Exam 1 Flashcards
What is Paranoid Personality Disorder and what are some manifestations?
A longstanding distrust and suspiciousness of others based on a belief that is unsupported by evidence that others want to harm them.
Social anxiety in childhood, jealous and controlling as adults, unwillingness to forgive and projection of feelings onto others
What are some nursing guidelines for Paranoid personality disorder?
Counteract mistrust by adhering to schedules, avoid being overly friendly, be neutral, therapy, anti anxiety, and antipsychotics
What is Schizoid personality disorder?
Lifelong pattern of social withdrawal and expressionless, restricted range of emotional expression.
What are some manifestations of schizoid personality disorder?
Loners, poor academic performance, disordered family life, avoidance of close relationships, depersonalization and detachment
What are some things the nurse should do with a schizoid personality pt and what are some treatment options?
Avoid being too nice, don’t try to increase socialization, protect against group ridicule.
Psychotherapy and antidepressants
What are some characteristics of schizotypal personality disorder?
Severe social and interpersonal deficits, anxiety in social situations, rambling in conversation, paranoia, suspiciousness, anxiety, distrust, brief episodes of hallucinations or delusions, can be made aware of own odd beliefs, may be vulnerable to cults
What are some nursing guidelines for schizotypal personality disorder?
Respect pt’s need for social isolation, monitor/intervene with pt’s suspiciousness, monitor for suicidal ideation, withhold judgement or ridicule
What are some characteristics of histrionic personality disorder?
Excitable, dramatic, often high functioning, bold behaviors, limited ability to form good relationships, attention seeking, self centered, excessive emotions
What are some nursing guidelines for histrionic personality disorder?
Know that seductive behaviors are a response to distress, be professional, ignore flirtations, pt may exaggerate symptoms, model concrete language, role model assertiveness, monitor for suicidal ideation, help pt identify feelings
What are characteristics of narcissistic personality disorder?
Feelings of entitlement, an exaggerated belief in one’s own importance, and a lack of empathy.
Tendency to exploit others, weak self esteem, hypersensitive to criticism, constant need for admiration, less functional impairment than other disorders
What are some nursing guidelines for caring for a pt with narcissistic personality disorder?
Remain neutral, avoid power struggles or becoming defensive, role model empathy.
Treat w/ CBT, group therapy, and lithium
What is antisocial personality disorder and some characteristics?
A pattern of disregard for, and violation of the rights of others; may be called a sociopath.
Antagonistic behaviors, disinhibited behaviors, profound lack of empathy, absence of remorse or guilt
What are some pt problems for antisocial personality disorder?
Tendency to be dishonest
Other directed violence
Defensive coping
Impaired social interaction
Ineffective health maintenance
What are some desired outcomes for a pt with antisocial personality disorder?
Restraining abusive behavior and aggression towards others
Coping, social interaction, and social isolation knowledge
Health promoting knowledge and behavior
What are some things the nurse should implement with a pt with antisocial personality disorder?
Boundaries, consistency, support, limits, realistic choices, teamwork, safety, therapeutic communication, mood stabilizers
What are some characteristics of borderline personality disorder?
Severe impairments in functioning, emotional liability, impulsivity, self destructive behaviors, antagonism, splitting
What are some patient problems for pts with borderline personality disorders?
Self mutilation, risk for suicide, risk for violence towards others, impaired social interaction, disturbed personal identity, ineffective coping
What are some things the nurse should implement for a pt with borderline personality disorder?
Provide clear and consistent boundaries, use clear and straightforward communication, calmly review goals, teamwork, safety, respond matter of factly to self injuries
What are some characteristics of avoidant personality disorder?
Extremely sensitive to rejection feeling inadequate, socially inhibited, avoids interpersonal contact in fear of rejection, low self esteem, shyness, feeling inferior, reluctance to engage with new people
What are some guidelines for nursing care for pts with avoidant personality disorder?
Use a friendly, accepting, and reassuring approach, accept pts fears, exercises to enhance new social skills, exercises to prevent failures, assertiveness training
What are some characteristics of dependent personality disorder?
