MH Exam 2 CH 18-22

concerns for anxiety related disorders

*Risk for suicide* Anxiety Death anxiety Stress overload Self-mutilation Hopelessness Powerlessness Social isolation Disturbed sensory perception Disturbed though processes Insomnia Impaired memory Deficient knowledge Fear Fatigue Chronic low self-esteem Disturbed body image Risk-prone behavior Ineffective role performance Ineffecting coping Defensive coping Ineffective denial Impaired social interaction Compromised family coping Interrupted family processes Spiritual distress Decisional conflict Noncompliance Posttrauma syndrome Risk for posttrauma syndrome

implementation for eating disorders

-*formulate a therapeutic nurse-client relationship early* -include behavioral interventions to interrupt the cycle of eating disorder behavior -improve emotional regulation, interpersonal skills, and awareness of other psychologic issues -provide a safe and structure environment to prevent self-harm and promote weight gain

implementation for anxiety related disorders

-*maintain safety* -assess own level of anxiety; remain calm -recognize pt's use of relief behaviors -inform pt of importance of limiting caffeine, nicotine, other CNS stimulants -teach pt to distinguish btwn anxiety connected to identifiable object/source and anxiety for which there is no identifiable cause -*use anxiety reducing strategies* -help pt build on previously used successful coping mechanisms -identify support persons -assist pt w gaining control of feelings/impulses through *brief and direct verbal interactions* -decrease stimulation in environment -*assess presence/degree of depression & suicidal ideation* -anxiolytic meds -teach importance of med administration

adjustment disordes

-Characterized by maladaptive reaction to an identifiable stressor(s) that results in the development of clinically significant emotional or behavioral symptoms -occurs within 3 months of the stressor/no longer than 6 months

post-traumatic stress disorder (PTSD)

-Individual's response to traumatic events (war, sexual abuse, physical abuse, disasters, accidents, and grieving process) -must have witnessed a traumatic event that involved a feeling of being threatened with death or severe injury -response is intense fear, helplessness, or horror -person often reexperiences the event -Avoidance of stimuli associated with the trauma and experiences a numbing of general responsiveness if reminded of incident -may have sleep disturbances, irritability, angry outbursts, difficulty concentrating, hypervigilance, and exaggerated startle response

nursing dx for somatic symptom and dissociative disorders

-Ineffective coping evidenced by numerous physical complaints (somatic symptom disorder) -Chronic pain (somatic symptom disorder) -Deficient knowledge [psychological causes for physical symptoms] (somatic symptom disorder) -Fear [of having a serious disease] (illness anxiety disorder) -Disturbed sensory perception (conversion disorder) -Self-care deficit (conversion disorder) -Deficient knowledge [psychological factors affecting medical condition] (psychological factors affecting medical condition) -Impaired memory (dissociative amnesia) -Powerlessness (dissociative amnesia) -Risk for suicide (DID) -Disturbed personal identity (DID) -Disturbed sensory perception [visual/kinesthetic] (depersonalization/derealization disorder)

predisposing factors for antisocial personality disorder

-Possible genetic influence -Having a disruptive behavior disorder as a child -History of severe physical abuse -Absent, erratic, or inconsistent parental discipline -Extreme poverty -Removal from the home -Growing up without parental figures of both sexes -Always being rescued when in trouble -Maternal deprivation

s/s of bulimia nervosa

-Recurrent episodes of binge eating and purging -Engages in purging to compensate for binge -Hypokalemia -Alkalosis -Dehydration -Idiopathic edema -Hypotension -Cardiac arrythmias/dysrhythmias -Cardiomyopathy -Hypoglycemia -Constipation/diarrhea -Gastroparesis -Reflux -Mallory-Weiss syndrome -Dental enamel erosion -Parotid gland enlargement -Body image disturbance -Persistent over concern with body weight, shape, and proportions -Mood swings -Denial -Secrecy and shame

