CMAN 272 Final Exam 2023 with complete solution

CMAN 272 Final Exam 2023 with complete solution Personality The sum total of a person's internal and external patterns of adjustment of life Personality traits Enduring patterns of perceiving, relating to and thinking about the environment and oneself; exhibited in social and personal contexts - introvert, extrovert Personality disorders: Common characteristics Inflexible and maladaptive responses to stress Disability in working and loving Ability to evoke interpersonal conflict Capacity to have an intense effect on others Cluster A Personality Disorders Paranoid Schizoid Schizotypal Cluster B Personality Disorders Borderline Narcissistic Histrionic Antisocial Cluster C Personality Disorders Avoidant Dependent Obsessive-compulsive Cluster A: Paranoid Personality Disorder: Characteristics May be apparent in childhood Social anxiety in childhood Jealous, controlling as adults Difficulty in relationships Unwillingness to forgive and projection of feelings - holds grudges See the world as an unsafe place and that people are out to get you Very suspicious Think others can't be trusted Hold grudges Have difficulty with forgiveness Very difficult to be in a relationship with because of paranoia SUSPECT Cluster A: Paranoid Personality Disorder: Treatment Counteract mistrust by: -adhering to schedules -avoiding being overly friendly - have an even/neutral effect -projecting a neutral but kind affect Psychotherapy (better) than group therapy May be on short-term antidepressants Most likely won't see in a psychiatric setting Paranoid: SUSPECT Spouse fidelity suspected Unforgiving (bears grudges) Suspicious of others Perceives attacks and reacts quickly Enemy or my friend (suspects associates, friends) Confiding in others is feared Threats perceived in benign events Cluster A: Schizoid Personality Disorder: Characteristics Symptoms appear in childhood and adolescence - teenagers that prefer to be alone, prefer solitude, not involved in social things around school Loners, poor academic performance Increased prevalence of disordered family life Avoids close relationships Depersonalization - feel not like themselves sometimes Detachment Prefer to be alone Likes solitary activities (e.g. reading a book, playing solitary games) No interest in being with people Have difficulty being with family No want to go to a party/be with people DISTANT Cluster A: Schizoid Personality Disorder: Guide for Nurses & Treatment Avoid being too "nice" or "friendly" Don't try to increase socialization - don't force socialization, not a goal Assess for symptoms the patient is reluctant to discuss Protect against group's ridicule May experience a lot of bullying in the school setting Do well in psychotherapy Don't do as well in group therapy May be on antidepressants (if they're having some medical problems, losses, or other issues) - typically not on meds Schizoid: DISTANT Detached (or flattened) affect Indifferent to criticism and praise Sexual experiences of little interest Tasks done solitarily Absence of close friends Neither desires nor enjoys close relations Takes pleasures in few activities Cluster A: Schizotypal Personality Disorder: Characteristics Severe social and interpersonal deficits - come across as being awkward Anxiety in social situations Rambling conversation Paranoia, suspiciousness, anxiety, distrust Brief, intermittent episodes of hallucinations or delusions (if under a lot of stress) Can be made aware of their own odd beliefs May be vulnerable to involvement with cults or unusual religious/occult groups Ideas of reference - magical thinking Not much affect Lack of close friends Unusual beliefs Superstitions Interested in paranormal Tend not to like to be with other people Ideas of reference (delusions that make them feel like they have special power or that things have special meaning) Can become psychotic under stress Magical thinking; can become psychotic under stress ME PECULIAR Cluster A: Schizotypal Personality Disorder: Nursing Care Guidelines & Treatment Respect patient's need for social isolation Be aware of and intervene appropriately with patient's suspiciousness Perform careful diagnostic assessment for symptoms that may need intervention (e.g. suicidal thoughts) - explain everything to them Withhold judgement or ridicule Be consistent and reliable Psychotherapy (investigate possible involvement with cults) Low-dose antipsychotics if they exhibit psychotic features Schizotypal: ME PECULIAR Magical thinking or odd beliefs Experiences unusual perceptions Paranoid ideation Eccentric behavior or appearance Constricted (or inappropriate affect) Unusual (odd) thinking and speech Lacks close friends Ideas of reference (thinking that certain things have certain meaning) Anxiety in social situations Rule out psychotic disorders and pervasive developmental disorders before Cluster B: Borderline Personality Disorder: Characteristics Severe impairments in functioning - most severe in terms of issues they have to deal with See on the unit because of suicide attempts Emotional lability - mood instability Impulsivity Self-destructive behaviors (e.g. attempting suicide, self-harm) Antagonism Splitting (inability to view both positive and negative aspects of others as part of a whole - either see people as all good or all bad and that changes daily) Hard time dealing with breakups Abandonment issues Can get very angry and/or suicidal Identity issues AM SUICIDE Cluster B: Borderline Personality Disorder: Epidemiology and Comorbidity 10% risk of suicide and mortality rate - high suicide rate 85% of BPD patients have another mental illness (e.g. eating disorder, substance use disorder, depression, anxiety) Cluster B: Borderline Personality Disorder: Etiology High genetic association Separation-individuation factors Cluster B: Borderline Personality Disorder: : Assessment Semi-structure interview Use of MMPI Self-assessment - being in a relationship would be like a rollercoaster because some days they really want to work with you and other days they'll want to stop and become angry - hard to stay connected because they'll just you - don't take it personally Cluster B: Borderline Personality Disorder: Nursing Diagnoses Self-mutilation Risk for suicide Risk for self and/or other-directed violence Impaired social interaction Disturbed personal identity Ineffective coping Cluster B: Borderline Personality Disorder: Outcomes & Planning NOC scales for measuring improvement Importance of the therapeutic relationship - be consistent with them Avoid manipulative behaviors Cluster B: Borderline Personality Disorder: Implementation Provide clear and consistent boundaries Use clear, straightforward communication Calmly review therapeutic goals Teamwork and safety Respond matter-of-factly to superficial self-injuries - deemphasize actual cutting, focus on what was going on before Cluster B: Borderline Personality Disorder: Pharmacologic Interventions Psychotropics geared toward symptom relief (mood stabilizers, anti anxiety, anticonvulsants, etc.) Borderline: AM SUICIDE Abandonment Mood instability (Marked reactivity of mood) Suicide (or self-mutilating) behavior Unstable and intense relationships Impulsivity (in two potentially self-damaging areas) Control of anger Identity disturbance Dissociative (or paranoid) symptoms are transient and stress-related Emptiness (chronic feelings of) Cluster B: Borderline Personality Disorder: Advanced Practice Assist staff in therapeutic alliance - may go to supervise when the other staff is having problems Cluster B: Borderline Personality Disorder: Psychotherapy Do well with CBT Dialectical behavior therapy (DBT) Dialectical Behavior Therapy (DBT) Marsha Lineham Works on emotional regulation - helps them to think before they act and identify feelings Focus on mindfulness Cluster B: Histrionic Personality Disorder: Characteristics Excitable, dramatic, often high functioning Bold external behaviors Limited ability to develop meaningful relationships Attention-seeking, self-centered, low-frustration level Excessive emotions, may be provocative, smothering - over the top emotions No insight into disorder or role in ruining relationship - always blame someone else for their problems Was called hysterical in the past PRAISE ME Cluster B: Histrionic Personality Disorder: Guidelines for Nursing Care & Treatment Know that seductive behavior is a response to distress - maintain boundaries Keep interactions professional - ignore flirtations Model concrete language Help patient clarify inner feelings Teach and role-model assertiveness - want them to learn how to ask for what they need instead of trying to get other people to do things for them through seduction