin, a crime, a symptom of mental illness, or even an honorable act (Clay, 2018). For instance, in some c... | {
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The Zero Suicide Institute's mission is to decrease the incidence of suicide in clients under the care of a health-care provider. Their website provides information [\(https://openstax.org/r/77ZeroSuicide\)](https://openstax.org/r/77ZeroSuicide) for implementation in clinics and practices.
#### **Preventing Suicide i... | {
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Self-harm, more formally referred to as **nonsuicidal self-injury (NSSI)**, is a behavior involving deliberate selfinflicted harm that is not intended to result in death. NSSI usually presents as skin cutting, burning, or severe scratching, and is often associated with a desire to cope with distressing emotions or to c... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Nonsuicidal Self-Injury**",
"token_count": 615,
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The Substance Abuse and Mental Health Services Administration has provided a [list of examples of self-harm](https://openstax.org/r/77selfharmexmpl) [\(https://openstax.org/r/77selfharmexmpl\)](https://openstax.org/r/77selfharmexmpl) that may be used by a mental health client.
#### **Addressing Nonsuicidal Self-Injur... | {
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Define bipolar disorder
- Describe the symptoms of bipolar disorder
- Outline the approaches used to treat bipolar disorder
Bipolar disorder is a chronic mental health condition characterized by fluctuating periods of intense mood sta... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**16.4 Bipolar Disorders**",
"token_count": 1105,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### Cultural Differences Relating to Elation
Elation is a universal human emotion characterized by a sense of joy, exhilaration, and high spirits. How this emotion is experienced, expressed, and interpreted differs greatly when accounting for cultural and age-related factors. Understanding these differences is key t... | {
"Header 1": "CULTURAL CONTEXT",
"token_count": 2030,
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Interpersonal and social rhythm therapy (IPSRT) aims to stabilize daily rhythms, such as sleep, wake, and mealtimes, which can be particularly beneficial for individuals with bipolar disorder; disruptions in these areas can precipitate manic or depressive episodes (Mayo Clinic, 2021). Familyfocused therapy involves fam... | {
"Header 1": "CULTURAL CONTEXT",
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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 distress or impairment in daily life. Major depressive disorder, the most severe form, and dysthymia, a ... | {
"Header 1": "CULTURAL CONTEXT",
"Header 3": "**[16.2](#page-499-0) [The Spectrum of Mood Disorders](#page-499-0)**",
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Define stress and explain how the body reacts to stress
- Describe coping strategies for stress
- Discuss the prevalence and impact of anxiety
- Outline approaches for managing and treating anxiety
Stress is a normal part of life. Eve... | {
"Header 1": "**17.1 Stress and Anxiety**",
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Many factors, including work, relationships, finances, and health problems, can cause stress. Stress is the brain's initial response to a demand or challenge. When confronted with a situation requiring attention or action, the brain's hypothalamus initiates a series of chemical releases, activating the sympathetic nerv... | {
"Header 1": "**17.1 Stress and Anxiety**",
"Header 3": "**Definition of Stress**",
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One approach to measuring stress uses Life Change Units [\(https://openstax.org/r/77lifechgunit\)](https://openstax.org/r/77lifechgunit) which involve calculating level of stress. Note that the same event may affect adults differently than it affects youths.
Reactions to stress vary from person to person and can be i... | {
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- Deep breathing exercises: Slow, deep breaths can activate the body's relaxation response, counteracting stress and promoting calm.
- • Progressive muscle relaxation: This technique involves systematically tensing and relaxing different muscle groups to release physical tension and promote relaxation.
- Visualizatio... | {
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Stress and anxiety in nursing students can arise from academic pressures, clinical experiences, or the impending responsibility of client care.
Common triggers of stress and anxiety in nursing students include:
- clinical mistakes or perceived errors
- fear of harming clients
- high academic workload
- balancing pe... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "Stress and Anxiety in Nursing Students",
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Individuals with severe anxiety may also have difficulty functioning in daily life and may require professional treatment (American Psychiatric Association, 2013).