s/s of anorexia nervosa

-Self-starvation -Rituals or compulsive behaviors regrading food -self-induced vomiting, laxative/diuretic use, excessive exercise -wears baggy clothing -weight 15% below ideal weight -amenorrhea -Slow pulse -Decreased body temperature -Cachexia -Lanugo -Constipation -Cold sensitivity -OH -Delay of puberty -Denial -Body image disturbance -Intense or irrational fear of gaining weight -Constant striving for the perfect body -Anxiety around food -Preoccupation w food -Delayed psychosocial development

evaluation for anxiety related disorders

-Using clinical rating scales -Yale-Brown Obsessive-Compulsive Scale -Beck Anxiety Inventory -Hamilton Anxiety Scale -should occur each time the patient progresses toward the identified outcome (during every interaction) -If satisfactory progress is not made, changes to the plan should be considered -All factors that relate to outcomes should be evaluated

mild anxiety

-VS normal -minimal muscle tension -pupils normal -perceptual field broad -awareness of multiple environmental stimuli -thoughts are random yet controlled -feelings of relative comfort/safety -relaxed and calm appearance/voice -performance automatic -habitual behaviors occur

moderate anxiety

-VS normal/slightly elevated -tension -uncomfortable or experiences pleasure (tense/excited) -alert -perception narrow/focused -optimum state for problem solving/learning -attentive -feelings of readiness/challenge -energized -engages in competitive activity -learns new skills -voice/facial expressions interested/concerned

planning/implementation for adjustment disorders

-adaptive progression through grieving process -help achieve acceptance of change in health status -assist w strategies to maintain anxiety at manageable level

planning/implementation for somatic symptom disorder

-aimed at relief of discomfort from physical symptom -assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms

planning/implementation for dissociative disorder

-aimed at restoration of normal thought processes -assistance is provided to the client in an effort to determine strategies for coping with stress by means other than dissociation from the environment

obsessive-compulsive disorder (OCD)

-causes person to experience presence of obsessions, compulsions, both -attempt to prevent/reduce the distress invoked by the obsession or to prevent some dreaded threatening situation from occurring -thoughts/behaviors cause anxiety/doing ritualistic things reduces anxiety -worsened by stress

cognitive therapy for anxiety related disorders

-centers pt's understanding that s/s are a learned response to thought/feelings about behaviors -identify target symptoms/examine associated circumstances -implement plan to change either the cognitions/behaviors

borderline personality disorder

-characterized by a pattern of intense and chaotic relationships -affective instability -fluctuating and extreme attitudes regarding other people -impulsivity -directly and indirectly self-destructive behavior -lack of a clear sense of identity -more common in women -chronic depression, inability to be alone, clinging and distancing behaviors, splitting, manipulation, self-destructive behaviors, impulsivity -protection from self harm -confront source of internalized anger

schizoid personality disorder

-characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful, emotional way -more common in men -indifferent to others, aloof, detached, unable to experience pleasure -affect is bland/constricted -no close friends/prefer to be alone -caused by genetics and childhood characterized as bleak, cold, unempathetic, notably lacking in nurturing

depersonalization/derealization disorder

-characterized by a temporary change in the quality of self-awareness, which often takes the form of feelings of unreality, changes in body image, feelings of detachment from the environment, or a sense of observing oneself from outside the body

histrionic personality disorder

-characterized by colorful, dramatic, and extroverted behavior in excitable, emotional persons -more common in women -self-dramatizing, attention-seeking, overly gregarious, seductive, manipulative, and exhibitionistic -have a consuming need for approval and feel dejected and anxious if they do not get it -highly distractible, have difficulty paying attention to detail, easily influenced by others, have difficulty forming close relationships, are strongly dependent, and may complain of physical symptoms -caused by increased noradrenergic activity, decreased serotonergic activity, genetics, biogenetically determined temperament, learned behavior patterns

adjustment disorder w disturbance of conduct

-characterized by conduct in which there is violation of rights of other or of major age-appropriate societal norms/rules -dx must be differentiated from those of conduct disorder or antisocial personality disorder