High need to be taken care of, submissiveness, fears of separation and abandonment, manipulates others to take responsibilities, intense anxiety when left alone
What are some guidelines for nursing care for pts with dependent personality disorder?
Help address stressors, set limits that don’t make pt feel punished, be aware of strong Countertransference, use therapeutic relationship as testing ground for assertiveness training
What are some characteristics of obsessive compulsive personality disorder?
Limited emotional expression, stubbornness, perseverance, indecisiveness, preoccupied with orderliness, perfectionism, and control. Rigidity, inflexible standards, constant rehearsal, excessive goal seeking, unhealthy focus on perfection
What are some nursing guidelines for pts with OCD?
Guard against power struggles and remember the pt has difficulty dealing with unexpected changes
What are some risk factors for personality disorders?
Genetics, neurobiological, psychological, environmental, diathesis stress model
What is anorexia nervosa?
Persistent energy intake restriction leading to significantly low body weight in fear of gaining weight or becoming fat.
2 types: restricting type and binging/purging type
What is bulimia nervosa?
Large quantities of food is consumed over a short period of time followed by self induced vomiting, laxatives, diuretics, or enemas (purging type) or excessive exercise (non purging type).
What is binge eating disorder?
Large quantities of food is consumed over a short period of time without compensatory behaviors. Excessive food consumption is due to a sense of lack of control.
What are risk factors for eating disorders?
Women, adolescence to young adulthood, stressful life events, jobs that encourage thinness, history of being a picky eater, athletes, history of obesity, family genetics, biological, close relationships, psychological influences, environmental, temperamental
What are some basic assessments that can be made for a pt with an eating disorder?
Eating habits, history of dieting, methods of achieving weight goal, values attached to weight, high interest in preparing foods but not eating, fear of gaining weight, perception of being extremely overweight, low self esteem, need for intense exercise, guilt or shame of eating behavior
What vitals sign and weight would a nurse see in a pt with an eating disorder?
Low BP w/ possible orthostatic hypotension
Hypertension in binge eaters
Decreased pulse and temp
Anorexia nervosa=weight is 85% less than normal
Bulimia= normal weight/ slightly higher
Binge eating= overweight/obese
What are some skin and musculoskeletal assessments the nurse might make for an eating disorder pt?
Lanugo in anorexia, yellowed skin, cool extremities, poor skin turgor, calluses or scars on hands on bulimic pts
Muscle weakness, decreased energy, and loss of bone density
What are some other assessments the nurse might make for a pt with an eating disorder?
Enlarged parotid glands in bulimia, dental erosions if purging, irregular heart rate, peripheral edema, cyanosis, constipation from dehydration, diarrhea from laxative abuse, abdominal pain, esophageal tears and gastric ruptures in bulimia, amenorrhea in anorexia, social withdrawal, irritability, insomnia
What is the criteria for treatment for an eating disorder?
Rapid weight loss or weight loss greater than 30% of body weight over 6 months, unsuccessful weight gain in outpatient treatment, heart rate less than 40, SBP less than 70, body temp less than 96.8 degrees, ECG changes, electrolyte disturbances, psychiatric criteria
What are some important nursing care guidelines to implement for eating disorders?
Provide a structured environment, create a trusting relationship, promote self esteem and positive self image, encourage participation for sense of control, establish realistic goals for weight (2-3lb/wk), reward positive behaviors, monitor pt before/after meals, allow appropriate exercise, provide small frequent meals, consult dietitian
What are some common lab abnormalities associated with anorexia nervosa?
Hypokalemia, anemia, leukopenia with lymphocytosis, thrombocytopenia, impaired liver function, hypoalbuminemia, elevated cholesterol, elevated BUN, abnormal thyroid, decreased bone density, abnormal glucose levels, ECG changes, metabolic alkalosis from vomiting, metabolic acidosis from laxatives
What are some lab abnormalities from bulimia nervosa?
Electrolytes imbalances depending on type of purging: hypokalemia, hyponatremia, hypochloremia, hypomagnesemia
What are standardized screening tools for eating disorders?
Eating disorder inventory, body attitude test, diagnostic survey for eating disorders, eating attitudes test
What are possible complications of eating disorders?
