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162 Cards in this Set

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What is circulation dependent on?
It's dependent upon hydration, blood viscosity, coagulation, fibrinolysis, and the changes in the diameter of the vessels.
What are the 3 layers of the vessel?
- Tunica Intima
- Tunica Media
- Tunica Adventitia
Why are the arterioles referred to as resistence vessels?
Because they can alter their diameter. They vasoconstrict and vasodilate. This allows them to regulate volume and pressure in the arteriole system and blood flow to capillaries.
What is arteriovenous anastomosis? What is its function?
They are special capillary beds whereby blood passes directly from arterial to venous system.

These vessels regulate heat exchange both locally and generally.
When does ischemia of a vessel occur?
When the blood vessels fail to dilate to accommodate the need for increased blood flow.
What is the pressure gradient in the vascular system?
Blood vessels provide opposing force and can change the rate of blood flow by changing their diameter.
What is the laminar or silent blood flow in blood vessels?
Blood in the center of the vessel moves faster than blood near the vessel walls.
What determines the direction of fluid movement across the capillary?
Hydrostatic and oncotic pressure.
What is hydrostatic pressure?
Blood pressure at the arterial end of the capillary is high and tends to drive fluid out of the capillaries into the tissue (edema).
What is osmotic pressure?
Plasma proteins in the capillaries exert an osmotic force that tends to pull fluid back into the capillaries from tissue space.
What is the normal level for albumin?
3.5 - 5.0, the same as potassium
Why may edema result?
- Damage to capillary walls
- Obstruction to lymphatics
- Elevation of Venous pressure
- Decrease in plasma protein osmotic force
What regulates the size of peripheral blood vessels?
- hypothalamus
- SNS (Adrenergic)
- NE; a neurotransmitter
- Epinephrine
- Angiotensin
- ADH
What does ADH do?
It's secreted directly into the blood by the hypothalamus. It causes water retension and increased b/p.
What is angiotensin? Where does conversion take place?
Angiotensin causes blood vessels to constrict, and drives blood pressure up. It is part of the renin-angiotensin system, which is a major target for drugs that lower blood pressure. Angiotensin also stimulates the release of aldosterone from the adrenal cortex. Aldosterone promotes sodium retention in the distal nephron, which also drives blood pressure up. A substance formed by the interaction of renin and angiotensin I causes vasoconstriction.

Conversion takes place in the lungs.
Where is ADH secreted and what does it do?
ADH is secreted directly into the blood by the hypothalamus and causes water retention and increased b/p.
What does aging cause in the vascular system?
Atherosclerosis: refers to conditions that lead to decreased blood supply to the body tissues due to thickening and decreased elasticity of arterial walls that result from aging, degenerative changes, and HTN. Progresses slowly.
What is athersclerosis characterized by?
It's characterized by a sequence of changes in the intimal layer of the arteries. Chiefly affecting the aorta, coronary arteries, cerebral arteries, and upper and lower extremity arteries.

It's more common in men.
How do you evaluate PVD?
Distal to proximal (arteries)
What in a nursing history make a person more inclined to get PVD?
**Smoking (vasoconstrictor)
- High fats in diet
- Family Hx
- Diabetes, HTN, hypothyroidism
- Obesity
- Cardiac Disease
- Med Hx
**ETOH history important
What is intermittent claudication?
It's similar to angina. It's a severe cramp-like pain in the extremity following exercise. It's due to the inability of the arterial system to meet O2 demands of the muscles and remove metabolites. The pain improves with rest.
What can mask claudication?
Collateral circulation.
How do you document claudication?
You document the degree of claudification in terms of how far the pt can walk before pain forces him to rest.
Why do you want a pt with claudication to walk?
To build collateral circulation.
What would heaviness in the legs indicate?
A problem with the venous system.
What is a marker for arterial disease of the leg?
A severe cramp-like pain in the extremity.
What is ischemic rest pain? What does it indicate?
It's persistent pain in the extremities; indication of severe arterial insufficiency or venous disease.
When does ischemic chest pain occur?
It occurs at night as severe diffuse foot pain. Walking relieves pain.
What does PVD edema cause? When? How does it pit?
It does pit in the early stages.

Long-standing edema destroys the structure of the skin.
What is brawny edema? How does it present?
It occurs with changes in venous pressure and HTN.