paranoid personality disorder

-characterized by extreme suspiciousness or mistrust of others -more common in men -constantly on guard, hypervigilant, and ready for any real or imagined threat; trust no one, and are constantly testing the honesty of others -insensitive to others yet extremely oversensitive; tend to misinterpret cues within the environment, magnifying and distorting them into thoughts of trickery and deception -do not accept responsibility for own behavior -caused by genetics and subject to early parental antagonism/harassment

obsessive compulsive personality disorder

-characterized by inflexibility about the way in which things must be done, and a devotion to productivity at the exclusion of personal pleasure -more common in men and oldest children -especially concerned with matters of organization and efficiency -tend to be rigid and unbending about rules and procedures -polite/formal social behavior -"rank conscious." can be very ingratiating with authority figures, but quite autocratic and condemnatory with subordinates -appear calm and controlled, but have ambivalence, conflict, and hostility -caused by over control of parents, lack of positive reinforcement for acceptable behavior and frequent punishment for undesirable behavior

dissociative identity disorder (DID)

-characterized by the existence of two or more personalities within a single individual -transition from one personality to another is usually sudden, often dramatic, and usually precipitated by stress

trauma related disorders tx

-cognitive therapy -prolonged exposure therapy -group/family therapy -eye movement desensitization and reprocessing -psychopharmacology

factitious disorder

-conscious, intentional feigning of physical and/or psychological symptoms -pretends to be ill in order to receive emotional care and support commonly associated with the role of "patient." -*Munchausen syndrome* -may be imposed on another person under the care of the perpetrator (formerly called Factitious Disorder by Proxy).

psychologic first aid for anxiety related disorders

-currently recommended as initial response of a person/group experiences a traumatic event or loss -protecting individuals who have experienced/witnessed trauma from any further injury/harm by reducing their psychological arousal -support is given -info about stress reduction is provided -implosion therapy

adjustment disorder r/t bereavement

-disturbances in grieving process following death of loved one -symptoms are exaggerated and exist for <12 mo.

narcissistic personality disorder

-exaggerated sense of self-worth -more common in men -over self centered -exploit others in an effort to fulfill own desires -Mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and carefree -*fragile self esteem* -caused by unfulfilled dependency needs; overly demanding, perfectionistic, critical parents that have unrealistic expectations; narcissistic parents; modeled behavior; parents overindulging children and failed to set limits on inappropriate behavior

avoidant personality disorder

-extreme sensitivity to rejection and social withdrawal -equally common in men and women -awkward/uncomfortable in social situations -desire close relationships -timid, withdrawn, cold/strange -lonely, express feelings of being unwanted -view others as critical, betraying and humiliating -no known cause, but potentially by parental rejection

assessment for anxiety related disorders

-feel like experiencing heart attack -Agoraphobia often presents itself when the patients is preparing to undergo CT or MRI scanning; patient becomes anxious

severe anxiety

-fight or flight -autonomic NS excessively stimulated -VS increased -diaphoresis -urinary urgency/frequency -diarrhea -dry mouth -decreased appetite -dilated pupils -muscles rigid/tense -senses affected -hearing decreased -pain sensation decreased -perceptual field greatly narrowed -problem solving difficult -selective attention/inattention -distortion of time -dissociative tendencies -detachement -vigilambulism -threatened/startled with new stimuli -overloaded -activity increase/decrease -pace, run away, wring hands, moan, shake, stutter, become disorganized/withdrawn, freeze -appears/feels depressed -demonstrates denial -complains of aches/pains -agitated/irritable -needs space -eyes move around room/gaze is fixed -close eyes to shut out environment

cognitive therapy for trauma related disorders

-goal is to replace negative thoughts w more accurate and less distressing thoughts, and to cope more effectively with feelings, such as anger, guilt, and fear -strives to help the individual recognize and modify trauma related thoughts and beliefs

dissociative amnesia

-inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness, and which is not due to the direct effects of substance use or a neurological or other medical condition-onset usually follows severe psychosocial stress -localized, selective, generalized

adjustment disorder

-individuals who have difficulties with stress reactions to more "normal" events -a psychological response to an identifiable stressor or stressors -can occur at any age

