Test 3 Flashcards
1
Q
Define at least two characteristics of personality disorders
A
- Involve long term and repetitive use of maladaptive and self defeating behaviors
- People with PD do not recognize their symptoms are uncomfortable; thus they do not seek treatment
- Inflexible and maladaptive response to stress
- Disability in working and loving
- Ability to evoke interpersonal conflict
- Capacity to frustrate others
2
Q
what is cluster A personality disorders?
A
odd or eccentric
3
Q
what personality disorders are included with Cluster A?
A
- Paranoid Personality disorder
- Schizoid personality disorder
- Schizotypal personality disoder
4
Q
Paranoid Personality Disorder
A
- Suspicious of others
- Fear others will exploit, harm, or deceive
- Hypervigilant, hostile, aloof
- Psychotic episodes may occur in times of stress
- Nurses should give straightforward explanations of tests, history taking, and procedures, side effects of drugs etc to counteract client fear
5
Q
Schizoid Personality Disorder
A
- Avoids close relationships
- Socially isolated
- Poor occupational functioning
- Cold, aloof and detached
- Social awareness is lacking
- Relationships generate fear and confusion
- Nurses should strive for simplifications and clarity to decrease client anxiety
6
Q
Schizotypal Personality Disorder
A
- Ideas of reference
- Magical thinking
- Odd beliefs
- Perceptual distortions
- Vague, stereotyped speech
- Frightened
- Suspicious
- Blunted affect
- Distant and strained social relationships
- Tend to be frightened/ suspicious in social situation
7
Q
what is cluster B personality disorders?
A
dramatic, erratic
8
Q
what personality disorders are included in Cluster B?
A
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissitic personality disorder
9
Q
Antisocial personality disorder
A
- Superficial charm
- Violates right of others
- Exploits other
- Lies, cheats, lacks guilt or remorse
- Impulsive
- Acts out
- Lacks empathy
- Manipulative
- Aggressive
- Nurses must establish and adhere to plan of care
- Maintain clear boundaries to minimize client manipulation and acting out
10
Q
Borderline Personality Disorder
A
- Unstable
- Intense relationships
- Identity disturbances
- Impulsivity
- Self- mutilation
- Rapid mood shifts
- Chronic emptiness
- Intense fear of abandonment
- Splitting
- Anger
- Self-mutilation and suicide prone behavior are often used
- Impulsive self destructive behaviors
- Anger is intense
- Nurses should help with anger management
- No self-harm contract
- Safety
- Limit setting important
11
Q
Histrionic Personality Disorder
A
- Center of attention
- Flamboyant
- seductive/ provocative
- Shallow
- Rapidly shifting emotions
- Dramatic expression of emotions
- Overly concerned with impressing others
- Exaggerates degree of intimacy with others
- Self aggrandizing
- Preoccupied with own appearance
- Experience depression when admiration of others is not given
- Assess for suicide risk
12
Q
Narcissitic Personality Disorder
A
- Grandiosity
- Fantasies of power or brilliance
- Need to be admired
- Sense of entitlement
- Arrogant
- Patronizing
- Rude
- Overestimates self
- Underestimates others
- Fragile ego
- Demands best
- thin-skinned
13
Q
what is Cluster C personality disorders?
A
anxious, fearful
14
Q
what personality disorders are included in Cluster C?