Reddish/brown discoloration occurs from the breakdown of extravasated red blood cells.
How would a normal pedal pulse be documented?
2+ = normal
What are some physical observable symptoms of peripheral arterial disease?
Bluish discoloration (cyanosis) or dusky color.

Prolonged ischemia may cause extreme dryness, scaling, and shiny skin over legs.

Skin also has an abscence of hair growth, nails may be thick and brittle.
What could indicate a subclavian stenosis?
Blood pressure should be checked in both arms. A gap of 20mmHg. Could indicate a subclavian stenosis.
What is the Ankle-Brachial Index test?
It's the most useful test for arterial disease of the lower extremities. It is determined by continuous wave doppler studies of pulses received from blood pressure measurements in the arm and ankle.

Normal resting index is 1:1. A resting index less than 50mmHg indicates severe arterial compromise.
What are the hallmarks of arterial insufficiency?
- Decreased or absent arterial pulses
- possible systolic bruit over involved arteries
- muscular atrophy
- Thin, shiny, hairless skin
- cool skin temp
- ulcers on pressure points of feet
- pain with leg elevation
What are some potential complications of arteriography?
Dehydration from dye-induced diuresis.
What is plethysmography?
This procedure measures fluid volume variations in an organ or body region.
What is thromboangiitis or Berger's disease?
It's an inflammatory disorder affecting veins and arteries that results in thrombus formation and occlusion of the vessels.

The legions affect medium-sized arteries and progress to larger vessels.

Affects men 20 to 35.
What are some interventions for thromboangiitis or Berger's disease?
- Protect extremities from injury; good shoes, warm socks, and no bare feet.
- Rest, hygiene, and scrupulous hygiene
- Special foot care
- NO SMOKING
What should be avoided with Raynaud's disease?
- Cold, smoking
- drugs producing vasoconstriction (beta blockers, birth control pills)
- Wear warm gloves
What is given for Raynaud's disease?
- Nifedipine
- Minipress
What can arterial embolisms result from?
These are emboli that arise from thrombi that develop. These thrombi develop in the heart as a result of atrial fibrillation, MI, infective endocarditis, or CHF.
What are the clinical manifestations of arterial embolism?
- acute, severe pain with gradual sensory loss and motor function in extremities.
- absense of distal pulses
- pale mottled limbs
- Sharp line of color and temp demarcation
- the classic 6Ps
- muscle necrosis occurs 2 hrs after occlusion
What are the classic manifestations of acute ischemia? (6Ps)
- pain or loss of sensory nerves due to ischemia
- parethesias and loss of position sense
- poikilothermia (coldness)
- paralysis
- pallor progresses to mottled cyanotic cadaverous cold leg
- pulselessness
How are arterial embolisms treated? After how much time does the muscle develop necrosis and the extremity can no longer be salvaged.
- embolectomy is the treatment of choice
- after 6 hrs of ischemia the muscle develops necrosis and the extremity cannot be salvaged
For an embolectomy, what are some nursing interventions pre-op?
- affected limb should be kept at room temperature and protected from trauma.
***Bed cradles should be used to keep weight off of the extremity.
- admin heparin
- thrombolytic agents such as streptokinase (tPA) and urokinase may be useful to hasten lysis of the clot.
Post-op care for embolectomy
- prevent stasis of the limb and promote circulation
- anticoagulants
- assess surgical wound
- assess pulses
What is thrombophlebitis?
It's an inflammation of the walls of the veins with the formation of a clot
What are 3 causes of thrombophlebitis?
- stasis of blood
- injury to vessel wall
- altered blood coagulation
What are some causes of venous stasis? How does bed rest affect this?
- retarded blood flow - CHF, shock
- reduced skeletal muscle contraction. Bedrest reduces blood flow to the legs by 50%.
What patients are at high risk for thrombophlebitis?
- bedrest, sepsis, traction, MI, CHF
- general surgery
- over age 40
- leg trauma - muscle tissue injuries
- obesity
- oral contraceptives
- malignancies
What are venous thrombi composed of?
They are composed of platelet aggregates attached to vein walls and a tail-like appendage composed of fibrin, white, and RBCs. The "tail" can grow larger. The danger is when a piece breaks off and travels.
What should be done for an assessment of thrombophlebitis?
Measure circumference of extremity
Impedance plethysmography
Blood pressure cuff applied to the leg and is inflated. Electrodes are used to measure blood flow. False negatives and positives can occur.
What is done to prevent thrombophlebitis?
- elastic stockings or compression device. (remove twice daily, check skin every shift)
- early ambulation
- deep breathing exercises produce negative thoracic pressure which assists in emptying large veins
What is the goal of managing thrombophlebitis?
Goal: **To prevent the growth of thrombus; **to prevent pulmonary embolism.