Severe anxiety profoundly impacts an individual's behaviors, thought processes, and problem-solving capacities. Individuals experiencing severe anxiety ma... | {
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"Header 3": "Stress and Anxiety in Nursing Students",
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#### Panic in a Nursing Student
Panic involves sudden and intense feelings of fear or terror, often accompanied by physical symptoms. These episodes can be overwhelming and disruptive.
Physical symptoms can include:
- Palpitations: rapid heart rate or skipped beats
- Trembling: shaking or shivering without an app... | {
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| Drug Name | Use | Duration of Action |
|---------------------------------------|-----------------------------------------------------------------------------|---------------------------------|
| Diazepam... | {
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Describe causes and treatment approaches for generalized anxiety disorder
- Understand and plan the nursing interventions for a person with a phobia
- Outline the attributes of, and approaches to care for, a person suffering from a pani... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "**17.2 Anxiety-Related Disorders**",
"token_count": 1694,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Clients can use the acronym STOP [\(https://openstax.org/r/77STOPanxiety\)](https://openstax.org/r/77STOPanxiety) to help de-escalate from moments of anxiety.
Client education and counseling are essential components of the treatment of GAD. Clients with GAD often have
misconceptions about their symptoms and may ben... | {
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"token_count": 410,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### Generalized Anxiety Disorder and Aggravating Factors
The following psychosocial factors may contribute to the degree, development, and maintenance of GAD:
- Early life experiences: Traumatic or stressful experiences in childhood or adolescence, such as abuse, neglect, or loss, can increase the risk of developi... | {
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A **phobia** is an excessive and irrational fear of a specific object, situation, or activity that is typically harmless. Unlike general fear or discomfort, a phobia is characterized by intense anxiety that can lead to avoidance behavior, severely impacting a person's daily life and functioning (American Psychiatric As... | {
"Header 1": "CULTURAL CONTEXT",
"Header 3": "**Phobias**",
"token_count": 967,
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#### Phobias in Children, Adolescents, and Older Adults
Phobias can affect individuals of any age, but age-related concerns may impact the diagnosis and treatment of phobias. In older adults, phobias may be more likely to co-occur with other medical or psychiatric conditions, complicating treatment. Older adults may ... | {
"Header 1": "LIFE-STAGE CONTEXT",
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Psychological factors include cognitive processes that may influence the development of panic attacks, such as heightened sensitivity to bodily sensations and misinterpretation of these sensations as life-threatening (Cleveland Clinic, 2023). Additionally, exposure to stressful life events and chronic stress can contri... | {
"Header 1": "LIFE-STAGE CONTEXT",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Outline the causes of obsessive-compulsive disorder
- Describe the signs and symptoms of obsessive-compulsive disorder
- Give examples of treatment approaches for obsessive-compulsive disorder
- Outline considerations when planning nurs... | {
"Header 1": "LIFE-STAGE CONTEXT",
"Header 3": "**17.3 Obsessive–Compulsive and Related Disorders**",
"token_count": 358,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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**Nurse:** Jane, RN **Years in Practice:** Seven **Clinical Setting:** Mental Health Unit, Regional Hospital **Geographic Location:** Louisiana
Jane, an experienced RN in a mental health unit, was assigned to care for a thirty-five-year-old client named Mark, who had been diagnosed with severe OCD. Mark's condition w... | {
"Header 1": "REAL RN STORIES",
"token_count": 1960,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Some common SSRIs used for OCD include:
- • fluoxetine (Prozac)
- • sertraline (Zoloft)
- • fluvoxamine (Luvox)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
Benzodiazepines, such as diazepam (Valium) and lorazepam (Ativan), are sometimes used for short-term relief of anxiety associated with O... | {
"Header 1": "REAL RN STORIES",
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Outline the causes, symptoms, and interventions for a person with body dysmorphic disorder
- Outline the causes, symptoms, and interventions for a person with hoarding disorder
- Outline the causes, symptoms, and treatment approaches fo... | {
"Header 1": "**17.4 Trauma-Induced and Stress-Related Disorders**",
"token_count": 1070,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The video titled [Because I'm Ugly: Body Dysmorphic Disorder and Me](https://openstax.org/r/77dysmorphia) (https://openstax.org/r/77dysmorphia) explores the challenges of living with BDD through the real-life testimony of Elias, a seventeen-year-old boy with the disorder.
