Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
51 Cards in this Set
- Front
- Back
|
Cluster A personality- Paranoid |
Suspicious of others. Fear of exploitation from others, slow to trust. Hypervigiliant, prone to counterattack, hostile |
|
|
Nursing interventions for Cluster A personality- Paranoid |
Give straightforward explanations of testing, history taking, procedures, etc to decrease pt’s fears. |
|
|
Cluster A personality- Schizoid |
Avoid close relationships, socially isolated, poor occupational functioning, cold, detached |
|
|
Nursing Intervention for Cluster A personality- schizoid |
Strive for simplification and clarity to reduce anxiety |
|
|
Cluster A personality- Schizotypal |
Ideas for reference, magical thinking/odd beliefs, perceptual distortions, vague, stereotyped speech, frightened, suspicious. Distant and strained social relationships |
|
|
Nursing Interventions for Cluster A personality- Schizotypal |
Explanations can ease anxiety |
|
|
Cluster B personality- antisocial |
Superficial charm, violates the rights of others, exploits others, lies, cheat, lacks guilt or remorse. Impulsive, act out, lacks empathy. Extremely manipulative and aggressive |
|
|
Nursing Intervention for Cluster B personality- antisocial |
Establish and adhere to a POC and maintain clear boundaries if they are to minimize client manipulation and acting out |
|
|
Cluster B- borderline |
Unstable, intense relationships, identity disturbances, impulsive, self mutilation, rapid mood shifts. Chronic emptiness, intense fear of abandonment, splitting, anger |
|
|
Nursing Interventions for Cluster B- borderline |
Focus on relationship building, safety, and set limits |
|
|
Cluster B- Histrionic |
Center of attention, flamboyant, seductive or provocative in bx. Shallow, rapidly shifting emotions, dramatic expressions of emotions, depression when admiration of others is not given. Preoccupied with own appearance. Suicide gestures may result in entry to healthcare center |
|
|
Nursing Interventions of Cluster B- Histrionic |
Support, psychotherapy (the treatment of mental disorder by psychological rather than medical means.) |
|
|
Cluster B personality- Narcissistic |
Grandiosity (over-inflated sense of worth, power, knowledge, or identity.) need to be admired, sense of entitlement, arrogant, patronizing, rude, overestimates self and underestimate others. When approached/corrected, person feels humiliated/degraded. To lower anxiety, person may counterattack |
|
|
Nursing Interventions for Cluster B personality- Narcissistic |
Gently help client identify attempts to seek and become perfect, exhibit grandiose bx, sense of entitlement |
|
|
Cluster A personalities are... |
Odd and eccentric Suspicious Cold Withdrawn Irrational |
|
|
Cluster B personalities are... |
Dramatic, emotional, erratic Attention seeking Labile (easily broken) Shallow Increased rates of substance use/suicide |
|
|
Cluster C personalities are... |
Anxious and fearful Tense Overcontrolled Depressed |
|
|
Cluster C personality- avoidant |
Social inhibition, feelings of inadequacy, hypersensitive to criticism, preoccupation w/ fear of rejection. Demands of workplace are overwhelming. Projects that caregivers will hall them through disapproval and perceive rejection where none exists. |
|
|
Nursing Interventions for Cluster C personality- avoidant |
Teach socialization skills, provide positive feedback, build self-esteem |
|
|
Cluster C personality- dependent |
Inability to make daily decisions without advice and reassurance, need of others to be responsible for important areas of life. Anxious and helpless alone, submissive. Solicit care taking by clinging. Fear abandonment if they are too competent. Experience anxiety and may have co-existing depression |
|
|
Cluster C personality- obsessive-compulsive |
Preoccupied with rules, perfectionist, too busy to have friends, rigid control (which is difficulty conceiving new viewpoints/ideas.), and superficial (what a person can do for them) relationships. Lack a sense of humor- formal demeanor. Complain about others’ inefficiencies (not achieving maximum productivity) and gives others direction |
|
|
Nursing Interventions for Manipulation |
1.) Assess your own rxn toward pt. If you feel angry, discuss with peers ways to reframe thinking to defray feelings of anger -Rationale: anger is a natural response to being manipulated and blocks effective nurse-pt interaction
2.) Assess pt’s interactions for a short period before labeling as manipulative - Rationale: a pt might respond to one particular, high stress situation with maladaptive bx, but use appropriate bx in other situations