- managed with therapeutic anticoagulation
- surgery
How is heparin administered? What is monitored? What can be used to lyse clots?
- heparin is administered by continuous infusion (always on a pump) or on intermittent admin SC
- PTT regulates dose 2-2 1/2 times the control or weight-based heparin protocol
- monitor patient for bleeding, check HCT
- streptokinase (tPA) or urokinase can be used to lyse clots
What must be monitored with Coumadin? Heparin?
Coumadin - INR
Heparin - PTT
What should be noted during the assessment of varicose veins?
- dull aches in the legs accompanied by vague sensation of pressure, fatigue, and heaviness
- max. discomfort after sitting of standing. Peaks in the evening and with warm weather.
What are some interventions for the small symptoms of varicose veins?
- elevate legs
- avoid tight clothing
- avoid standing
- exercise frequently - walking
- elastic stockings
What are some interventions for moderate symptoms of varicose veins?
- support hose - measure calf and length from knee down (custom)
- elastic stockings
With vein ligation what MUST be checked?
arterial blood flow
What is Unna's Boot?
It's a moist gauze impregnated with zinc oxide that is applied in layers and hardens. It can be used for the treatment of venous stasis ulcers and other venous insufficiencies of the leg. It's changed weekly at home by a home care nurse. Very effective for healing and comfort.
What is lymphedema? Signs?
Lymphedema is swelling of tissues in the extremities due to increased quantity of lymph that result in obstruction of lymphatics.

Edema becomes hard/firm, fixed, non-pitting and unresponsive to treatment. Often unilateral.
What are some ways to prevent thrombus formation? (arterial)
- exercise
- low cholesterol diet
- control diet
- avoid tobacco
- aspirin or other antiplatelet meds.
- Trental (pentoxifylline) - reduces blood viscosity and enhances O2 delivery to muscle
- Plavix is good too
what are some ways to prevent venousthrombus formation?
- avoid prolonged bedrest
- prevent dehydration
- ROM exercises
- proper positioning in bed
- subcutaneous heparin in low doses
- lovenox
- anti-embolism stockings
Buerger-Allen exercises for Raynaud or Berger's patients
- elevate feet for 3 minutes
- sit in relaxed postion for 3 minutes
- pronate and supinate foot
- lie flat for 5 minutes
How does the endocrine secrete hormones?
Directly into the blood stream.
What type of effect do hormones have?
The effects have a slower onset of action but a longer duration of action than neural transmissions.

The actions of hormones may be local or general.
What do hormones do?
They act as chemical messengers that communicate between body systems.
How/why are hormones secreted?
They are secreted cyclically in response to body environmental rhythms.
What are some characteristics of hormones?
- they control the rate of cellular activities.
- they are secreted in small concentrations.
- they are arranged in clusters called acini.
- no ducts; glands have a rich blood supply.
What mechanism regulates the concentration of hormones?
Negative Feedback
How does the pituitary gland regulate other glands?
through tropic hormones
What are tropic hormones?
These hormones get feedback about their specific target glands by continually monitoring levels of hormones produced by these glands.

When changes occur trophic hormones correct it by stimulating or inhibiting target glands.

Tropic hormones are hormones that regulate the activity of various other endocrine glands.
In addition to the pituitary gland, what else produces trophic hormones?
The hypothalamus also produces trophic hormones. They are called releasing or inhibiting factors. These factors regulate the anterior pituitary hormones. This allows the hypothalamus to indirrectly control the target gland hormones.
What does the posterior pituitary gland regulate?
It regulates ADH and oxytocin.
What does prolactin cause the production of?
breast milk
What does the thyroid gland regulate? How about the parathyroid?
Thyroid: metabolism
Parathyroid: calcium
What 2 hormones do the kidneys secrete and what do they do?
They secrete 2 important hormones that regulate blood pressure and erythropoietin that stimulates bone marrow to produce RBCs.