#### **Diagnosing BDD**
BDD can be complex ... | {
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Difficulty maneuvering through cluttered spaces may lead to falls and other injuries (American Lung Association, 2021). There is also an increased risk of fire or other hazards due to the cluttered living environment (Mayo Clinic, 2018a).
#### **Diagnosing Hoarding Disorder**
The diagnosis of hoarding disorder is b... | {
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#### A Social Perspective on Trichotillomania
While genetic and neurological factors may contribute to trichotillomania, psychosocial factors can also play a role in the development of the disorder. These factors include stress and anxiety, lack of social support, shame and embarrassment, and family dynamics (America... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
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#### **Nursing Interventions**
Nursing interventions for excoriation disorder are an important component of the multidisciplinary care approach often used to manage this condition. Nursing interventions may include educating and supporting individuals with the disorder, developing coping strategies to manage trigge... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
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Rates of PTSD are highest after traumas involving interpersonal violence, such as rape or child abuse (Kessler et al., 2017).
#### **Treatment of PTSD**
PTSD is a complex and challenging disorder, but evidence-based interventions help individuals manage their symptoms and improve their quality of life. Treatment ap... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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This short video from the Veterans Health Administration explains [eye movement desensitization](https://openstax.org/r/77EMDP) [\(https://openstax.org/r/77EMDP\)](https://openstax.org/r/77EMDP) and reprocessing (EMDP) for treatment of PTSD, sometimes used with veterans.
#### **Medications**
Medication can effectiv... | {
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#### Applying the CJMM to a Person with PTSD
Estelle is a thirty-year-old female who was diagnosed with anxiety and PTSD following an incident when she was attacked and robbed in a parking garage three years ago. She lives alone and has asked to be readmitted to the psychiatric unit because she states that she is "st... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "CLINICAL JUDGMENT MEASUREMENT MODEL",
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The diagnosis of ASD is based on the presence of a cluster of symptoms—including intrusive thoughts or memories, avoidance of event reminders, and hyperarousal or hypervigilance—that occur in response to a traumatic event. According to the DSM-5, an individual may be diagnosed with ASD if they meet the following criter... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Diagnosis of ASD**",
"token_count": 2034,
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#### **Diagnosing Attachment Disorders in Children**
Attachment disorders in children can manifest in various ways, including behavioral, emotional, and social difficulties. For example, children with attachment disorders may display aggressive or hostile behavior toward caregivers, peers, and authority figures. Th... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Diagnosis of ASD**",
"token_count": 788,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Define dissociative disorder
- Recall the symptoms and prevalence of dissociative identity disorder
- Outline approaches to treating dissociative identity disorder
A disruption in consciousness, memory, identity, or perception not cau... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**17.5 Dissociative Identity Disorder**",
"token_count": 264,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Dissociative disorders are psychiatric conditions characterized by disruptions in consciousness, memory, identity, emotion, perception, behavior, and sense of self (American Psychiatric Association, 2013). These disturbances may be sudden or gradual, acute or chronic. Dissociative disorders are thought to arise as a ps... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Defining Dissociative Disorder**",
"token_count": 2013,
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Aggressive or poorly timed challenges can exacerbate dissociation, increase resistance, or damage the therapeutic alliance (ISSTD, 2011). Before any confrontation can occur, develop a solid foundation of trust and safety, understand the unique experiences of each identity state, build rapport, and create a secure envir... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Defining Dissociative Disorder**",
"token_count": 356,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### QSEN Competencies in Treatment of DID
Applying the QSEN competencies to the treatment of DID helps guide the nurse to prioritize client safety, ethical considerations, and evidence-based interventions.