Conversion Disorder (Functional Neurological Symptom Disorder)

-loss of/change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism -most obvious and "classic" conversion symptoms are those that suggest neurological disease -may be precipitated by intense psychological stress

adjustment disorder w depressed mood

-most common -less pronounced than MDD -exceed what would be the normative response to an identified stressor

planning for eating disorders

-nurse needs to assess personal attitudes about the patient and eating disorders before developing a plan of care -patients with eating disorders are vulnerable but they are often rigid and frustrating -must include consistent and collaborative efforts by the patient, the family, and interdisciplinary staff

Generalized Anxiety Disorder (GAD)

-occurs when a person experiences excessive anxiety and worry that impedes the person's ability to function at home, work, school, etc. -difficultly controlling worry -restless, on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances

social anxiety disorder

-overwhelming fear of being in a social situation/having to interact w many people at once -great concern of criticism -avoid social situation -unable to work well in a group -group therapy isn't therapeutic -treatment: SSRIs

anorexia nervosa

-pathologic drive for thinness and a disturbed body image that leads to self-starvation -characterized by a morbid fear of obesity Symptoms: gross distortion of body image, preoccupation with food, and refusal to eat

dependent personality disorder

-pattern of relying excessively on others for emotional support -more common in women and youngest siblings -notable lack of self-confidence that is often apparent in their posture, voice, and mannerisms; typically passive and acquiescent to the desires of others -avoid positions of responsibility; become anxious when forced into them -low self worth, easily hurt by criticism/disapproval -caused by genetics and when stimulation and nurturance are experienced exclusively from one source, and a singular attachment is made by the infant to the exclusion of all others

antisocial personality disorder

-pattern of socially irresponsible, exploitative, and guiltless behavior -evident in the tendency to fail to conform to the law, to sustain consistent employment, to exploit and manipulate others for personal gain, to deceive, and to fail to develop stable relationships -more common in men -protect others from client's aggression

biologic interventions with anxiety related disorders

-pharmacologic/cognitive behavioral interventions deemed most successful -benzodiazepines (anxiety); short term use (addictive) -SSRIs

adjustment disorder w anxiety

-predominant manifestation = anxiety -dx must be differentiated from anxiety disorder

adjustment disorder w mixed anxiety and depressed mood

-predominant manifestation = depressed mood and anxiety -symptoms more pronounced than normally expected

anxiety reducing strategies

-progressive relaxation techniques -mindfulness meditation -slow deep breathing exercises -focusing on a single object in room -listening to soothe music/relaxation tapes -visual imagery/nature related DVDs -exercise

planning/implementation for trauma related disorders

-reassurance of safety -decrease in maladaptive symptoms (flashbacks/nightmares) -demonstration of more adaptive coping strategies -adaptive progression through grieving process

panic disorder

-recurrent panic attacks -two criteria must be met: recent unexpected panic attacks and at least one of the attacks has been followed for 1 or more months by a) persistent concern about having additional attacks OR b) worry about the implications of the attack or its consequences -symptoms not associated w direct effects of a substance/not result of physical condition

psychosocial aspects of trauma related disorders

-seeks to explain why some exposed to massive trauma experience PTSD and some do not -variables include: characteristics that relate to experience, individual, and recovery environment

Acute Stress Disorder (ASD)