Reseeding syndrome: when fluid, electrolytes, and carbohydrates are introduced to a severely malnourished pt
Cardiac dysrhythmias, severe bradycardia, and hypotension
What is bipolar 1 disorder?
Most severe form, highest mortality rate of 3, at least 1 manic episode, possibly alternating with episodes of depression
What is bipolar 2 disorder?
At least 1 hypomanic episode and at least 1 major depressive episode
What is cyclothymic disorder?
At least 2 years of repeated hypomanic manifestations that do not meet criteria for hypomanic episodes alternating with minor depressive episodes for adults (1 year for children)
What are some speech pattern and thought content assessments a nurse might find with a pt who has bipolar disorder?
Pressured speech, circumstantial speech, tangential speech, loose associations, flight of ideas, clang associations
Grandiose delusions and persecutory delusions
What are some expected findings for a pt with mania?
Labile mood with euphoria, agitation, irritability, restlessness, flight of ideas, grandiose views of self and abilities, impulsive, demanding, manipulating, poor judgement, attention seeking, neglect of ADLs, delusions, and hallucinations
What are some expected findings for a pt experiencing a depressive episode associated with bipolar disorder?
Flat, blunted, labile effect, tearfulness, lack of energy, anhedonia, physical discomfort, difficulty concentrating, self destructive behavior, decrease in personal hygiene, loss of appetite and sleep
What are some nursing care guidelines for pts in acute mania?
Managing medications, decreasing physical activity, increasing food and fluid intake, ensuring at least 4-6 hrs of sleep per night, meeting self care needs
What is the most common medication used to treat bipolar disorder and what does it do?
Lithium: lessens agitation and stabilizes mood
Also decreases hallucinations, grandiose actions, impulsivity, irritability,flight of ideas, and insomnia, and increases sexuality
What is the therapeutic level for lithium and how do we test to get to maintain that level?
Therapeutic level: 0.8- 1.4
Measure blood levels every 5 days after starting or after dosage change until therapeutic range is met, then every month for 6-12 months then every 3 months
What are some classic symptoms of psychosis?
Delusion, hallucinations, disorganized thinking, abnormal motor behavior, negative symptoms (blunting, dissociating, etc.)
What are some risk factors for psychosis?
Preexisting personality disorder, substance abuse, complications associated with pregnancy and birth, genetic variations, psychological factors such as sleep deprivation
What are some consequences of psychosis?
Neural circuit degradation, side effects of meds, comorbidity w/ substance abuse, problems w/ ADLs, cognitive dysfunction, impaired personal, social, or occupational function
What is the criteria for a diagnosis of schizophrenia?
Two or more of the following for a significant portion of time in 1 month:
Delusions, hallucinations, disorganized speech, gross disorganizations, negative symptoms, or functional impairments of some kind
OR or has continuous disturbances for at least 6 months
What are the normal ranges for the 4 main electrolytes?
Sodium: 135-145
Potassium: 3.5- 5.0
Calcium: 9-11
Magnesium: 1.5-2.5
What are some risk factors for hypo and hyper natremia?
Hypo: excessive sweating, diuretics, vomiting, diarrhea, wound drainage, NG suction, inadequate sodium intake, kidney disease, HF, liver cirrhosis
Hyper: NPO, heat stroke, hyperventilation, fever, burns, respiratory infection, excess IV fluids and intake of sodium
What are some symptoms of hypo vs hyper natremia?
Hypo: headache, muscle twitching, hyperreflexia, tremors, confusion, lethargy, anxiety, decreased LOC, seizures, n/v, diarrhea
Hyper: thirst, dry mucus membranes, red, swollen tongue, hot, dry skin, flushing, restlessness, irritability, weakness, intracranial bleeding
What are some risk factors for hypo vs hyper kalemia?
Hypo: overuse of potassium wasting diuretics or corticosteroids, aldosterone excess, vomiting, diarrhea, alkalosis, excessive sweating
Hyper: burns, crush injuries, kidney disease, potassium sparing diuretics, insulin deficit, chemo, acidosis
What are some symptoms of hypo vs hyper kalemia?