3.) Set limits on any manipulative bx such as •arguing/begging •flattery/ seductiveness •instilling guilt/clinging •constant attn seeking •pitting one person, staff, group against another • frequent disregard to rules •constant engagement in power struggles •angry/demanding bx -Rationale: From the beginning, limits need to be clear. It will be necessary to refer to these limits frequently because it is to be expected that the patient will test these limits repeatedly
4.) Intervene in manipulative bx •all limits should be adhered to by all staff involved •objective physical signs in managing clinical problems should be carefully documented •bx should be documented objectively (give times, dates, circumstances) •provide clear boundaries and consequences •enforce consequences -Rationale: pt’s will test limits, and once they understand the limits are solid, this understanding can motivate them to work on other ways to meet their needs. It is hoped that this will be done either the nurse clinician by following problem-solving alternative bx and learning new effective communication skills
5.) Be vigilant (careful); avoid: •discussing yourself or other staff members with the patient •promising to keep a secret for the patient •do special favors for the pt -Rationale: pts can use this kind of information to manipulate you and/or split staff. Decline all invitations in a firm, but straightforward manner; for example: -“I am here to focus on you” -“I cannot keep secrets from other staff. If you tell me something, I may have to share it” -“I cannot accept gifts, but I am wondering what this means to you” -“You are to return to the unit by 4 on Sunday, period”
|
|
|
Child abuse |
When a child is harmed physically, psychologically, sexually or through acts of neglect |
|
|
Physical abuse |
Intentional physical injury inflicted by a caregiver |
|
|
Physical indicators of physical abuse |
Bruises, wounds, injuries in differing stages of healing. Pattering of abuse- cigarette burns, coat hangers in areas that can be hidden by clothes. Bald patches, hemorrhaging |
|
|
Bx indicators of physical abuse |
Excessive fear of parents/constant efforts to please, wary of adult contact, nightmares/anxiety, obvious attempts to hide bruises, withdrawn, depressed, aggressive or disruptive bx at home/school, regressive bx. |
|
|
Neglect |
Failure to provide for the child’s basic needs |
|
|
Physical indicators of neglect |
Physical neglect: •malnourished •underweight/poor growth pattern •inadequately supervised •Poor hygiene •unattended physical problems •inappropriately dressed -Educational neglect •school problems/failure •not enrolled in mandatory school for age of child |
|
|
Bx indicators for neglect |
•Soiled clothing/poor hygiene •begging/stealing food •emaciated-distended belly •arrives early, stay late for school •psychosomatic complaints •delinquency/chronic truancy •ETOH/drug abuse •special educational needs not being attended
|
|
|
Sexual abuse |
Perpetrated by family or non-family member. Some types include exhibitionism (mental condition characterized by the compulsion to display one's genitals in public.) touching, sexual penetration, being forced to watch sex acts or porn. In extreme cases, being sold for sexual favors |
|
|
Physical indicators of sexual abuse |
Difficulty in walking or sitting, itching in private areas, UTIs, painful urination, torn-stained-bloody underclothes, bruises and bleeding/swelling in genitalia/anal area- discharge. STIs especially in preteens, objects/liquid in vagina/rectum/urethra |
|
|
Bx indicators for sexual abuse |
•mistrust of adults •abnormal/distorted views of sex •advanced/unusual sexual bx/knowledge for age •phobias: fear of the dark, men, strangers, leaving the house •delinquency/running away •self-injury/suicidal thoughts or bx •mental disorders may develop, including PTSD, depression, dissociative disorders, eating disorders, conduct disorders, mood swings, and anxiety |
|
|
Emotional/Psychological abuse |
Bx that convey to the child that he/she is worthless, flawed, unloved, unwanted. These include constant criticism, threats, insults, yelling, ignoring, favoritism, and harsh demands |
|
|
Physical indicators of Emotional/Psychological abuse |
Speech disorders, lag in physical development |
|
|
Bx indicators of Emotional/Psychological abuse |
•Difficulty in learning and living up to potential •lack of self-confidence •inappropriate adult like bx/infantile bx •poor social skills •dramatic bx changes such as aggressiveness, drug use, change in friends or clothing, self-harm bx, compulsiveness, and a needy pursuit of attn |
|
|
Sexual assault |
An act of violence, power, and hate- not sex- and most often results in devastating severe and long term trauma.