-similar to PTSD -symptoms are limited (1 mo. following trauma)

common behaviors for antisocial personality disorder

-sociopathic/psychopathic behavior -Exploitation and manipulation of others for personal gain -Belligerent and argumentative -Lacks remorse -Unable to delay gratification -Low tolerance for frustration -Inconsistent work or academic performance -Failure to conform to societal norms -Impulsive and reckless -Inability to function as a responsible parent -Inability to form a lasting monogamous relationship -*act cheerful, gracious, charming when things go their way* -*do not accept responsibility for the consequences of their behavior* -*perception that they are being victimized by others justifies their malicious behavior, lest they be the recipient of unjust persecution and hostility from others*

biological aspects for trauma related disorders

-suggested that the symptoms related to the trauma are maintained by the production of endogenous opioid peptides that are produced in the face of arousal; result in increased feelings of comfort and control -when the stressor terminates, the individual may experience opioid withdrawal (resemble PTSD)

panic anxiety

-symptoms increase until sympathetic NS release occurs -paleness -BP decreased -hypotension -poor muscle coordination -pain/hearing sensations are minimal -perception is scattered/closed -unable to take in stimuli -problem solving/logical thinking highly improbable -perception/unreality about self, environment, or event -dissociation often occurs -helpless -total loss of control -angry/terrified -combative/totally withdrawn -cries/runs away -completely disorganized -extremely active/inactive

adjustment disorder unspecified

-symptoms not consistent w any other category -may have physical complaints, withdraw from relationships, or exhibit impaired work or academic performance, but without significant disturbance in emotions or conduct

panic attack

-symptoms, not disorder -sudden, spontaneous episodes -occur w variety of anxiety disorders -occur is specific, cued/uncued situations -*HCP need to assess underlying medical problems that can mimic panic attacks*

behavior therapy for anxiety related disorders

-systemic desensitization -identify and define phobic stimulus -exposed to events based on hierarchy of phobic stimulus (low to high) -pt eventually masters increasing levels of anxiety until they encounter phobic stimulus

planning for anxiety related disorders

-tx is complex/varied -hospitalization is not required -inpatient hospitalization is increasingly only available for short periods of time for patients *who are at risk to themselves*

illness anxiety disorder

-unrealistic/inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease -behavioral response to even the slightest changes in feeling or sensation is unrealistic/exaggerated -anxiety and depression are common, and obsessive-compulsive traits frequently accompany the disorder

adjustment disorders tx

1. To relieve symptoms associated with a stressor. 2. To enhance coping with stressors that cannot be reduced or removed. 3. To establish support systems that maximize adaptation. -individual psychotherapy (most common) -family therapy -behavior therapy -self help groups -crisis intervention -psychopharmacology (not commonly used)

five functions of DBT

1. enhance behavioral capabilities 2. improve motivation to change 3. ensure new capabilities generalize to the natural environment 4. structure tx environment such that the client and therapist capabilities are supported and effective behaviors are reinforced 5. enhance therapist capabilities and motivation to treat clients effectively

how many personality disorders are there?

10 (3 clusters)

what is the median age of onset for social phobia?

13 years old

what is the median age of onset for OCD?

19 years old

what is the median age of onset for anxiety?

21 years old

what is the median age of onset for GAD?

31 years old

what is the median age of onset for phobias?

7 years old

splitting

A primitive ego defense mechanism; unable to integrate and accept both positive and negative feelings; either all good or all bad

Perceptual, cognitive, and emotional disturbances in bulimia nervosa

Anxiety Disturbed body image Hopelessness Chronic low self-esteem

difference in binge eating disorder and bulimia nervosa

BED is the absence of purging

obesity

BMI > 30

Disruptions in coping abilities may manifest as: in bulimia nervosa

Compromised family coping Disabled family coping

patient and family teaching for anorexia nervosa

Deficient knowledge regarding nutrition and medical side effects of anorexic behavior Noncompliance with refeeding process

Patient and family teaching for bulimia nervosa

Deficient knowledge regarding nutrition and side effects of bulimic behavior Noncompliance with treatment programs

behavior modification

Efforts to change the maladaptive eating behaviors of clients with anorexia nervosa and bulimia nervosa have become the widely accepted treatment.