• Client-centered care: Understand the unique experiences of DID clients, including their history, individual... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
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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 s... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**[17.1](#page-537-0) [Stress and Anxiety](#page-537-0)**",
"token_count": 559,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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This section explored various mental and emotional disorders, providing insight into causes, diagnosis, symptoms, nursing care, and treatment approaches. BDD, hoarding, trichotillomania, excoriation, PTSD, ASD, and attachment disorders all have genetic, neurobiological, and environmental influences to various degrees. ... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**[17.4](#page-565-0) [Trauma-Induced and Stress-Related Disorders](#page-565-0)**",
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**acute stress disorder (ASD)** psychiatric condition that can occur in the aftermath of a traumatic event **anxiety** heightened state of arousal and worry that may not always have a clear external cause **attachment disorders** group of psychiatric conditions resulting from a disruption in the normal attachment
pro... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Key Terms**",
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**FIGURE 18.1** The etiology of psychological and mental health disorders can be multifaceted, ranging from genetic and biological to environmental; often, specific causes are a combination of the types of factors or remain a mystery. (credit: "National Nurses Week: Capt. Stephanie Smidd... | {
"Header 1": "CHAPTER 18 Personality Disorders",
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Personality disorders are characterized by rigid and inflexible traits that are pervasive and persist over time (American Psychiatric Association [APA], 2022a). These patterns are typically stable and consistent, beginning in adolescence or early adulthood and continuing throughout a person's life. While specific sympt... | {
"Header 1": "**18.1 Identification and Diagnosis**",
"Header 3": "**Symptoms and Signs of Personality Disorders**",
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#### Personality Disorders and Cultural Factors
Part of the defining feature of a personality disorder is that the behaviors exhibited must be different from the cultural norms of the client. Different cultures have different standards for what is considered "normal" behavior and this must be taken into account durin... | {
"Header 1": "CULTURAL CONTEXT",
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Personality disorders can only be diagnosed by highly trained, qualified professionals—generally a psychiatrist, a psychiatric nurse practitioner, or a clinical psychologist—following a comprehensive and complex history and behavioral assessment of the client. It is important to remember that many clients who are diagn... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Diagnosis of Personality Disorders**",
"token_count": 384,
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By the end of this section, you will be able to:
- Outline the key features related to different types of cluster A personality disorders
- Outline the key features related to different types of cluster B personality disorders
- Outline the key features related to different types of cluster C personality disorders
... | {
"Header 1": "**18.2 Cluster Disorders (A, B, C)**",
"Header 3": "**LEARNING OBJECTIVES**",
"token_count": 346,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder (APA, 2022a). Cluster A is characterized by eccentric, odd, or peculiar behavior, thinking, and beliefs. Individuals with these disorders often struggle socially. They can often app... | {
"Header 1": "**18.2 Cluster Disorders (A, B, C)**",
"Header 3": "**Cluster A**",
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Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic personality disorders [\(Figure 18.3](#page-610-0)). Cluster B personality disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. These individuals may also have a history of unstable ... | {
"Header 1": "**18.2 Cluster Disorders (A, B, C)**",
"Header 3": "**Cluster B**",
"token_count": 970,
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The [National Education Alliance for Borderline Personality Disorder](https://openstax.org/r/77borderlineweb) (https://openstax.org/r/77borderlineweb) is a comprehensive site for those seeking information on BPD.
#### **Histrionic**
The essential features of histrionic personality disorder are a pattern of pervasiv... | {
"Header 1": "LINK TO LEARNING",
"token_count": 495,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Cluster C personality disorders share a common theme of anxious and fearful behaviors [\(Figure 18.4](#page-612-0)). They are characterized by a chronic pattern of thoughts, feelings, and behaviors that are driven by a sense of fear, insecurity, and a desire for safety (Cleveland Clinic, 2022).