They are the right and left adrenal glands. These are also responsible for "fight or flight".
Where is the thymus gland located and what is its major role?
It's located below the sternum. It shrinks as one ages. It's major role is the production of T cells which are critical in cell mediated immunity.
What does the adrenal cortex produce? What does the adrenal medulla produce?
Adrenal cortex: cortisol
Adrenal medulla: epinephrine & NE
How do endocrine disorders arise?
They may arise from either hyperfunction or hypofunction.

The problems may also be primary (from the organ) or secondary (pituitary).
What does lithium do?
It may enhance the reuptake of NE and 5HT, may interfere with ionic pump mechanisms in the brain cells, may compete with or replace sodium ions.
What labs must be drawn for lithium and in what frequency?
Baseline creatinine, TSH, CBC; after 3 months, then every 6 months.
What is the maintenance level for lithium?
0.5 - 0.6 to 1.2mEq/L
Side Effects of lithium
- GI; metallic taste
- thyroid abnormalities
- polyuria, polydipsia
- hairloss, acne
- reduces seizure threshold, cognitive slowing, fine tremors.
Mild lithium toxicity range and side effects
Mild: 1.5 - 2.0

Blurred vision, ataxia, tinnitus, N/V/D, slurred speech, confusion, appears intoxicated, increased tremors
Moderate lithium toxicity range and side effects
Mod.: 2 - 2.5

Muscular irritability/clonic limb movements, change in LOC, seizures, syncope, delirium
Severe lithium toxicity range and side effects
Severe: >2.5

Generalized convulsions, oliguria, renal failure, coma, MI, cardiovascular collapse
What can cause lithium toxicity?
Hyponatremia and dehydration.

Encourage fluid intake 1 1/2 L/day
What is Depakote (Valproate)? What is it used for? Possible side effects?
It's a mood stabilizer. Depakote is used for schizoaffective disorder (better tolerated than lithium). More effective treating mania vs. depression.

Side effects include **weight gain**, GI upset, sedation, hair loss, liver toxicity, ataxia, displaces highly protein-bound drugs from their binding sites, it increases their levels. Check for mild leukopenia. WBC >3,000
What is Tegretol (Carbamazepine)? What does it do? What are the side effects?
It's a mood stabilizer. It's the DOC for acute mania, rapid cycling and mixed. Use for aggressive or TLE.

Side effects include sedation, ataxia, confusion, aplastic anemia, agranulocytosis, **rashes**, water retention (hyponatremia), AV conduction delays, many drug-drug interactions.
What is Lamictal (Lamotrigine)? What does it do? What's the side effects?
It's a mood stabilizer. Rapid cycling or mixed, bipolar depression, well tolerated; proposed level 1 to 5 mcg/mL.

Side effects include N/V, sedation, dizziness, ataxia, confusion, rare blood dystrasias, Stevens-Johnson Syndrome (life threatening rash); especially with children < 16 years. (Toxic epidermal necrolysis, epidermis separates from dermis); TX like a burn.
What is Neurontin (Gabapentin)? What's it used for? What are some side effects?
It's a mood stabilizer. It's used as an anticonvulsant which may have mood stabilizing properties (used with other drugs).

Possible side effects are fatigue, dizziness, uncoordination, tremor, nausea, and weight gain.
What is Topamax (Topiramate)? What's it used for? What are some side effects?
It's a mood stabilizer.It's thought to have mood stabilizing properties for atypical bipolar; can reduce appetite.

Side effects include psychomotor slowing, sedation, dizzy, poor concentration, weight loss, and vision changes.
What is Trileptal (Oxcarbazepine)? What does it do? What are some side effects?
It's a mood stabilizer. It's a metabolite of carbamazepine; it bypasses the metabolism that creates many of the side effects and adverse reactions to tegretol, different with concentration, speech or language problems, gait disturbances.
What is Klonopin (Clonazepam)? What does it do? What is it used for? What are some side effects?
It's a mood stabilizer. It's off-label use is for bipolar mania, caution in elders, liver disease, lactation, renal disease, glaucoma.