Hypo: weak, irregular pulse, fatigue, urinary retention, confusion, leg cramps
Hyper: slow, irregular pulse, hypotension, irritability, weakness to point of paralysis, absence of reflexes, heart block
What are some risk factors for hypo vs hyper calcium?
Hypo: diarrhea, chrons disease, vitamin D deficiency, hypoparathyroidism
Hyper: thiazide diuretics, hyperparathyroidism, bone cancer, Paget’s disease, immobility, hyperthyroidism, long term glucocorticoid use
What are some symptoms of hypo vs hyper calcium?
Hypo: numbness, tingling, frequent, painful muscle spasms at rest, hyperactive reflexes, positive chvosteks sign, positive trousseau’s sign, weak trendy pulse, cardiac dysrhythmias, seizures
Hyper: decreased reflexes, bone pain, flank pain, increased risk for blood clot, anorexia, n/v, constipation, confusion, decreased LOC
What are some risk factors of hypo vs hyper magnesium?
Hypo: diarrhea, NG suction, thiazide or loop diuretics, malnutrition, alcohol use, laxatives
Hyper: kidney disease or injury, laxatives or antacids containing magnesium
What are some symptoms of hypo vs hyper magnesium?
Hypo: increased nerve impulse transmission, positive Chvostek’s and trousseau’s sign, seizures, hypoacitve bowel sounds, constipation, abdominal distinction, tachycardia, hypertension
Hyper: decreased reflexes, muscle paralysis, shallow respirations, decreased RR, bradycardia, hypotension, cardiac arrest, lethargy
What are the normal ranges for pH, PaCO2, HCO3, and PaO2?
pH: 7.35- 7.45
PaCO2: 35-45
HCO3: 21-28
PaO2: 80-100
What is our first line of defense for acid-base balance and what does it do?
Bicarbonate: is a buffer that can act as a acid or a base; retained when body is too acidic, excreted when body is too alkalolatic
What is our 2nd line of defense for acid-base balance and what does it do?
Lungs: excretes carbonic acid in form of carbon dioxide and water.
Hyperventilates when body is too acidic
Hypoventilates when body is too basic
What is our 3rd line of defense for acid-base balance and what do they do?
Kidneys: controls the movement of bicarbonate in urine.
High pH: reabsorption of bicarbonate
Low pH: excretes bicarbonate
What are the consequences of acid-base imbalances?
Altered cell function, especially in brain
Change in intracellular enzyme activity resulting in cell dysfunction
Acidosis: decreases the LOC
Alkalosis: decreases LOC and has other neurological manifestations, may cause dysrhythmias
What are some risk factors for respiratory acidosis and some symptoms?
Risks: respiratory depression, brain injury/tumor, stroke, airway obstruction, PE, asthma, COPD, pneumonia- anything that inhibits adequate ventilation
Symptoms: initial tachycardia and hypertension, anxiety, irritability, confusion, shallow rapid breathing, flushed skin, cardiac dysrhythmias
What are some risk factors for respiratory alkalosis and some symptoms?
Risks: hyperventilation from fever, infections, anxiety, trauma, excessive mechanical ventilation
Hypoxemia
Symptoms: tachypnea, tachycardia, inability to concentrate, tremors, blurry vision, loss of consciousness, palpitations, deep respirations, SOB, chest tightness
What are some risk factors and symptoms of metabolic acidosis?
Risks: diabetic ketoacidosis, starvation, hyperkalemia, lactic acidosis, excessive intake of alcohol or aspirin, kidney disease, liver failure, diarrhea
Symptoms: dysrhythmias, tachycardia, weak peripheral pulses, hypotension, tachypnea, headache, lethargy, confusion, decreased LOC, rapid and deep respirations, n/v
What are some risk factors and symptoms of metabolic alkalosis?
Risks: excess base, hypokalemia, excess intake of antacids, blood transfusions, prolonged vomiting, NG suction, potassium depletion
Symptoms: tachycardia, hypotension, bradypnea, hyperreflexia, dizziness, confusion, muscle twitching, convulsions, shallow respirations, cyanosis