A
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive Compulsive Personality Disorder
15
Q
Avoidant Personality Disorder
A
- Social inhibition
- Feelings of inadequacy
- Hypersensitivity to criticism
- Preoccupation with fear of rejection
- Self perceived to be socially inept
- Low self esteem and hypersensitivity grw as support networks decrease
- Demands of workplace often overwhelming
- Project that caregivers will harm them through disapproval
- Perceive rejection where none exists
16
Q
Dependent Personality Disorder
A
- Inability to make daily decisions without advice and reassurance
- Need others to be responsible for important areas
- Anxious, helpless when alone
- Submissive
- Solicit care taking by clinging
- Fear abandonment if they are too competent
- Experience anxiety/ may have co- existing depression
17
Q
Obsessive Compulsive Personality Disorder
A
- Preoccupied with rules
- Perfectionistic
- Too busy to have friends
- Rigid control
- Superficial relationship
- Complains about other inefficiencies
- Gives others directions
- Does NOT have obsessions, compulsions (that’s OCD)
18
Q
nursing interventions for Cluster A Personality Disorders
A
- Adopt an objective, matter of fact manner when interacting with client
- Maintain clear, consistent verbal/nonverbal communication
- Provide daily structure for activities of daily living
- Maintain focus on reality and reality based topics
- Help client to clearly identify feelings that are implied
- Help client with problem solving life issues identified as sources of stress
- Gradually involved the client in group situations
- Provide positive feedback for appropriate behavior
19
Q
nursing interventions for Cluster B Personality Disorders
A
- Prevent self-harm by observing client frequently and developing a no harm contract
- Give immediate feedback when confronting manipulative behavior
- Help client examine consequences of behavior
- Act as role model for appropriate expression of feelings
- Work with treatment team to maintain consistent feedback, reinforcing specific treatment objectives, avoiding manipulations of staff by client
- Avoid rescuing or rejecting client
- Set limits
- Reinforce consequences of manipulative behavior
- Give positive feedback for achieving goals and independent behavior
- Explore client’s feelings regarding rejection, being alone, and fear of abandonment
- Use a problem solving approach to help client explore necessary changes
- Encourage clients participation in follow up treatment
20
Q
nursing interventions for Cluster C Personality Disorders
A
- Establish a caring, consistent therapeutic relationship and clear expectations for responsible behavior
- Expect client to make decisions
- Teach him how to be assertive
- Encourage client to identify positive self attributes
- Provide positive feedback when client interacts in social situations appropriately
- Teach client to use stress management and relaxation techniques to cope with anxiety
21
Q
describe clinical features of anorexia nervosa
A
- Low weight
- Amenorrhea
- Yellow skin
- Lanugo - soft, fine downy hair, Develops with malnutrition
- Cold extremities
- Peripheral edema
- Muscle weakening
- Constipation
- Bradycardia (<40)
- Low Blood pressure (SBP<70)
- Decreased bone density
- Hypokalemia (<3.0)
22
Q
describe clinical features of bulimia nervosa
A
- Do not appear physically or emotionally ill
- Weight is usually at/slightly below ideal body weight
- Normal to slightly low weight
- Dental caries, tooth erosion
- Parotid swelling (from increased serum amylase levels)
- Gastric dilation, rupture (binge eating), abnormal lab values (hypokalemia)
- May have poor impulse control
- Impulsivity
- Chaotic, interpersonal relationship
- Sensitive to others’ perception of illness
- May experience shame and feeling out of control
23
Q
nursing interventions for anorexia and bulimia
A
- Collaborate with other health teams
- Reinforce dietitian’s prescription for healthy eating to accomplish a realistic weight gain of 2-3lbs weekly
- Reinforce treatment plan that establishes privileges and restriction based on compliance
- Discuss client’s fears of weight gain and loss of control
24
Q
refeeding syndrome
A
- A severe and potentially catastrophic complication, involving a metabolic alteration in serum electrolytes, vitamin deficiency, and sodium retention
- Client may experience cardiovascular collapse as a result of the strain on the circulatory system
25
Q
what is the importance of proper protocol in the therapeutic milieu for bulimia?
A
- Structured to interrupt the binge-purge cycles by observation during/ after meals to prevent purging
- If client wants to use the bathroom immediately after meal, nurse HAS to accompany pt to bathroom
- Normalization of eating
- Appropriate exercise
26
Q
what is the importance of proper protocol in the therapeutic milieu for anorexia?
A
- Focus is on establishing more adaptive behavioral patterns including normalization of eating
- Precise mealtimes
- Adherence to selected menu
- Observation during and following meals
- Regularly scheduled weighing
- Client privileges correlated with weight gain and treatment plan compliance
- To ensure there is no self induced vomiting, close monitoring of bathroom use after meals and after visits is necessary
27
Q
long term therapy for bulimia nervosa
A
- Cognitive behavioral therapy is most effective
- Reduction is purging by session 6 predicts a successful outcome
- Focus on changing dysfunctional attitudes to ones of self acceptance and correcting faulty perceptions and be able to treat comorbid disorders at the same time
28
Q
counseling for bulimia nervosa
A
- Therapeutic alliance is important
- Allows the nurse to provide feedback regarding distorted thoughts
- Clients learn how to eat out in a health manner