Klonopin is not first line choice for mood stabilizer, and often
is used as an adjunct.
What are some examples of antianxiety meds? Benzos and others...
Benzos include Xanax, Librium, Klonopin, Valium, and Ativan.

Others include antihistamines (Vistaril, Atarax), BuSpar.

It takes 2+ weeks before results.
What do releasing factors and releasing hormones do?
They cause the pituitary to release hormones to act on target organs.
What is the pituitary gland protected by?
The sella turcica
What does the anterior pituitary lobe secrete?
It secretes:
- Adrenocorticotrophic hormone ACTH; Corticotropin)
- TSH
- FSH
- LH
- Prolactin
- Melanocyte Stimulating Hormone (MSH)
What does the posterior lobe secrete?
- Vasopressin (ADH)
- Oxytocin
What should be looked at if there's an increased amount of prolactin?
the pituitary gland
What can result from a pituitary adenoma?
Hyperpituitarism: excessive production and secretion of one or more tropic hormones from the anterior pituitary.

Found in 30 to 50 year group.
**What can result from growth hormone excess in adults?
- Acromegaly: characterized by continued growth of bone and connective tissue in the distal parts of the body.
- Noticed in 30 to 50 year group
- Also splenomegaly and hepatomegaly
What is giantism?
- hypersecretion of growth hormone prior to puberty
- often die prior to to 21 years
- die from infection and various hormone imbalances
- hypersecretion of ACTH resulting in Cushing Disease
- hyperprolactemia
What can adenomas cause?
Their space-occupying properties interfere with pituitary function, and cause the central nervous system symptoms or visual problems.
Where do malignant tumors mainly occur?
In the anterior lobe of the pituitary gland.
What is hypophysectomy? What is the procedure of choice?
It's the surgical removal of the pituitary gland which can be done by means of a transfrontal craniotomy when the tumor involves the optic chiasm.

*Transsphenoidal hypophysectomy is the procedure of choice.
Why are steroids begun the evening prior to surgery?
Because glucocorticoid levels drop immediately after surgery.
Post-op care for a hypophysectomy
- Neuro assessment: check ICP, LOC, pupils, motor and sensory
- HOB elevated 30 degrees to decrease ICP
- No straining
- Nose is packed for 24 to 48 hours and should be assessed. Check for CSF leakgae (sweet).
- monitor I&O
- constant swallowing notify nurse
- antibiotics given
- could result in diabetes insipidus
What could cause adrenal crisis?
If ACTH (Adrenocorticotropic hormone) is no longer secreted by the anterior pituitary gland.

Hypofunction of all target organs.
What is Adrenocorticotropic hormone (ACTH or corticotropin)? What does it do?
A tropic hormone produced and secreted by the anterior pituitary gland. It is often produced in response to biological stress (along with corticotropin-releasing hormone from the hypothalamus). Its principal effects are increased production of androgens and, as its name suggests, cortisol from the adrenal cortex.
ADH Deficiency
Can prove fatal if interventions are not taken. Usually resolves in 3 weeks. **Careful output monitoring.

Vasopressin given if urine output exceeds 300 to 400cc per hour or specific gravity below 1.004.
What can cause hypopituitarism? Onset?
Any destructive lesion or process of pituitary. May also be a result of destruction of the hypothalamus.

Onset of severe hormone deficiency may be sudden or chronic - sometimes takes months.
How much of the anterior lobe has been destroyed before symptoms begin?
75%
What are the 3 major mechanisms that lead to the development of hypopituitarism?
- decreased release of hypothalamic hormones that stimulate pituitary function.
- any event or mass which interrupts the delivery of hormones from the hypothalamus. These may include particular tumors and aneurisms.
- damage to the pituitary gland cells.
What is hypopituitism often caused by? Which is the most common?
Most often caused by tumors, the most common of which is pituitary adenoma.
How is diagnosis of hypopituitarism made?
- CT Scan
- GH Reserve Test - in affected people, growth hormone serum fails to rise in response to insulin-induced hypoglycemia.
Treatment for hypopituitarism?
- Replace target hormones that are deficient.
- Prolactin usually not replaced.
What does the posterior pituitary gland work with? What hormones are produced?
The posterior pituitary gland is part of the nuerosecretary system together with the hypothalamus.