![](_page_612_Figure_1... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Cluster C**",
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Personality disorders are some of the most difficult disorders to treat in psychiatry (Fariba et al., 2023). Clients with personality disorders often do not have insight into their condition and are unlikely to seek treatment for a personality disorder. They often go undiagnosed unless they seek treatment for another p... | {
"Header 1": "**18.3 Nursing Care and Treatment Approaches**",
"Header 3": "**Approaches to Treatment**",
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#### Stress Management: Stimulate the Parasympathetic Nervous System
For clients seeking immediate relief from intense symptoms, such as panic or depersonalization, nurses can teach how to stimulate the parasympathetic nervous system. Stimulation of the vagal nerve can result in an immediate, direct relief of intense... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"token_count": 610,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### QSEN Competency: Client-Centered Care
Strategies for assisting nurses in overcoming biases when working with clients with personality disorder include the following:
Self-reflection: Nurses should engage in regular self-reflection to identify and understand their own biases. This
involves acknowledging perso... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"token_count": 1763,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Planning nursing care for a client with a personality disorder begins with a thorough assessment of the client. Assessment of the client with a personality disorder includes interviewing the client, observing verbal and nonverbal behaviors, completing a mental status examination, and performing a psychosocial assessmen... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Planning Nursing Care**",
"token_count": 2036,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
|
| Reality | Provide gentle redirection and clarification to help maintain a shared reality, especially for |
| orientation | clients who may... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Planning Nursing Care**",
"token_count": 509,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Personality Disorder **Nurse:** Susan, RN **Years in Practice:** 14 **Clinical Setting:** Acute psychiatric unit **Geographic Location:** Texas
As a registered nurse working in an acute psychiatric unit, Susan often encountered clients with various mental health challenges, including personality disorders. One partic... | {
"Header 1": "REAL RN STORIES",
"token_count": 941,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **[18.1](#page-605-0) [Identification and Diagnosis](#page-605-0)**
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 ... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Summary**",
"token_count": 659,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
- **body illusion** discrepancy between the actual physical characteristics of the body and the way it is perceived by an individual
- **de-escalation** use of strategies and communication techniques to calm and reduce agitation or aggression in individuals experiencing heightened emotional distress or crisis
**disso... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Key Terms**",
"token_count": 264,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**1**. Antonio, a twenty-eight-year-old male, seeks treatment at the outpatient mental health clinic due to interpersonal difficulties and ongoing emotional distress. He reports a history of strained relationships, frequent job changes, and a sense of emptiness. Antonio describes intense and unstable emotions, fearing ... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**What Should the Nurse Do?**",
"token_count": 1085,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**FIGURE 19.1** The etiology of psychological and mental health disorders can be multifaceted, ranging from genetic and biological to environmental; often, specific causes are a combination of the types of factors or remain a mystery. (credit: "National Nurses Week: Capt. Stephanie Smidd... | {
"Header 1": "CHAPTER 19 Substance Use and Misuse",
"token_count": 379,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Define substance use disorder
- Demonstrate an understanding of substance use disorder
- Outline the symptoms of substance use disorder
- Describe the role of the nurse in planning care and approaches to recovery for a client with subst... | {
"Header 1": "**19.1 Substance Use Disorders**",
"token_count": 223,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Substance Misuse: Part 1
The nurse is assessing a thirty-year-old female who has been admitted to the hospital psychiatric unit.
| PMH | Client is a thirty-year-old female who works as a project manager at a construction firm. She<br>has a medical-surgical history of lumbar disc herniation repair,... | {
"Header 1": "**19.1 Substance Use Disorders**",
"Header 3": "UNFOLDING CASE STUDY",
"token_count": 1139,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
in the plan of care?
A **substance** is defined as a psychoactive compound with the potential for dependence and detrimental effects, including substance use disorder. According to Substance Abuse and Mental Health Services Administration (SAMHSA, 2022d), **substance use disorders (SUD)** happen when the repeated use... | {
"Header 1": "**19.1 Substance Use Disorders**",
"Header 3": "**Defining Substance Use Disorder**",
"token_count": 981,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The DSM-5 [diagnostic criteria for the diagnosis of substance use disorders](https://openstax.org/r/77DSM5SUD) (https://openstax.org/r/77DSM5SUD) is reproduced in the Clinical Guidelines Program published by Johns Hopkins University.
