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NURS 363 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Criteria 1 for Personality Disorders

A

Significant impairment in self or interpersonal functions

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2
Q

Criteria 2 for Personality Disorders

A

One or more pathological personality traits

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3
Q

Criteria 3 for Personality Disorders

A

Impairments are stable over time/across situations

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4
Q

Criteria 4 for Personality Disorders

A

Personality traits or trait expressions are not normative for developmental stage or cultural environment

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5
Q

Criteria 5 for DSM V Personality Disoders

A

Not due to use of a substance of medical condition

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6
Q

Personality

A

complex pattern of characteristics, largely outside of the person’s awareness, which compromise the individual’s distinctive pattern of perceiving, feeling, thinking, coping, and behaving
OVERARCHING PATTERN*

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7
Q

personality traits

A

prominent aspects of personality that are exhibited in a wide range of social and personal contexts
–more specific aspects of someone’s personality

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8
Q

Cluster A

A

1) paranoid personality disorder
2) schizoid personality disorder
3) schiotypal personality disorder

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9
Q

DSM V and Personality Disorders criteria

A

1) significant impairment to one’s self or interpersonal functions
2) one or more pathological impairments
3) impairments stable over time/ across situations
4) personality traits or trait expression are not normative for developmental stage or cultural enviornment
5) not due to use of substance or medical condition

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10
Q

Paranoid personality disorder definition

A

o A pervasive distrust and suspiciousness of others such that others’ motives are interpreted as malevolent
o Quick to take offense – don’t have insight
• Do not acknowledge their negative feelings
• Project negative feelings on others, look for hidden meanings in conversations
o Paranoid flare within their interactions
o Not psychosis but not a significant enough level of paranoia
• Condition begins by early adulthood and presents in a variety of contexts

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11
Q

Paranoid personality disorder clinical manifestations

A

o Constantly on guard
o Hyper vigilant, guarded, oversensitive to surroundings and interactions
o Ready for any real or imagined threat mistrusts and misinterprets cues
o Magnifies and distorts environmental cues
o Trusts no one – has few if any friends
o Constantly tests the honesty of others
o Do not lose contact with reality  do not have sx of psychosis

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12
Q

Paranoid personality disorder predisposing factors

A

o Possibly hereditary link

o Subjected to early parental antagonism and harassment

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13
Q

Schizoid personality disorder

A

o Show indifference to social and personal relationships
o Characterized primarily by a profound defect in the ability to form personal relationships
o Failure to respond to others in a meaningful, emotional way
o Flattened affectivity, cold, unsociable, seclusive demeanor

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14
Q

schizoid personality disorder clinical manifestations

A

o Indifferent to others and environment
o Client is aloof, withdraws from social events
o Client is emotionally cold, flat affect
o In the presence of others, clients appear shy, anxious, or uneasy
o Inappropriately serious about everything and has difficulty acting in a light-hearted manner

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15
Q

schizoid personality disorder predisposing factors

A

o Possible hereditary factor

o Childhood has been characterized as: bleak, cold, unempathetic, notably lacking in nurturing

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16
Q

schizotypal personality disorder

A

o Displays an enduring and pervasive pattern within interpersonal relationships
o Interpersonal deficits with extreme discomfort and intolerance for close relationships
• Thought patterns are disturbed with odd behaviors
o A graver form of the pathologically of the less severe schizoid personality pattern

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17
Q

schizotypal personality disorder clinical manifestations

A

o Exhibits bizarre speech pattern
o Aloof, isolative, inappropriate affect, social anxiety
o When under stress, may decompensate and demonstrate psychotic sx
o Demonstrates bland and apathetic manners
o Everyday world manifests with magical thinking and ideas of reference
o Delusions, depersonalization

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18
Q

schizotypal personality disorder predisposing factors

A

o Possible hereditary factor
o Possible physiological influence such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain (dysregulation of dopaminergic pathways)

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19
Q

Antisocial Personality Disorders

A

o Aggressive and irresponsible behaviors, superficially charming, lack genuine warmth
o Motive of something that they are trying to obtain

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20
Q

Antisocial Personality Disorders clinical manifestations

A

—> difficult time functioning in society
o Fails to sustain consistent employment
o Exploits and manipulates others for personal gain
o Cold, callous, intimidating
o Inconsistent work or academic performance
o Failure to conform to societal norms – cannot control impulses
o Cruel and malicious
o Inability to form lasting monogamous relationship
o Low levels of behavioral inhibitions
o Very difficult diagnose and treat
o Lack fear, decision-making