Hormones produce ADH, Vasopressin, anti-diuretic hormone; oxytocin.
What is the hypothalamus?
The hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland (hypophysis).
What does excess ADH cause?
It causes the Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
What is SIADH?
It's a condition in which there is persistent release of ADH unrelated to plasma osmolarity or volume deficit.

The normal posterior pituitary mechanism is hypoactive causing continuous release of ADH.
What is the result of SIADH?
Fluid overload, hyponatremia, and hemodilution result.
What does water intoxication cause?
It causes cerebral edema.
What may produce symptoms of SIADH?
Disorders of the CNS such as head injury, brain surgery, tumor, or infection pneumonia.
What drugs have been implicated in producing symptoms of SIADH?
Vincristine, phenothiazine, tricyclic anti-depressants, and thiazide diuretics.
How is diagnosis of SIADH determined?
- 2 successive hyponatremia levels.
- Low serum osmolality with high urine osmolality.

Can happen with lung cancer.
Treatment of SIADH
- fluid restriction
- demeclocycline can restore sodium levels within 2 weeks (600-1200mg)
- Lithium can also be used.
- HOB elevated 30 degrees.
- Monitor I&O
- weight checks
- neuro checks
What must be avoided with SIADH?
Avoid MSO4, it increases ADH secretions.

Causes spasms of the sphincter of oddi - not good for Gall Bladder.
What is diabetes insipidus characterized by? What's the underlying cause?
- ADH deficit
- characterized by the kidney's inability to conserve water.

Underlying causes:
- neoplastic or inflammatory processes impinging upon hypothalamus
- surgery or irradiation
- severe head injuries