#### **Addictive Disorders**
Addictive disorders that are not substance-related in... | {
"Header 1": "LINK TO LEARNING",
"token_count": 2016,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Cannabis has been classified as a Schedule 1 drug since the 1970 Controlled Substances Act. However, more than half of the states in the nation have decriminalized the substance, with some permitting medical usage and others both medical and recreational usage. As of May 2024, the Drug Enforcement Agency has recommen... | {
"Header 1": "LINK TO LEARNING",
"token_count": 1636,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### The Cycle of Addiction
Research has shown that a person who first tries drugs in their teens is more apt to develop an SUD than a person who first tries drugs as an adult (NIDA, 2022). Conduct problems and delinquent behaviors, such as vandalism and violence, are usually precursors to the initiation of substance... | {
"Header 1": "LIFE-STAGE CONTEXT",
"token_count": 817,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
This SAMHSA information sheet [explains how to start a conversation with a family member](https://openstax.org/r/77talkaboutprob) (https://openstax.org/r/ [77talkaboutprob\)](https://openstax.org/r/77talkaboutprob) who is using or having mental health problems. This sheet could be used as a handout for client/ family e... | {
"Header 1": "LINK TO LEARNING",
"token_count": 1972,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Define and recognize how to diagnose alcohol use disorder
- Outline approaches to treating alcohol use disorder
- Plan nursing care for a client with alcohol use disorder
- Comprehend the risks a client in alcohol withdrawal might have ... | {
"Header 1": "**19.2 Alcohol Use Disorder**",
"token_count": 240,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The DSM-5 recognizes **alcohol use disorder (AUD)** as a 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 causing negative social, occupational, or health-related consequences (SAMHSA, 2022c). M... | {
"Header 1": "**19.2 Alcohol Use Disorder**",
"Header 3": "**Diagnosis and Definition of Alcohol Use Disorder**",
"token_count": 1363,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Alcohol Use among the Asian Community
Genetics are a component of alcohol use disorder (AUD). Genetics influence a person's risk of developing AUD. Some individuals of Asian descent are affected by a gene variant that changes their ability to metabolize alcohol. When they drink, they have flushing, nausea, and a... | {
"Header 1": "CULTURAL CONTEXT",
"token_count": 2032,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The nurse has the client sit in a chair with their feet flat on the floor, then takes and records vital signs. The nurse proceeds to go down the form's checklist choosing answers on a Likert scale based on the scale's directions to either observe symptoms or ask the client a question about certain symptoms. The CIWA-Ar... | {
"Header 1": "CULTURAL CONTEXT",
"token_count": 989,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Considering that only one in six people ever talks to their health-care professional about their drinking, nurses need to know how to start the conversation; after all, this important step can reduce drinking by 25 percent (CDC, 2020). Nurses and other health-care professionals must collaborate to help these clients. ... | {
"Header 1": "CULTURAL CONTEXT",
"Header 3": "**Planning Nursing Care for a Client with Alcohol Use Disorder**",
"token_count": 485,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The CDC (2017) produced this [one-minute public service announcement](https://openstax.org/r/77AlcoholPSA) (https://openstax.org/r/77AlcoholPSA) to share the importance of screening and counseling clients on alcohol use.
