Shared Flashcard Set

Details

Personality disorders
psych
37
Nursing
Not Applicable
02/10/2012

Additional Nursing Flashcards

 


 

Cards

Term

 

Personality traits

 

Definition

 

 enduring patterns of relating

 

 
Term
Personality
Definition
Characteristics traits and responses
Term
healthy personality
Definition
positive self concept, body image, can relate to others openly and honestly
Term

Personality Disorders

 

common characteristics

Definition

 

qAre an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture

 

qAre pervasive & inflexible

 

qHave an onset in adolescence or early adulthood

 

qAre stable over time, and leads to distress or impairment

 

qConsistent problems with daily functioning in thoughts, emotions, & interpersonal relationships

 

qTolerates stress poorly

 

qLife events & losses increase anxiety

 

qUnconsciously use primitive defenses to defend themselves

Need treatment when in crisis

qLack or have weak conscience, no guilt

 

qCo-morbidity with substance abuse, depression

 

qPoor success in education, profession, love

 

qVery good at causing interpersonal conflict

 

 

Term
defense mechanisms review
Definition

 

qProjection – denies own feelings & puts responsibility for those feelings outside one’s self (think of Im not angry you are angry at me)
qSplitting – inability to integrate the good & bad about people or objects, polarity of feelings
qDissociation – separate mental processes from behavior & from consciousness
qProjective identification 

 

   justifies feelings by assigning those feelings onto another

qEntitlement – feels deserving of special attention & demands it
qIdealization – views others as perfect with unrealistic powers to fulfill all needs
qDevaluation – criticizes others to defend feelings of inadequacy
qOmnipotence – fantasies of exaggerated importance or greatness

 

Term
Clusters of personaliy disorders
Definition

A) odd, eccentirc

Schizoid, Schizotypical, Paranoid

 

B) dramatic, emotional, erratic

Antisocial, Borderline, histrionic, Narcissiatic

 

C ) Anxious, fearful

avoidant, dependaent, obsessive compulsive

Term

 

Paranoid Personality disorder

 

Definition

 

qSuspicious of others without reason
qDoubts loyalty of friends & co-workers
qReads hidden meaning & personal attacks into everyday remarks or actions
qSuspects significant other of unfaithfulness without justification 
 

S: Spouse fidelity suspected

U: Unforgiving, bears a grudge

S: Suspicious of others

P: Perceives attacks (and reacts quickly)

E: “Enemy or friend,” suspects associates & friends

C: Confiding in others is feared

T: Threats perceived in benign events

 

Term
Schizoid Personality
Definition

 

qPrefers to be alone (lives in own word, dont care)
qIndifferent to praise or criticism 
qIndifferent to social relationships other than with 1st degree relatives
qEmotionally cold & detached with flattened affect

D: Detached or flattened affect

I: Indifferent to criticism and praise

S: Sexual experiences of little interest

T: Tasks (activities) done solitarily

A: Absence of close friends

N: Neither desires or enjoys close relationships

T: Takes pleasure in few activities

 

Term
Schizotypal personality disorder
Definition

 

qUncomfortable with social interaction so usually isolated
qMagical thinking & odd beliefs
qIdeas of reference
qIllusions, delusions, hallucinations
qInappropriate affect
qBizarre speech & appearance
Think of star trek weirdos and comicon conventions
qSuspicious & withdrawn

M: Magical thinking or odd beliefs

E: Experiences unusual perceptions

P: Paranoid ideation

E: Eccentric behavior or appearance

C: Constricted (or inappropriate) affect

U: Unusual (odd) thinking and speech

L: Lacks close friends

I: Ideas of reference

A: Anxiety in social situations

R: Rule out psychotic disorders and pervasive developmental disorder

 

Term

Cluster A (odd or eccentric)

Personaliy Disorder Interventions and treatment

Definition
qBe aware of tendency toward isolation & suspiciousness
qAvoid being “too nice” or overly friendly
qUse neutral, matter of fact approach
qGive clear, straight forward explanations
qSupportive psychotherapy
qAntidepressants or antipsychotics
Term
Antisocial Personality disorder
Definition

