Exam 3: W10 Chapters 24 & 27 Flashcards

Question

Histrionic PD - Nurse Guide

Answer 1

Know that seductive behavior is a response to distress. Keep interactions professional; ignore flirtations. Model concrete language. Help patient clarify inner feelings Teach and role-model assertiveness. Assess for suicidal ideation.

Answer 2

Characteristics: grandiosity, fantasies of power or brilliance, need to be admired, sense of entitlement, arrogant, patronizing, rude, overestimates self and underestimates others. Feelings of entitlement, exaggerated self importance Lack of empathy; tendency to exploit others Weak self-esteem and hypersensitivity to criticism Constant need for admiration Less functional impairment than other personality disorders

Answer 3

Difficult to treat: patients not likely to seek help or confront shortcomings Cognitive-behavioral therapy (CBT) to deconstruct faulty thinking Group therapy; lithium for mood swings Couples or group therapy because it is unlikely patients will be seen individually CBT may be helpful Group therapy to share with others Mood swings- Lithium Depression- antidepressants

Answer 4

Remain neutral. Promote a stronger patient self-identity Avoid power struggles or becoming defensive. Role-model empathy.

Answer 5

Characteristics: has superficial charm, violates rights of others, exploits others, lies, cheats, lacks guilt or remorse, is impulsive, acts out, and lacks empathy. As patients, these individuals are extremely manipulative and aggressive. Nurses must establish and adhere to a plan of care and maintain clear boundaries if they are to minimize patient manipulation and acting out. Pattern of disregard for, and violation of, the rights of others “Sociopaths” Concerned with gaining personal power Focus on gratification of self

Answer 6

No FDA approved meds. No specific medications Often used off-label: mood stabilizers (lithium, valproic acid) for aggression, impulsivity, depression SSRIs (fluoxetine, sertraline) decrease irritability, help anxiety and depression Benzodiazepines for anxiety (caution bc addictive) Mood-stabilizers may help with aggression Also possible: SSRIs, benzodiazepines, or Ritalin Psychological Therapies: Some evidence that this patient population may bond with psychotherapists CBT, MBT, or DBT

Answer 7

Implementation: Set firm boundaries Consistency in response Consequences for actions Watch for manipulation Document behaviors Medication Address manipulative behaviors—especially bullying—openly, along with consequences (loss of privileges). Anticipate and seek team support for aggressive behaviors. Reduce their anxiety and anger through physical outlets.

Answer 8

Characteristics: unstable, intense relationships; identity disturbances; impulsivity; self-mutilation; rapid mood shifts; chronic emptiness; intense fear of abandonment; splitting; and anger. A major defense is splitting (alternating between idealizing and devaluing). Self-mutilation and suicide-prone behavior are frequently seen. Anger is intense and pervasive, and help with anger management is an important intervention. Relationship building, safety, and limit setting are other foci.

Answer 9

High genetic association Neurobiological Cognitive: Separation-individuation

Answer 10

Provide clear and consistent boundaries Use clear, straightforward communication Calmly review therapeutic goals Teamwork and safety Respond matter-of-factly to superficial self-injuries

Answer 11

Medication: No meds specifically approved for BPD May be used off label SSRIs, anticonvulsants, lithium for mood stabilization Naltrexone to reduce self-harm behaviors Second-generation antipsychotics for anger, psychosis Biological Treatment Psychotropics geared toward symptom relief Psychological Therapies CBT Dialectical behavior therapy (DBT) Schema-focused therapy

Answer 12

CBT: identify and change inaccurate perceptions and harmful behaviors DBT: using mindfulness to be aware of thoughts and shape them Schema-focused therapy: CBT plus other therapy that work on “reframing”

Answer 13

Characteristics: social inhibition, feelings of inadequacy, hypersensitivity to criticism, preoccupation with fear of rejection and criticism, and self perceived to be socially inept. Low self-esteem and hypersensitivity grow as support networks decrease. Demands of workplace often overwhelming. Project that caregivers will harm them through disapproval and perceive rejection where none exists.

Answer 14

Guidelines for nursing care: Friendly, accepting, reassuring approach Don’t push! Acceptance of patient fears Group therapy Exercises to enhance new social skills Design exercises to prevent failures Assertiveness training

Answer 15

Treatment: Convey attitude of acceptance Nurses can teach socialization skills, provide positive feedback, and build self-esteem. Assertiveness training Medications: Anti anxiety medication Beta blockers to ANS hyperactivity SSRIs/SNRIs

Answer 16

Characteristics: inability to make daily decisions without advice and reassurance, need of others to be responsible for important areas of life, anxious and helpless when alone, and submissive. Solicit care taking by clinging. Fear abandonment if they are too competent. Experience anxiety and may have coexisting depression.

Answer 17

Nurses identify stressors Be aware of countertransference Work on assertiveness through role-modeling Guidelines for nursing care Help address current stressors Set limits that don’t make the patient feel punished Be aware of strong countertransference Use therapeutic relationship as a testing ground for assertiveness training

Answer 18

Psychotherapy (CBT) - treatment of choice Treat symptoms of anxiety and depression

Answer 19

Characteristics: preoccupied with rules, perfectionistic, too busy to have friends (but feel genuine affection for friends and family), rigid control, and superficial relationships. Complains about others’ inefficiencies and gives others directions. Personality traits are rigidity and inflexible standards Practice responses for social situations

Answer 20

Guidelines for nursing care: Guard against power struggles Remember that the patient has difficulty dealing with unexpected changes Provide structure, but with time to complete habitual behaviors

Answer 21

Patients tend to seek help Also seek help for anxiety or depression Group and individual therapy Clomipramine (anafranil) for obsessions, anxiety, and depression Other serotonergics (fluoxetine) may also help

Answer 22

ANSWER: A Borderline personality disorder is characterized by splitting—that is, seeing people in terms of bad or good with few in-betweens. An example from Sydney is her statement that all “women are jerks” in response to the calming effect of a male nurse and is no doubt an impulsive response to her recent traumatic break from her female roommates. Inflexible standards is consistent with OCD, not BPD. Similarly, lack of empathy and an absence of remorse—not demonstrated in our patient at this time—are both associated with antisocial personality disorder, not BPD.