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21
Q

Antisocial Personality Disorders Predisposing Factors

A

o Possible genetic influence
o Sociopathic or alcoholic mother / father
o Aggressive temperament as a child
o Parental deprivation during the first 5 years of life
o History of ADHD or conduct disorder during childhood or adolescence
o Absence of parental discipline or influence
o Erratic and inconsistent methods
o Extreme poverty
o Removal from the home
o Being “rescued” each time they are in trouble (never having to suffer the consequences of their own behavior)
o Maternal / Paternal deprivation

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22
Q

Borderline Personality Disorder

A

o Characterized by a pattern of intense and chaotic relationships with affective instability
o Have fluctuating and extreme attitudes and moods regarding other people
o View life experiences and relationships to the extremes of either very good or very bad (splitting)
o View themselves as victims
o Highly impulsive with mood swings, depression, anger or anxiety
 If feelings of being ignored  can self-mutilate, self-harm, become aggressive for attention or numb emotions
 Many times have ongoing suicidal thoughts
 Manipulative element

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23
Q

Borderline Personality Disorders Clinical Manifestations

A
  • Intense & unstable affect and behavior ***
  • Always seem to be in a state of crisis  life is a “soap opera”
  • Self-destructive behaviors
  • Affect is of extreme intensity
  • Common behaviors:
    • Depression
    • Inability to be alone
    • Fear of abandonment
    • Attention-seeking behaviors
    • Clinging/distancing behavior
    • Splitting **
    • Dichotomous thinking ***
    • Manipulation
    • Dissociation
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24
Q

Psychoanalytical

A

emphasize importance of nurturing from immediate caregivers and loved ones for fostering positive personality traits

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25
Q

Biological

A

stress influence of genetic transmission combined with environmental exposures for the formation of personality

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26
Q

Social

A

people acquire personality characteristics through thought and interaction with their environment

27
Q

Lithium Toxicity <1.5

A

lethargy, slurred speech, muscle weakness, hand tremors, nausea, vomiting, diarrhea

28
Q

Lithium Toxicity 1.5-2

A

– coarse hand tremor, mental confusion, drowsiness, lack of coordination, GI distress, EKG changes

29
Q

Lithium Toxicity 2-2.5

A

ataxia, blurred vision, stupor, coma, respiratory failure

30
Q

Lithium Toxicity > 2.5

A

life threatening

31
Q

Selective Serotonin Reuptake Inhibitors

A

inhibit the reuptake of sertonin by blocking its transport into the presynaptic neuron, thus increasing the concentration of serotonin

32
Q

SSRIs Side effects

A

1) Headache
2) Transient Nause and Dizziness
3) Insomnia
4) Increased perspiration
5) diastolic hypertension
6) sexual dysfunction
7) sedation
8) anxiety
9) V/D

33
Q

SNRIs

A

prevent reuptake of both serotonin and norepi

34
Q

SNRIs side effects

A

same of SSRIs with risk of increased blood pressure

35
Q

NDRIs

A

-Bupropion (Wellbutrin, Zyban)

inhibit the reuptake of norepi, serotonin, and dopamine

36
Q

NDRIs SE

A

1) Agitation
2) Anxiety
3) Appetite suppression–> can lead to weight loss
4) insomnia
5) psychosis
6) **INCREASE SEIZURES BY LOWERING THRESHOLD SO VERIFY SEIZURE HISTORY

37
Q

A2 ANTAGONIST (NaSSA)

A

boosts norepi/ noradrenaliene and serotonin by blocking a2- adregneric presynaptic receptors on a serotonin receptors

38
Q

a2 antagonists side effects

A

1) Sedation (at lower doses)
2) Dizziness
3) Weight gain
4) Dry mouth
5) Constipation
6) Change in urinary function

39
Q

serotonin-2 antagonist/ reuptake inhibitor (SARI)

ex) trazadone

A

blocks serotonin 2A receptor potently and blocks the serotonin reuptake pump less potently

40
Q

SARI side effects

A

1) Sedation
2) Weight gain
3) Dizziness
4) N/V
5) Constipation
6) Fatigue
7) Incoordination
8) Tremor

41
Q

Serotonin Syndrome

A

can occur if there is an overactivity of serotonin sites or an impairment of serotonin metabolism
– Medical emergency!!!
– Can occur with concurrent use of other drugs that increase serotonin
• Signs/symptoms:
– Mental status changes – hallucinations, agitation and coma
– Autonomic instability – tachycardia, hyperthermia, changes in BP
– Neuromuscular problems – hyperreflexia, incoordination
– GI disturbances – NVD
• Can be life-threatening
• Under medical supervision  discontinue the medication

42
Q

Patient teachings for SSRIs and SNRIs

A
  • effects generally not seen for 10-21 days so educate patients that relief may not be immediate but will be experienced
  • do not discontinue medications prematurely
  • skipping a dose may cause withdrawal symptoms
  • low- to medium dose may cause sexual side effects
43
Q