 

qSuperficial charm
qViolates rights of others
qExploitive
qManipulative
qGuiltless
          C: Conformity to law lacking
O: Obligations ignored
R: Reckless disregard for safety of self or others
R: Remorse lacking
U: Underhanded (deceitful, lies, cons others)
P: Planning insufficient (impulsive)
T: Temper (irritable and aggressive)

 

Term

Antisocial personality disorder

interventions and treatment

Definition

 

qDocument manipulation, aggression, impulsivity
qSet up clear boundaries & consequences
qUse clear, realistic limits on specific behaviors
qStaff should guard against being manipulated or feeling guilty
qUse team meetings to gather support
qAsk patient to control their behavior but assist prn
qAssess threats
qGet help if patient out of control
qIncrease restrictions for client/unit safety
qOffer antianxiety meds or antidepressants for anxiety, agitation
qRitalin for ADHD
qAnticonvulsants to decrease impulsive behavior
qGoals are to improve relationships, gain insight into feelings & behaviors

 

Term
Histrionic Personality disorder
Definition

 

qNeeds to be center of attention
qDramatic & flamboyant
qShallow
qSeductive & provocative
qOverly concerned with need to impress
qExaggerates to gain attention
qColorful extroverted behavior in excitable, emotional people

 

          P: Provocative or sexually seductive behavior
R: Relationships considered more intimate than they are

         A: Attention, are uncomfortable when not the center of attention
I: Influenced easily
S: Style of speech is impressionistic, lacks detail
E: Emotions are rapidly shifting and shallow

         M: Made up, uses physical appearance used to draw attention to self

         E: Emotions exaggerated & theatrical

 

Term

histrionic personality disorder

interventions and treatment

Definition

 

qSeductive & flamboyant behavior used as response to stress
qKeep nurse-pt relationship professional
qEncourage/model use of concrete language
qTeach & model assertiveness
qGroup therapy
qAntidepressants
qGoals are to prevent suicide, gain insight into unrealistic expectations & fears

 

Term
narcissistic personality dissorder
Definition

 

qGrandiose self-importance
qExploits others
qSense of entitlement
qFantasies of power & greatness
qArrogant, patronizing, rude
qCovering a fragile ego
qWhen limits are set feels humiliated & may counter attack

 

         S: Special, believes he or she is special and unique
P: Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
E: Entitlement
C: Conceited with grandiose sense of self-importance

         I: Interpersonal exploitation
A: Arrogant

         L: Lacks empathy

Term

Narcissist personality disorder

interventions and treatment

Definition

 

qStay neutral & avoid power struggles
qAvoid being defensive when client is critical
qConvey unassuming self-confidence
qPsychotherapy if pt acknowledges narcissism
qGroup therapy
qLithium for mood swings, antidepressants
qGoals are to promote healthier sense of individuality, recognize others as separate people, improve coping

 

Term
Borderline personality disorder
Definition

 

qMood shifts, anger, depression
qUnstable, intense relationships
qImpulsive, self-mutilating, or suicidal
qFeelings of chronic emptiness
qFear of abandonment
qLacks clear identity, life plan, values
qSplitting, all or nothing thinking

Episodes of psychotic regression

 

 

A: Abandonment issues

 

 

 

M: Mood instability (marked reactivity of mood)

 

 

 

S: Suicidal or self-mutilating behavior

 

 

 

U: Unstable and intense relationships

 

 

 

I: Impulsivity in two potentially self-damaging areas

 

 

 

C: Control of anger is lacking

 

 

 

I: Identity disturbance

 

 

 

D: Dissociative or paranoid symptoms that are transient and stress-related

 

 

 

E: Emptiness, feelings of chronic emptiness 

 

 

 

 

 

 

Term

Borderline Personality disorder

interventions and treatment

Definition

 

qAssess: impulsivity, SI, self-mutilation, aggressiveness, psychosis
qMaintain safety
qSet clear, realistic goals
qBe alert to manipulative behavior
qHelp to cope/control emotions by structured environment, journaling, & consistent limits
qDecrease splitting & staff conflicts by team communication
qCheck self for counter-transference
qDo not reject or rescue
qBehavioral problems are addressed by revisiting goals & boundaries
qPsychotherapy, Dialectical Behavior Therapy, group therapy
qAntipsychotics to control anger & psychosis
qAntidepressants