Answer 23

ANS: A Persons with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness.

Answer 24

An emotional response to frustration of desires, threat to one’s emotional or physical needs, or a challenge

Answer 25

Action or behavior that results in verbal or physical attack

Answer 26

An objectionable act that involves intentional use of force that results in, or has potential to result in injury to another person

Answer 27

Emergency departments Psychiatric units Geriatric units Intensive care units

Answer 28

Genetic predisposition Neurobiological: brain injury or abnormalities Neurotransmitters

Answer 29

Behavioral theory—learned response Social learning theory—imitate others

Answer 30

General Assessment It is important to identify anxiety before it escalates to anger and aggression. Expressions of anxiety and anger look quite similar: increased rate and volume of speech, increased demands, irritability, frowning, redness of face, pacing, twisting hands, or clenching and unclenching of fists. **Assessment should include taking an accurate history of the patient’s background, usual coping skills, and perception of the issue. Patients’ perceptions often provide a useful point of intervention.

Answer 31

ANS: B A calming voice and simple, nonemotional directions can help de-escalate the patient’s anxiety. This is an initial intervention, so do not threaten him with seclusion or resort to antipsychotics. Rubbing his shoulders is inappropriate and may contribute to anxiety, not calm.

Answer 32

1. A history of violence is the single best predictor of future violence. 2. Patients who are delusional, hyperactive, impulsive, or predisposed to irritability are at higher risk for violence. 3. Major factors associated with violence can be assessed with these questions: Does the patient have a wish or intent to harm? Does the patient have a plan? Does the patient have means available to carry out the plan? Does the patient have demographic risk factors (i.e., male gender, age 14 to 24 years, low socioeconomic status, inadequate support system, prison time)? 4. Aggression by patients occurs most often in the context of “limit setting” by the nurse. 5. History of limited coping skills, including lack of assertiveness or use of intimidation, indicates a higher risk of using violence. 6. Like patients, nurses have their own histories. The nurse’s ability to intervene effectively depends on self-awareness of strengths, needs, concerns, and vulnerabilities. Without this awareness, nursing interventions can end up being impulsive or emotion-based responses. 7. Self-awareness includes recognizing choice of words and tone of voice, as well as nonverbal communication through body posture and facial expressions.

Answer 33

1. Avoid wearing dangling earrings, necklaces, and scarves in acute care environments. The patient may become focused on these and grab at them, causing serious injury. 2. Ensure that there is enough staff for backup. Only one person should talk to the patient, but staff need to maintain an unobtrusive presence in case the situation escalates. 3. Always know the layout of the area. Correct placement of furniture and elimination of obstacles or hazards are important to prevent injury if the patient requires physical interventions. 4. Do not stand directly in front of the patient or in front of the doorway. The patient may consider this position as confrontational. It is better to stand off to the side and encourage the patient to have a seat. 5. If a patient’s behavior begins to escalate, provide feedback: “You seem to be very upset.” Such an observation allows exploration of the patient’s feelings and may lead to de-escalation of the situation. 6. Avoid confrontation with the patient, either through verbal means or through a “show of support” with security guards. Verbal confrontation and discussion of the incident must occur when the patient is calm. A show of force by security guards may serve to escalate the patient’s behavior. Security personnel are better kept in the background until they are needed to assist.

Answer 34

ANS: D Ensure that there is enough staff for backup. Only one person should talk to the patient, but staff need to maintain an unobtrusive presence in case the situation escalates. Avoid confrontation with the patient, either through verbal means or through a “show of force” with security guards. Verbal confrontation and discussion of the incident must occur when the patient is calm. A show of force by security guards may serve to escalate the patient’s behavior; therefore, security personnel are better kept in the background until they are needed to assist.

Answer 35

Involuntary confinement of a patient alone in a room, or area from which the patient is physically prevented from leaving

Answer 36

Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely

Answer 37

The goal of seclusion is never punitive. Rather, the goal of seclusion is safety of the patient and others. Seclusion is less restrictive than restraint and may be helpful in reducing sensory overstimulation.

Answer 38

Seclusion and physical restraints cannot be used without a physician’s order and are used only after exhaustion of all other intervention alternatives have failed. The patient must have 24-hour one-on-one observation.

Answer 39

patient is a clear and present danger to self or others, patient has been legally detained for involuntary treatment, or patient requests seclusion or restraints for his or her own safety.

Answer 40

Pharmacotherapy Offer PRN medication to alleviate acute symptoms : Antianxiety agents & Antipsychotics Long-term management of chronic aggression ***During violent incidents, haloperidol has historically been the most widely used antipsychotic, but with the introduction of IM atypical antipsychotics, the use of olanzapine (Zyprexa) and ziprasidone (Geodon) has become more widespread, in part because of the severe side effects of haloperidol.

Answer 41

ANS: B Once in restraint, a patient must be directly observed and formally assessed at frequent, regular intervals for level of awareness, level of activity, safety within the restraints, hydration, toileting needs, nutrition, and comfort.

Answer 42

ANS: B Indications for the use of mechanical restraint include protecting the patient from self-harm and preventing the patient from assaulting others.

Exam 3: W10 Chapters 24 & 27 Flashcards

(67 cards)