-Gender: women have a higher vulnerability rate than men (3 in 1) both are at high risk if they are handicapped/mental disorders -Age: people ages 16-19 have higher risk; children b/t 8 and 12 (1 in 3 girls; 1 in 6 boys before the age of 18) -Older Adults -H/O sexual abuse: women who were raped before the age of 18 are 2-3 times more likely to be sexually assaulted as adults -Drugs/ETOH use -High-risk sexual bx: often a consequence of childhood sexual abuse -Poverty: poor women may be at risk when they need to support themselves/children and trade sex for necessities -Ethnicity/culture: NA/ Alaskan Native women are more than 2.5x more likely to be raped/assaulted than other women in the US |
|
|
Psychosocial factors of sexual assault |
Sexual offenders are found to have antisocial personality disorders who view humans as objects. |
|
|
Cycle of violence |
Three Phases: 1.) tension-building 2.) battering 3.) honeymoon |
|
|
Sexual Assault 5 Step Best Practice Guidelines/ Assessment |
1.) Head to toe physical assessment, observing for signs of injury 2.) Detailed genital examination, observing for signs of injury 3.) Evidence collection and preservation 4.) Documentation of physical findings (both written/photo documentation) 5.) Tx, discharge planning and F/U care |
|
|
Priority Intervention for Sexual Assault |
Critical/serious physical injuries |
|
|
Mandatory reporting for Sexual Assault |
- age 0-17 - elders at risk *consents are obtained prior to reporting on pt’s who are over the age of 18 and who are not cognitively delayed/impaired |
|
|
Domestic violence |
(Also called family abuse/battering) normally thought of as occurring b/t more powerful (perpetrator) and less powerful (victim) family members. Can be an authority figure- religious leader, caregiver, HCP, teacher, coach |
|
|
Elder Abuse |
Most often abusers are middle aged child/family member, staff members |
|
|
Elder Abuse Assessment |
*Adult Protective Services (APS) •mandatory reporting -fear of being alone with caregiver -malnutrition, begging for food, dehydration -bedsores, S/Ts, bruises, swelling, fx -in need of medical/dental care -left unattended for long periods of time -reports of abuse/neglect -passive/withdrawn/emotionless bx -appears overmedicated -vaginal/rectal pain/tears/bleeding or STIs -concern over finances -inability to pay for medications/needed services -transfer of property by elder who lacks the mental capacity to consent -valuables missing |
|
|
*borderline personality bx- serious and disabling brain disease marked by impulsivity and dysregulation |
1.) Dialectic bx therapy- mindfulness, deep breathing, relaxation techniques.— helps switch brain from SNS to PSNS (relaxation mode) 2.) Medications- SSRIs, anticonvulsants, second generation antipsychotics, lithium— helps dampen angry, impulsive, labile bx |
|
|
Restraints |
|
|
|
Milieu Therapy- personality disorders |
Providing a safe environment is fundamental that is quiet, structured, and supportive. Task-oriented therapy/occupational and art therapy can be helpful for these pt’s to calm and express feelings. Therapeutic goals is to make needs/thoughts conscious |
|
|
Celexa/citalopram |
Antidepressant- SSRI Body system affected: CV: torsade de pointes May cause serious/fatal rxn to MAOs No caffeine |
|
|
Marplan/isocarboxazid |
Antidepressant- monamine oxidase inhibitors (MAOI) Body system Affected: CNS: seizure CV: Hypertensive Crisis No tyramine- BP, meats/fish, yeasty food, fermented foods, milk products, foods high in PROTEIN (overripe fruits/veggies), |
|
|
Rohypnol |
Illegal in the USA- Schedule IV drug Benzo to tx severe insomnia and assist with anesthesia- short term use |
|
|
Indicators of Domestic Violence |
- recurrent ED visits for physical injuries attributed to being “accident prone” - somatic sx reflecting anxiety/chronic stress ie: hyperventilation, GI distress, HTN, insomnia, nightmares, eczema or hair loss in some places - signs of depression- sadness, tearfulness, sleep/appetite disturbance, irritability, loss of interest in usual activities, fatigue, suicidal ideations |
