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101 Cards in this Set
- Front
- Back
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Define Personality
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* a deeply ingrained patters on behaviors
* self perception |
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What influences personality?
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Heredity, temperament, level and control of anxiety, nurturance, life circumstances, environment, culture
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When are personality disorders recognized or discovered?
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Usually in childhood and adolescence.
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What factors contribute to personality disorders?
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*issues of self worth
*unhealthy attachments and maltreatment in childhood * Poor compensation skills |
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How does issues of self worth play into personality disorders?
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The quality of emotional attachments during childhood give a better sense of self and affects ones ability to trust
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How does issues of unhealthy attachments and maltreatment play into personality disorders?
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Causes an inability to connect to people
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How does poor compensation play a role in personality disorders?
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These cause a negative view of one self and others and do a lot of defensive coping i.e. aggression, overly sensitive.etc
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What are some of the characteristics of a person with personality disorder?
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Lack of objectivity
limited ability to change repetitive maladaptive behaviors inadequate functioning poor relationships --work and personal poor problem solving defensive coping inconsistent responses poor emotional responses |
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What are the nursing goals with patients with personality disorders?
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1) help them develop insight
2) hep them manage their anxiety 3) avoid harm 4) help develop meaningful relationships 5) help them function within the rules and expectations 6) give adaptive ways to effectively cope with stress |
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What is the cognitive-behavioral approach to managing personality disorders?
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1) Here and now approach- focus on the present and help them move to the present
2) Identify thoughts leading to maladaptive behaviors and the consequences 3) Establish new thinking and adaptive behaviors |
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What medications are prescribed for people with personality disorders?
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* antidepressants
*anti psychotics *lithium *benzodiazepines |
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True or false:
Prescribing medication to a person with personality disorder will cure them? |
False-- medication only addresses the symptoms of their disorder and not their core pathology.
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What is the preferred method of treatment for personality disorders?
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Psychotherapy
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Describe a person with Schizoid personality disorder
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Schizoid types have a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.
They often seem: reclusive, cold, lonely, prefer solitary jobs, unable to achieve intimacy. |
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Describe a person with Schizotypal disorder
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These personalities are usually a precursor to schizophrenia, they are aloof and isolated and behave in a bland and apathetic manner.
Magical thinking is prime example, (telepathy, clairvoyance). |
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Describe a person with Paranoid personality disorder
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These people suffer from severe suspiciousness and mistrust; they are self-isolating; they excessively use projection as a defensive coping skill, and are a potential for violence.
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What development stage in Erickson's do schizotypal, schizoid, and paranoid personality disorders are these people found in?
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Trust vs. mistrust
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What nursing behaviors are needed to treat patients with personality disorders?
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1) cultivate feelings of trust -- give pt info, keep commitments, avoid laughing or joking.
2) offer a relationship - non threatening, keep dialogue simple 3) have self awareness 4) enlist the patient's cooperation |
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True false:
Nursing behaviors are directed toward confronting and stopping the behaviors of the people suffering from personality disorders |
FALSE:
Nursing behaviors are directed toward working WITH the patient's personality disorder rather than against it. |
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Describe a person with Histrionic personality disorder
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Usually women; these types need to be the center of attention; dramatic, overly emotional, easily excitable, over exaggerates, attention seeking, flirtatious, but unable to keep and maintain long lasting relationships
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Describe a person with Narcissistic personality disorder.
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These people have over-rated sense of self-importance; are ego-centric; grandiose, exploit others, have major interpersonal conflict, can be violent.
They are describes as in love w/oneself, constantly seeking praise, envious of others, expect special treatment, unable to tolerate correction |
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What level of development are Narcissistic and Histrionic types fall into on Erickson's scale?
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Industry vs. inferiority
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Describe Antisocial personality types
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Antisocial types violates the types of others, they lack guilt, shame or remorse for their action, they are usually charming but hostile, they are known for lying, truancy, thefts, fights, drug abuse and suicidal tendencies.
These are the: con-man, they are the promiscuous types, they have a long hx of violence, and difficulty in keeping a job |
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What level of development are Antisocial types fall into on Erickson's scale?
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Autonomy vs. shame and doubt
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Describe the Borderline personality type
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These people have unstable object relationship, unable to tolerate being alone, they lack a sense of self-identity, overly dependent, views people concretely as all good or all bad, they do "splitting" activities when it comes to relationships, they do impulsive self destructive acts.
These are your: "FATAL ATTRACTION" types. |
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What are the nursing behaviors needed to treat the patients with dramatic or emotional personality disorders?
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1) team unity and consistency of care - defer all questions to the nurse.