TCA uses

A

1) early morning wakening
2) weight loss
3) panic disorders
4) compulsive disorders

44
Q

SSRI’s may increase the effects of

A

** St. John’s Wort

45
Q

SSRIs may decrease the effect of

A

Buspirone and Digoxin

46
Q

Important info about TCAs

A
  • just as effective as SSRI’s with treating depression but lead to more serious side effects and a higher lethal potential**
  • if given to elderly, dosages need to be 1/2 of normal adult
  • alcohol conjunction with TCA will cause sedation and ataxia
  • *******suicidal clients cannot take TCAS because of fatal cardiac and cerebral toxicity in overdose
47
Q

most common side effects of TCAs

A

1) sedation
2) hypotension
3) anticholinergic effects

48
Q

other side effects of TCAS

A 
	Headache
	N/V
	Restlessness 
	Tremors
	Insomnia
	Confusion
	Pedal edema
	Seizures
	Blood dyscrasias
49
Q

drugs that increase the effects of tricyclics

A

1) bupropion
2) cimetidine
3) haloperidol
4) SSRIs
5) Valproic acid

50
Q

drugs that decrease the effects of tricyclics

A

1) rifamycin
2) carbamzepine
3) barbs

51
Q

Nursing considerations for TCAs

A

1) hypertensive crisis, convulsants, an death can occur with MAO inhibitors
2) hypertensive crisis can occur with clonidine
3) TCAs decrease the effects of levodopa and guanethidine

52
Q

Kava

A

– Uses: anxiety reduction
– Action: interacts with dopaminergic transmission, inhibits the MAO-B enzyme system, and modulates the GABA receptor
– Risks: severe liver injury, thrombocytopenia, leukopenia, and hearing impairment

53
Q

Side effects of MAOIs

A 
–	Dizziness
–	Headache
–	Nausea
–	Insomnia
–	Dry mouth
–	Blurred vision
–	Constipation
–	Peripheral edema
–	Urinary hesitancy
–	Muscle weakness
–	Forgetfulness
–	Weight gain
–	Sexual dysfunction
54
Q

Tyramine

A

main problem in MAOIs

- it’s a vasopressor that induces hypertension

55
Q

Hypertensive crisis signs and symptoms

A

1) increased HR
2) severe headache
3) excessive perspiration
4) lightheadedness
5) vomiting

56
Q

Signs and symptoms of PTSD

A

1) generalized anxiety
2) intrusive thoughts
3) flashbacks
4) nightmares
5) sleep disturbances
6) need to avoid triggers
AFTER 3 MONTHS–> CONSIDERED TO BE CHRONIC

57
Q

goals for treating anxiety disorders

A
  • Is able to recognize signs of escalating anxiety
  • Is able to intervene so that anxiety does not reach level of panic
  • Is able to discuss long-term plan to prevent panic anxiety when stressful situations occur
  • Practices techniques of relaxation daily
  • Engages in physical exercise three times a week
58
Q

Outcomes for Anxiety disorder treatment

A

1) the client will report a decrease in aggressive behaviors and a decrease in the intensity of anxiety
2) the client will report the effective use of coping strategies to deal with symptoms of anxiety
3) the client will demonstrate breathing techniques to control anxiety and hyperventilation

59
Q

Generalized Anxiety disorder

A
  • Chronic, unrealistic and excessive anxiety and worry for at least 6 months
  • Anxiety does not usually pertain to a specific situation – concerns several real-life activities or events
  • So much worry and anxiety causes interference with ADL’s and relationships
  • Persistent and chronic s/sx of:
  • Muscle tension
  • Autonomic hyperactivity
  • Apprehension
  • Feeling “on edge” – sense of uneasiness and fear of imminent disaster
  • Can lead to  inability to concentrate, chronic fatigue, impaired sleeping patterns, depression
60
Q

signs and symptoms of Withdrawal Delirium Tremens (DT’s)

A
  • Autonomic hyperarousal
  • Disorientation and clouding or changes in LOC
  • Visual or tactile hallucinations
  • Lability  hyper-excitability to lethargy
  • Paranoid delusions, agitation
  • Risk for grand mal seizures**– occurs within first 48 hours if going to occur
61
Q

Desired effects of marijuana

A

1) euphoria
2) relaxation
3) detachment

62
Q

Other effects of marijuana

A

talkativeness, heightened sensitivity, anxiety, paranoia, slowed perception of time, inappropriate hilarity

63
Q

long term effects of marijuana

A

1) memory impairment
2) anhedonia
3) difficulty concentrating
4) loss of memory

NURS 363 (3 decks)

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