Lack of ADH causes a failure of the distal and collecting ducts of the nephrons to absorb water.
What's the clinical picture with diabetes insipidus?
- polyuria - hourly urine >200cc/hr
- polydipsia (excessive thirst)
- serum osmolarity becomes elevated with serum NA levels
- urine output may go as high as 10 liters or more in 24 hours.
- abrupt onset
- water-like urine; specific gravity 1.001 to 1.005
How is diabetes insipidus diagnosed?
- urine osmolarity low, serum osmolarity high
- water deprivation test - tests kidneys ability to conserve water
- ADH administered via nasal spray. If symptoms clear up test positive.
Treatment for Diabetes Insipidus
- fluid replacement with hypotonic solutions
- Vasopressin IM (given s/p head injuries)
- nephrogenic DI treated with thiazide diuretics which have a paradoxical effect.
What is the incidence of causes for diabetes insipidus?
- head injury 16%
- tumors 25%
- cranial surgery 20%***
What is the incidence of SIADH?
80% of small cell CA patients have impaired ability to excrete water secondary to ectopic production of vasopressin.
What is vasopressin?
It's a hormone found in most mammals. It is synthesized in the hypothalamus and stored in vesicles at the posterior pituitary. Most of it is stored in the posterior pituitary to be released into the blood stream; however, some of it is also released directly into the brain.
Nursing care for DI
- record I&O
- monitor spec. gravity of urine, b/p, weights, temp.
- admin vasopressin therapy IV, SQ, intranasal solution is DOC. Onset of action is 1 hr.
- monitor electrolytes
Nursing care for SIADH
- restrict water intake (500 - 600cc/24hrs)
- admin diuretics to promote excretion of water
- hypertonic saline (3% NaCL) IV
- weigh daily
- I&O
- monitor serum Na
- Assess LOC (from excess fluid in brain).
What is personality?
It's one's temperament; one's perception of self; a defense structure.
What is the definition of personality disorder?
It's a disorder of the self; lack of a genuine sense of self. Impairment of self-regulating abilities. They typically look outside themselves for guidance for evaluations, directions, opinions. They cannot self-sooth. A lot of time their problems "are caused by someone else".
How can Cluster A be described?
Odd, eccentric, cold cluster, clients all have difficulty relating to others, isolate themselves, and are unable to socialize comfortably.
What personality disorders are included in cluster A?
Paranoid, Schizoid, and Schizotypal
What are the key features of Paranoid Personality?
- distrusts others; highly suspicious
- They have no positive signs or symptoms
- hold grudges
- happens with males more
What are the key features of Schizoid Personality?
- This is phase 1 for schizophrenia
- Restricted emotional expression, no close friends, no desire for intimacy or sexual contact, lacks stron emotions
- lacks trust in others
- males slightly more than females
- Have more negative symptoms than schizotypal
What are the key features of Schizotypal Personality?
- More silly, strange behavior; magical thinking, action-orientated.
- preoccupation with paranormal phenomenon Hallucinations, delusions)
- unusual perceptions, incorrect interpretation of external events
- belief that all events refer to self, ideas of reference.
How can Cluster B be described?
Emotional, erratic, dramatic; each personality disorder shares a dramatic quality in the way the individual lives his/her life.
What personality disorders are included in cluster B?
Antisocial, Borderline Personality Disorder, Histrionic, and Narcissistic personality.
What are the key features of Antisocial Personality?
- violates the rights of others
- enduring pattern of violation of social norms, inability to conform - results in impaired life functioning.
- lying cheating, stealing, running away from home, drug abuse, criminal activity, difficulty learning from their mistakes.
***Disregard for the of others - JAIL. Lack of empathy, lack of social conscience; do NOT feel remorse about mistreating others.
- can be witty, charming, seductive - initially, dissolves to coldness, blaming others, manipulation - to have their needs met.
- do not tolerate delay of gratification
- aggression common
- have a history of conduct disorder before age 15
What are the key features of Borderline Personality Disorder?
- pervasive disturbance in self-image, mood, affect, impulsivity, excessive NEED state
- can have transient psychotic symptoms, disturbances in identity, sexual orientation
- chronic feelings of boredom, excessive fears of abandonment, engulfment, difficulty being alone
- MANIPULATIVE
- intense feelings of ambivalence
- they feel empty inside and are very needy
- the world is seen in black and white
- impulsive - eating, shoplifting, casual sex, SA, suicidal gestures
- feelings of depersonalization/dissociation - numbness or detachment from reality, that's why they might be cutters
- mostly female
- History of physical and sexual abuse, neglect, hostile conflict, and early parental losses/separation
What are the key features of Histrionic Personality?
- They must be the center of attention.
- Excessively dramatic, extroverted or flamboyant, impressionistic speech style
- complaints of physical illness, somatization
- use of suicidal gestures or threats to get attention
- more females
What are the key features of Narcissistic Personality?
- grandiose sense of self-importance, entitlement, believe they are unique and deserving of special treatment - demand constant attention
- become enraged by others criticim
- lack empathy for others, exploitothers for self-aggrandizement
- preoccupation with fantasies of success, brillance, beauty, ideal love
- more male
How can Cluster C be described?
Anxious, fearful
What personality disorders are included in cluster C?
Avoidant, Obsessive-compulsive, and dependent personality disorders.
What are the key features of Avoidant Personality?
- extreme submissiveness toward others, dependence on others to assume responsibility for their lives.
- no self-confidence, no decision making
- despise being alone
***Fearful of criticism, disapproval, rejection (why they can't make decisions), avoids social interactions
- negative sense of self, low self-esteem
What are the key features of Obsessive-compulsive Personality?
- Exaggerated orderliness, yet unable to part with any possessions
- not a lot of affect, restricted emotionally, rigid, inflexible
- perfectionist
- have an irrational fear of making a mistake
- rejection of praise
- reluctance to delegate, insistence on others' conforming to own methods
- reluctance to spend money
- background of stiff and formal relationships
What are the key features of Dependent Personality?
- submissive, clinging
***Unable to make decisions independently
- cannot express negative emotions
- difficulty thru on tasks; wants others to do things for them because they can't.
More females
Is limit setting confrontational?
NO
What are the 5 domains of behavior to assess?
Physical, emotional, cognitive, social, spiritual
What hormones are secreted by the anterior pituitary?
--Tropic hormones made and secreted by the anterior pituitary include:
--Thyroid-stimulating hormone (TSH) - stimulates the thyroid gland.
--Adrenocorticotropic hormone (ACTH or corticotropin) - stimulates the adrenal cortex.
--Luteinizing hormone (LH) - stimulates the release of steroid hormones in the ovary and
testes.
--Follicle-stimulating hormone (FSH) - stimulates the maturation of eggs and sperm.