2) self awareness - be calm and non-confrontational in approach to patient 3) assist patient to develop functional behavior (promote autonomy, and self care) 4) Help patient to develop distress tolerance skills (teach coping effectiveness) 5) assist patient to learn self-observation (let them exp. the consequences of their behavior) 6) assist pt. to develop appropriate expressions of feelings and needs (i.e. journal) 7). promote self responsibility |
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Describe the avoidant type personality
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Avoidant types are: extremely sensitive to rejection, they are withdrawn, puts self down
They tend to be: shy, reluctant to participate, desires companionship but lack confidence, reluctant to try, they always need validation |
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Describe the dependent type personality
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Dependent types are usually: intensely uncomfortable being alone, forgo their own needs for others, passive, submissive, easily manipulated
These types tend to: fear rejection, are followers, gets others to assume responsibility for their own lives, have anxious attachments |
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Describe the Obsessive-compulsive types
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Obsessive-compulsive types: strive for perfection in self/others, preoccupied by details, they are rigid, formal, stingy with emotions, have hoarding behaviors, and alienate others.
These types tend to: be overly careful and follow procedures, seen as very serious. |
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Describe the passive-aggressive types
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Passive-aggressive types are: resentful, covert obstructionist, procrastinators, anxious with success, resists demands, underlying aggression, afraid to express self directly.
These tend to be: rarely tranquil/happy, resists demand for performance |
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What behaviors are needed for the nurse in the management of anxious fearful types?
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1) Nurse must initiate the relationship.
2) manage pt anxiety 3) set limits on maladaptive behaviors 4) give control appropriately 5) assist to verbalize feelings and needs directly 6) promote self-acceptance 7) reduce behaviors or secondary gains 8) help patient to learn to play |
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Kim has a diagnosis of borderline personality disorder. She often exhibits alternating clinging and distancing behaviors. The most appropriate nursing intervention with this type of behavior would be to:
a) encourage Kim to establish trust in one staff person, with whom all therapeutic interaction should take place b) Secure a verbal contract from Kim that she will discontinue these behaviors c) withdraw attention if these behaviors continue d) rotate staff members who work with Kim so that she will learn to relate to more than 1 person |
answer: d.
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Kim, the borderline personality type, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in borderline client except:
a) refusal to stay in room alone, stating, "it's so lonely" b) Asking nurse Jones for cigarettes after 20 minutes, knowing the assigned nurse has explained she must wait 1 hour c) stating to nurse Jones, " I really like having you for my nurse. You're the best one around here." d. Cutting arms with razor blade after discussing dismissal plans with the doctor. |
answer: a.
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"Splitting" by the client with borderline personality disorder denotes
a. Evidence of precocious development b. a primitive defense mechanism in which the client sees all objects as good or all bad c. a brief psychotic episode in which the client loses contact with reality d. two distinct personalities within the borderline cliet |
answer: b.
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Jack has been arrested for breaking into a jewelry store and thousands in diamonds. Based on a long hx of maladaptive behavior he has been given the diagnosis of antisocial personality disorder.
Which of the following characteristics would you expect to asses in Jack. a. lack of guilt for wrong doing b. insight into his own behavior c. ability to learn form the past experiences d. compliance with authority |
answer. a.
Antisocial have no guilt or conscience of their actions |
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Milieu therapy is a good choice of therapy for antisocial personality types b/c it:
a) provides a system of punishment and rewards for behavior modification b. emulates a social community in with the client may learn to live harmoniously with others c. provides mostly one to one interactions between the client and therapist d. proves a very structure setting in which the clients have very little input into the planning of their care |
answer: b.
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in evaluating Jack, the antisocial, progress, which of the following behaviors would be considered the most significant indication of positive change?
a) jack got angry at the group only once this week b) jack was able to wait a whole hour for cigarette w/o verbally abusing the staff c) On his own initiative, Jack sent a note of apology to a man he had injured in recent fight d. Jack sated he would no longer start any more fights |
answer. c.
Jack initiated the activity and it was a sign of remorse. |
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Katie was given a task at the last minute before work was over but passes it along to Donna, stating "I can't stay over! I'm meeting a friend at 5, be a doll and finish this for me." Donna agrees, but is silently fuming at Katie since it is the 3rd time 2 weeks Katie has done this. Donna, decides to leave instead and w/o finishing the job by stating" Screw her, let's see her get in trouble for a change." This is an example of:
a. antisocial b. paranoid c. passive-aggressive d. obsessive-compulsive |
Answer: c.
actions don't match up to their words. |
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Which of the following behavioral patters is characteristic of individuals with histrionic personality disorder?
a) belittling themselves and their abilities b. overreacting inappropriately to minor stimuli c. suspicious and mistrustful of others d. a lifelong pattern of social withdraw |
answer: b.