 

Term
Avoidant personality disorder
Definition

 

qInhibited
qWithdrawn
qFeels inadequate
qIs uninvolved
qFears disapproval & rejection
qSelf-perceived to be socially inept

       C: Certainty of being liked required before willing to get involved with others
R: Rejection or criticism preoccupies one's thoughts in social situations
I: Intimate relationships are restrained due to fear of being shamed
N: New interpersonal relationships are inhibited
G: Gets around (avoids) occupational activity involving significant interpersonal contact
E: Embarrassment (potential) prevents new activity or taking personal risks
S: Self viewed as unappealing, inept, or inferior

 

Term

Avoidant personality disorder

interventions and treatment

Definition

 

qFriendly, accepting, reassuring approach
qEase into social situations very gradually
qPsychotherapy & group therapy for trust issues
qAssertiveness training
qAntidepressants & antianxiety agents
qAlpha adrenergic agents to reduce ANS hyperactivity

 

Term
Dependent personality disorder
Definition

 

qDecreased self confidence
qWants to be taken care of
qAnxious, helpless, fearful
qPassive & clinging

      R: Reassurance required for decisions
E: Expressing disagreement is difficult due to fear of loss of support or approval
L: Life responsibilities need to be assumed by others

       I: Initiating projects is difficult due to lack of self-confidence)

       A: Alone, feels helpless and uncomfortable when alone
N: Nurturance, goes to excessive lengths to obtain nurturance and support from others
C: Companionship from another relationship sought urgently when close relationship ends
E: Exaggerated fears of being left to care for self

 

Term

Dependent personality disorder

interventions and treatment

Definition

 

qIdentify & help address stressors
qNeed to meet pt’s needs while setting limits on clinging behavior
qModel assertiveness
qPsychotherapy, behavioral, group & family therapy
qAntianxiety agents & antidepressants for specific symptoms
qImipramine for panic attacks

 

Term

Obsessive compulsive

personality disorder

Definition

 

qPreoccupied with details, rules, organization
qToo busy for friends, stays polite & formal
qPerfectionist
qInflexible
qSuperficial
qInner struggle to control self, others, environment
qNo actual obsessions or compulsions
 

     L: Loses point of activity due to preoccupation with  detail

     A: Ability to complete tasks due to perfectionism
W: Worthless objects can’t be discarded

       F: Friendships & leisure activities excluded due to a preoccupation with work
I: Inflexible, scrupulous, over conscientious on ethics, values, or morality, not accounted for by religion or culture
R: Reluctant to delegate unless others submit to exact guidelines
M: Miserly toward self and others

         S: Stubbornness & rigidity

 

Term

Obsessive compulsive personality disorder

intervention and treatments

Definition

 

qGuard against power struggles & use of defense mechanisms (intellectualization, rationalization, isolation, undoing, reaction formation)
qPsychotherapy
qClomipramine & SSRIs for obsessional thinking & depression

 

Term
Etiology of personality disorders
Definition

 

qGenetics & child’s temperament
qPsychological factors
qEnvironmental factors
qDiathesis-Stress Model
ØDiathesis: biology & environment, inc. temperament
ØStress:  influences on personality ie., physical, social, psychological, emotional

 

Term
Assessment of personality disorders
Definition

 

qMinnesota Multiphasic Personality Inventory
qMedical history
qMeds used, other substances used/abused, food & money habits
qInvolvement with court system
qCurrent level of crisis
qDysfunctional coping style

 

Term
Self Awareness
Definition

 

qHave capacity to frustrate providers
qPerceived as aggravating & demanding by staff, value judgments
qWill try to merge personal boundaries with staff
qHave problems with trust so difficult to engage in treatment
qEffective care is at risk – staff need to set clear boundaries!