#### **Overcoming Risks of Developing AUD**
Many factors influence the development of substance... | {
"Header 1": "LINK TO LEARNING",
"token_count": 266,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Identify stimulants that can be misused
- Describe the symptoms of stimulant use disorder
- Outline the role of the nurse in treating stimulant use disorder
Amphetamine-type substances, cocaine, and crack are **stimulants**; they caus... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**19.3 Stimulant Use Disorders**",
"token_count": 225,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Legal stimulants are most commonly prescribed to address attention-deficit hyperactivity disorder (ADHD) and include the medications Ritalin and Adderall, among others (NIDA, 2020a). These medications enhance cognition and focus in clients with ADHD. When used by a person who does not have ADHD, these substances can be... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Stimulants That Can Be Misused**",
"token_count": 209,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Nonmedical Prescription Stimulant (NMPS) Use among College Students
Increased academic performance is the number one reason for college students obtaining and misusing prescription stimulants, such as Adderall and Ritalin. Fairman et al. (2020) report that 45.7 percent of 219 students responding used a NMPS with... | {
"Header 1": "LIFE-STAGE CONTEXT",
"token_count": 1122,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**Nurse:** Shannan **Years in Practice:** Sixteen **Clinical Setting:** ER **Geographic Location:** Unknown
In From Impaired to Inspired: One Nurse's Story of Addiction and Recovery (2018), Shannan F. shares her story of recovery. She and her husband met when she was eighteen, married when she was twenty-two, and had... | {
"Header 1": "REAL RN STORIES",
"token_count": 1292,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Define opioid use disorder
- Outline methods used to treat opioid use disorder
From 1999 to 2021, over 600,000 people died in the United States from an overdose involving prescription or illicit opioids (CDC, 2023). This rise in opioi... | {
"Header 1": "REAL RN STORIES",
"Header 3": "**19.4 Opioid Use Disorder**",
"token_count": 1142,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Take Action: Administering Naloxone
After recognizing the signs of opioid overdose, there are five steps nurses and other health-care providers should take:
- 1. Obtain emergency assistance—when in a facility, gather team members, and, if not in a facility, call 911.
- 2. Provide rescue breathing, chest compre... | {
"Header 1": "REAL RN STORIES",
"Header 3": "CLINICAL JUDGMENT MEASUREMENT MODEL",
"token_count": 430,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
There are several approaches to treating opioid use disorder. These methods include outpatient counseling, intensive outpatient treatment, short-term residential treatment, long-term therapeutic communities (sober living), and medication-assisted treatment (MAT) (Cleveland Clinic, 2022b). The most effective treatment c... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Approaches to Treating Opioid Use Disorder**",
"token_count": 813,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Outline the approaches used to treat addiction
- Recall the principles used to treat an overdose
- Review management of a client who is in withdrawal
- Plan collaborative care for a client who has an addiction
Substance use disorder t... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**19.5 Dealing with Addiction**",
"token_count": 218,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Culturally Sensitive Prevention Programs for Substance Use among Adolescents of Color This systematic review analyzed substance use prevention programs for adolescents of color in the United States. The study found that when culturally sensitive assessment addressed factors specific to certain populations and communiti... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"token_count": 460,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
SAMHSA has developed a short booklet called "Faces of Change. Do I have a Problem with Alcohol or Drugs?" It covers the case studies [\(https://openstax.org/r/77alcdrugprob\)](https://openstax.org/r/77alcdrugprob) of five people who have problems with either drugs or alcohol.
#### **Steps for Quitting Addiction**
A... | {
"Header 1": "LINK TO LEARNING",
"token_count": 849,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Substance Misuse: Part 3
See [Substance Misuse: Part 2](#page-646-0) for a review of the client data.
| Nursing<br>Notes | 1445 Ongoing Assessment<br>The client is seen in her bedroom, lying on her bed. She appears to be more relaxed. Currently,<br>you repeat her vitals. She reports f... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "UNFOLDING CASE STUDY",
"token_count": 2034,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### QSEN Competency: Teamwork and Collaboration
One part of working with clients who are withdrawing from substance use is teaching them about relapse prevention. During this interaction, the nurse will:
- treat clients holistically with no judgment toward their substance use
- discuss the danger of using again at... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"token_count": 1249,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **[19.1](#page-631-0) [Substance Use Disorders](#page-631-0)**
Chronic substance use disorders significantly impact individuals, families, communities, and society. Misuse of alcohol, drugs, and prescribed medications is estimated to cost the United States more than \$400 billion in healthcare expenses (SAMHSA &... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Summary**",