Histrionic types are prone to exaggerating |
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Define Mood
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an internal emotional state; it is our source of emotional energy, expression of feelings and state of being.
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What is the psychoanalytic definition of depression?
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Depression is a suppression of anger and hostility against loss that has been directed inwards that lowers our emotional level
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What is the Cognitive view of a person with depression like?
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People suffering from depression have a negative view of self and the world; having a negative reinforcement of their views
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What is learned helplessness with depression?
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People with learned helplessness lack a sense of autonomy and are dependent of others.
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What are the biochemical reasons for depression?
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Depression maybe caused by a decrease in the catecholamine neurotransmitters
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Which neurotransmitters play a role in depression?
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Serotonin and Epinephrine. Decrease in either one can cause depression
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What medical conditions play a role in depression?
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Endocrine disorder, Neurologic disorders, Hepatitis, and autoimmune disorders and SE from Meds
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How can Drugs and Alcohol induce mood disorders?
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Drugs such as stimulants can cause manic like states, Alcohol can cause depressive states
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What is a situational crisis and how does it effect mood disorders?
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Situational crisis are crisis brought about a third party, loss of a job, death, these can cause mood disorders such as depression
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What does the clinical feature of depression look like?
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a. anergia
b. mutism/imparied communication c. impaired acitvity d. regressed behaviors e. anhedonia |
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What are secondary gains?
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Gains that come from being in a certain state---such as more attention, escaping responsibilities,
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What emotions may you see with a person with depression?
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anger, guilt, futility, anxiety, helplessness, hopelessness, crying and weeping
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What is the thought process like for a person with depression
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1) the ruminate over feelings of inadequacy and worthlessness
2) can be psychotic; have delusions and develop paranoia and hallucinations 3) have suicidal ideations and gestures 4) psychomotor retardation/agitation--slow thought formation and lacking in focus |
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What impact does depression have on the physical and psychological needs of a person?
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1) sleep disturbances--too much/little
2) Altered nutrition--too much/little 3)decreased libido 4)poor hygiene 5) decrease physiologic process--urination/defication |
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What class of medications are used to treat depression?
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Antidepressants
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How do antidepressants work?
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They manipulate either the re-uptake, breakdown, or reduce the stimulation of the receptors at the beta-adrenergic level.
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What are the therapeutic effects of antidepressants?
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1. elevated mood
2. increase and organize thought process 3. animated behavior 4. improve sleep and appetite These take 7-10 days to reach peak, but 4-6 weeks to reach therapeutic levels |
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Give a list of Tricyclics
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Elavil
Tofranil Sinequan Norpramine Aventyl Pamelor Vivactil Asendin |
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What is the action of Tricyclics?
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They block re-uptake of neurotransmitters
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What are the SE of tricyclics?
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Anticholinergic like SE; blurred vision, dizziness, urinary retention, tachy cardia
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What effects do Tricyclics have on the CNS?
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They have a sedative effect; they increase seizure potential
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List MAOI inhibitors
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Parplan, Nardil, Parnate
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What is the action of MAOI drugs?
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MAOI inhibit naturally occuring monamine oxidase activity
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what are the SE of MAOI drugs?
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Orthostatic hypo-tension,weight gain, edema arrhythmia, cardiovascular conduction disorder, and multiple over the counter drug interactions
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TRUE or FALSE:
MAOI are the preferred drug of choice for depression and other mood disorders? |
FALSE:
The side effects of MAOI drugs make them a last ditch effort for therapeutic treatment of mood disorders. |
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What foods must people avoid on MAOI drugs?
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Anything aged, dried, fermented, salted, smoked or pickled. Aged cheese.Fava or broad beans, sauerkraut, pickles, olives. Any fermented soy products (ie miso, soy sauce, teriyaki sauce).
All nuts, All alcoholic and fermented beverages |
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List the SSRI drugs
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Prozac, Zoloft, Paxil, Luvox, Celexa, Remeron, Lexapro.
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What is the action of SSRI drugs?
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They inhibit Serotonin reuptake
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What are the SE of SSRI drugs?
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They are fewer than tricyclics, increase sexual dysfunction, produces GI upset, Nausea, Vomiting, weight loss
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What other disorders are SSRI used for?
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Anorexia, bulimia, and Anxiety disorders
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What must the nurse educate patients about SSRI drugs?
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Do not abruptly discontinue this drug; this can cause dizziness, lethargy, and HA and Nausea
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What is serotonin syndrome?