 

Term

treatment

of personality disorders

Definition

 

qRealistic goal setting is important!
qExpect improved relationships
qCommunicate positive expectations
qCase management geared toward reducing the need for hospitalization
qShort Term Goal: specific to immediate problem, insure safety, decrease acting out behavior, offer structure
qLong Term Goal: will tolerate anxiety while learning to relate openly & directly
qCan learn to cope with support from provider
qClient’s ability is change is limited yet prognosis is more optimistic than in past
qProtect client from harm, to self or others
qFocus on strengths, behavior, expectations, positive reinforcement
qUse limits & verbal contracts to decrease splitting, clinging, & other primitive defense mechanisms
qCheck context when client blames
qOrient to reality
qEncourage client to verbalize or journal feeling vs. acting out or self-harm
qMeds for anxiety, depression, psychosis
qCase management

 

Term
Dialectical Behavior therapy
Definition

 

qSome success with Borderline Personality Disorder clients
qEvidenced based
qLong term, structured weekly therapy
qPhone access for support in crisis
qDialectics is method of argument using contradictory facts to resolve differences into united whole

 

Term
treating impulsive behavior
Definition

 

qIdentify antecedent needs & feelings
qDiscuss current & previous acts
qExplore impact on self & others
qRecognize cues to impulsive behavior
qRefer/teach coping skills & alternative behaviors
qRole play new skills offering feedback & support
qIdentify strengths
qUse clear communication

 

Term

 

During the assessment interview your client says, “I’m a free agent who tries to live off the grid.  No way for the government to monitor me if I keep to myself.  People tell me I’m paranoid but I’m just looking out for myself.”  Which approach would work best with this client with Paranoid Personality Disorder?

a.  interpretation of his behaviors

 

b.  active friendliness and nurturing

 

c.  a neutral but courteous and concerned manner

 

d.  a cynical, joking approach

 

Definition
C. a neutral but courteous and concerned manner
Term

 

Which should a nurse include as a primary outcome for an individual with Schizoid Personality Disorder?

 

a.Validates ideas with someone before taking action

 

b.Is able to function independently in the community

 

c.Can cope with stress and control emotions

 

d.Is able to recognize limits

 

Definition
B is able to function independently in the community
Term

 

Which of the following statements, if made by a client during a group therapy session, would the nurse identify as reflecting a client’s narcissistic personality disorder?

 

a.  I’m sick of hearing about all your life tragedies.

 

b. I know I’m interrupting others, so what?

 

c. I just can’t stop wanting to slash myself.

 

d. I just have no hope for the future.

 

Definition
a. Im sick of hearing about all your life tragedies
Term

 

A client with Borderline Personality Disorder has just cut their arm with a sharp piece of plastic.  How should the nurse respond?

 

a.Care for the wounds without offering sympathy or attention.

 

b.Act quickly to dress the wounds so the client feels safe.

 

c.Call the doctor to dress the wounds so the client feels important.

 

d.Let the client dress the wounds themselves.

 

Definition
A. care for the wounds without offering sympathy or attention
Term

 

A client on a psychiatric unit is very demanding and critical, talking with others and telling them how mean one of the nurse is to clients.  Which nursing diagnosis is most appropriate for this client?

 

a.Social isolation related to negative behavior.

 

b.Chronic low self-esteem related to use of the defense mechanism splitting.

 

c.Risk for other-directed violence related to negative verbal communication.

 

d.Ineffective coping related to inability to interact with unit personnel.

 

Definition
B. chronic low self esteem related to use of the defense mechanism splitting
Term

 

Which interventions should a nurse plan for a client with Avoidant Personality Disorder?  Select all that apply.

 

a.Provide support and reassurance.

 

b.Explore positive self-aspects.

 

c.Use reframing.

 

d.Identify negative responses from others.

 

e.Offer de-catastrophizing.

 

f.Make group attendance mandatory.

 

Definition
a.Provide support and reassurance.

 

b.Explore positive self-aspects.

 

c.Use reframing.
e.Offer de-catastrophizing.
Term

 

Limit setting is an important part of working with clients who have personality disorders.  What strategy could the nurse first use to make limit setting more accepted by the client?

 

a.  state a value judgment regarding the behavior and its consequences

 

b.  reflect back to the client an understanding of the client’s distress

 

c.  confront the client with the inappropriateness of the behavior

 

d.  explore with the client the underlying dynamics of the behavior

 

Definition
B. reflect back to the client an understanding of the clients distress
Supporting users have an ad free experience!