"token_count": 1135,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**addiction** associated with compulsive or uncontrolled use of one or more substances
**alcohol intoxication** refers to problematic behavioral or psychological changes that develop during or shortly after alcohol ingestion
**alcohol use disorder (AUD)** chronic medical condition that is categorized by difficulty ... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Key Terms**",
"token_count": 650,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**FIGURE 20.1** Neuroimaging can be an important part of a psychological diagnosis. (credit: "National Nurses Week: Capt. Stephanie Smiddy" by Staff Sgt. Shane Hughes/Air Force Medical Service, Public Domain)
#### **CHAPTER OUTLINE**
20.1 [Psychological, Social, and Physiological Fac... | {
"Header 1": "CHAPTER 20 Eating Disorders",
"token_count": 428,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Discuss psychological factors associated with eating disorders
- Discuss social factors associated with eating disorders
- Relate physiological, hereditary, and environmental factors to the development of eating disorders
- Determine nu... | {
"Header 1": "**20.1 Psychological, Social, and Physiological Factors**",
"token_count": 319,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Statistics around Eating Disorders
The National Eating Disorders Association has published [statistics on eating disorders](https://openstax.org/r/77eatngdisorder) (https://openstax.org/r/ [77eatngdisorder\)](https://openstax.org/r/77eatngdisorder) across all genders and groups, military, students, and athletes,... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"token_count": 204,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Studies reveal that psychological factors, such as having a history of anxiety disorder, can increase an individual's chance of developing an eating disorder (NEDA, 2023a). Other psychological factors—displeasure with body image and behavioral rigidity, meaning that the person may have habits that are inflexible, compu... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "**Psychological Factors**",
"token_count": 880,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The USDA offers [tips and resources to help people learn how to eat healthy](https://openstax.org/r/77healthyeating) (https://openstax.org/r/77healthyeating) in its MyPlate campaign. Users can personalize it to create a healthy eating plan.
#### **Biological and Genetic Factors**
There are several biological factor... | {
"Header 1": "LINK TO LEARNING",
"token_count": 1663,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- List risk factors associated with and etiology of anorexia nervosa
- Plan nursing care for clients in treatment for anorexia nervosa
- Discuss nursing implications for the therapeutic relationship and milieu management in care of client... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**20.2 Anorexia Nervosa**",
"token_count": 1378,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Anorexia Nervosa in Persons Assigned Male at Birth
Eating disorders are one of the most gendered mental health disorders, so eating disorders in persons assigned male at birth (AMAB) were not recognized until recently (Gorrell & Murray, 2019). Anorexia nervosa has a lifetime prevalence in persons AMAB of 0.1 to ... | {
"Header 1": "CULTURAL CONTEXT",
"token_count": 805,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Clinical Judgment Measurement Model Sample Care Plan for a Client with Anorexia Nervosa
This sample care plan uses the steps of the CJMM.
| CJMM Step | Notes |
|------------------|------------------... | {
"Header 1": "CULTURAL CONTEXT",
"Header 3": "CLINICAL JUDGMENT MEASUREMENT MODEL",
"token_count": 1582,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The American Psychiatric Association provides [clinical practice guidelines, screening tools, and a toolkit](https://openstax.org/r/77APAeating) [\(https://openstax.org/r/77APAeating\)](https://openstax.org/r/77APAeating) that can be used to assess eating disorders.
#### **Therapeutic Relationship**
Establishing a ... | {
"Header 1": "LINK TO LEARNING",
"token_count": 977,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Differentiate between anorexia nervosa and avoidant/restrictive food intake disorder
- Plan nursing care for clients in treatment for avoidant/restrictive food intake disorder
Formery known as feeding disorder of infancy and childhood... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**20.3 Avoidant/Restrictive Food Intake Disorder**",
"token_count": 851,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Nurses play an important role in caring for clients with ARFID, including obtaining a thorough history from clients who present with symptoms of ARFID. Questions related to eating habits, food aversions, and history of traumatic experiences related to food should take place along with an assessment of nutritional statu... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Nursing Care**",
"token_count": 836,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
This [webinar discusses cognitive behavioral therapy](https://openstax.org/r/77ARFIDinfo) (https://openstax.org/r/77ARFIDinfo) used for ARFID. It describes its uses for clients ages ten to older adults and clinical practice information along with ongoing treatment of ARFID.
#### **Dialectal Behavior Therapy**
DBT c... | {
"Header 1": "LINK TO LEARNING",
"token_count": 261,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
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