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It is an over abundance of serotonin caused by drug interaction with other antidepresants; this can cause diaphoresis, tachycardia, restlessness,
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List the SNRI drugs
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Cymbalta, Effexor, Pristiq
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What are the actions of SNRI drugs?
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increase serotonin and norepinepherine by inhibiting their re-uptake; lowers glutamate sensitivity
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What is the therapeutic effect of cymbalata?
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manges physical pain associated with depression
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What is the therapeutic effect of effexor?
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manages generalized/social anxiety
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Give 3 examples of atypical antidepressants
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Wellbutrin (good for suicidial thoughts)
Desyrel - helps with sleep disturbances Serzone |
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when is ECT used?
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only indicate when other antidepressants are not effective, when acutely suicidal psychotic features or vegetative states present themselves
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When is ECT contraindicated?
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those with Increased intracranial pressure
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what is the action of ECT?
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increases brain sensitivity to norepinepherine
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What are the pre-procedural prep for the patient having ECT?
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pt muse have informed consent
pt must be npo vitals must be monitored Atropine must be given (decreases mucus secretions) |
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what kind of SE are seen with ECT?
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Memory impairment--retrograde amnesia that can last from 1 month - 6 weeks.
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In suicide prevention, where should you intervene for the patient?
a) threats b) gestures c) thoughts d) attempt |
Answer: c.
Thoughts--start from the beginning immediately! |
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What are the psycho-therapeutic management skills needed for a patient with suicide intentions/depression?
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1) self awareness for the nurse
2) assume all depressed pts are a high risk for suicide 3) inquire into suicidal ideas 4) determine intent (do they have a plan, how are they going to do this..etc) 5) closely observe behaviors 6) prevent isolation 7) assist in ADL 8) ensure nutrition 9)encourage rest 10) encourage activity 11) prevent rumination 12) set small goals 13) set limits on maladaptive behaviors 14) promote independence |
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What is Mania?
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It is a reaction formation to depression (opposite response). Keeping oneself in euphoric state to avoid depression
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What is the biochemical reason behind mania?
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increase in cathecolamine neurotransmitters; neuroepinepherine and serotonin
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what medical condition can contribute to mania?
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Hypothyroidism
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What are the clinical manifestations of mania far as the thought process?
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1. racing thoughts, flights of ideals
2. overly talkative, boisterous 3. rapid slurred pressured speech, rambling 4. witty, amusing, full of fun 5. easily distracted 6. inflated ego 7. lack of insight |
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What are the clinical manifestations of mania far as the emotional aspect of mania?
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Manics are:
1. appeared to be elated all the time, always on the go 2. irritable, or labile 3. can become argumentative, unreasonably demanding, derogatory 4. thrive on attention, love, affection 5. increased libido! |
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What are the clinical manifestations of mania far as the behavioral aspect of mania?
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1. excessive behavior, constantly active w/o any accomplishment
2. un-inhibited behavior - no self control 3. little patience- impulsive 4. can become volatile, abusive, resort to pushing/shoving/hitting 5. behavior is not related to what is happening around him 6. difficult to interpret behavior 7. increase substance and drug abuse |
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How does the manic physically appear?
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1. skinny--decreased nutritional intake
2. physically tired--due to decrease need to sleep |
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What is the action of lithium?
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Lithium alters the acid-base ratio of neurons by substituting sodium ions in the neurons with lithium
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What is the therapeutic effect of lithium?
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Lithium produces a stabilization in mood and prevents further manic episodes
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What other drugs are usually prescribed with lithium?
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usually an anti-psychotic drug i.e. Respirodol or Zyprexa
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What is the therapeutic levels of lithium?
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1.0-1.5 mmol/L, serum level must be maintained from 0.6-1.2 mmol/l
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What point is lithium toxic?
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when it reaches 2.0 mmol/l
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What are the toxic side effects of lithium?
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Very similar to Na imbalance; confusion, dizziness, seizures, vomiting, HA, blurred vision, tinnitus
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What diet restrictions are there for lithium?
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watch for fluid and sodium intake. Too much fluid can cause dilution of lithium, too little can cause toxic effects of lithium. Too much Na in diet can cause no therapeutic effect vs too little can cause toxic effect.
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List the anticonvulsant drugs
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Tergretol, Depakote, Klonopin, Lamictal, neurotinin, gabitrl
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What is the action of anticonvulsant drugs?
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inhibit the spread of abnormal electrical activity in the brain by normalizing abnormal fluxes of sodium across the nerve cell membrane. Reduces firing rate of the nerve.
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What are the therapeutic effects of anticonvulsant drugs?
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They produce stabilization of moods and decreases mood swings
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What labs are required for anticonvulsants?
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PTT, INR, serum drug levels
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