psychoanalytical psychotherapy

Focuses on the unconscious motivation for seeking total satisfaction from others and for being unable to commit oneself to a stable, meaningful relationship

predisposing factors for somatic symptom disorders

Genetics Biochemical -decreased levels of serotonin and endorphins may play a role in the etiology of somatic symptom disorder, predominantly pain Neuroanatomical -brain dysfunction has been implicated as a factor in factitious disorder. Psychodynamic Theory -suggests that illness anxiety disorder is an ego defense mechanism; physical complaints are the expression of low self esteem and feelings of worthlessness -conversion disorder may represent emotions associated w traumatic event that are too unacceptable to express and so are acceptably "converted" into physical symptoms Family Dynamics In dysfunctional families, when a child becomes ill, a shift in focus is made from the open conflict to the child's illness, leaving unresolved the underlying issues that the family is unable to confront openly; somatization brings some stability to the family and positive reinforcement to the child (tertiary gain). Learning Theory -Somatic complaints are often reinforced when the sick person learns that he or she may avoid stressful obligations or be excused from unwanted duties (primary gains); become the prominent focus of attention because of the illness (secondary gains); or relieve conflict within the family as concern is shifted to the ill person and away from the real issue (tertiary gains). -past experience with serious or life threatening physical illness, either personal or that of close family members

tx for dissociative disorders

Individual psychotherapy Hypnosis Supportive care Cognitive therapy Group therapy Integration therapy (DID) Psychopharmacology

Disruptions in coping abilities in anorexia nervosa

Ineffective coping Disabled family coping Ineffective denial

what is stress?

Mental, emotional, or physical strain experienced by an individual in response to stimuli from the external or internal environment

co-morbidity exists for which disorders?

OCD, substance abuse, major depression, and eating disorders

nursing dx for anorexia nervosa

Risk for self-mutilation Risk for imbalanced body temperature Deficient fluid volume Risk for imbalanced fluid volume Constipation Perceived constipation Imbalanced nutrition: less than body requirements Delayed growth and development

nursing dx for bulimia nervosa

Risk for self-mutilation Risk for imbalanced fluid volume Constipation Perceived constipation Imbalanced nutrition: less than body requirements

Perceptual, cognitive, and emotional disturbances in anorexia nervosa

Sexual dysfunction Impaired social interaction Social isolation

Problems with communicating and relating to others in bulimia nervosa

Sexual dysfunction Impaired social interaction Social isolation

cognitive theory for trauma related disorders

Takes into consideration the cognitive appraisal of an event and focuses on assumptions that an individual makes about the world

what is the exception for adjustment disorders?

The Related to Bereavement subtype, in which case the symptoms exist for at least 12 months following the death of a loved one

A client diagnosed with a personality disorder states, "You are the very best nurse on the unit and not at all like the mean nurse who never lets us stay up later than 9pm." This statement would be associated with which personality disorder? a. Borderline personality disorder b. Schizoid personality disorder c. Dependent personality disorder d. Paranoid personality disorder

a

A client diagnosed with borderline personality disorder superficially cut both wrists, is disruptive in group, and is "splitting" staff. Which nursing diagnosis would take priority? a. Risk for self-mutilation R/T need for attention b. Ineffective coping R/T inability to deal directly with feelings c. Anxiety R/T fear of abandonment d. Risk for suicide R/T past suicide attempt

a

A client diagnosed with somatization disorder visits multiple physicians because of various, vague symptoms involving many body systems. Which nursing diagnosis takes priority? a. Risk for injury R/T treatment from multiple physicians b. Anxiety R/T unexplained multiple somatic symptoms c. Ineffective coping R/T psychosocial distress d. Fear R/T multiple physiological complaints

a

Which individual would be at highest risk for obesity? a. A poor black woman. b. A rich white woman. c. A rich white man. d. A well-educated black man.

a

obsession

a recurrent and persistent thought, impulse, or image that feels intrusive and inappropriate and is difficult to suppress or ignore

A client is diagnosed with hypochondriasis. Which of the following assessment data validate this diagnosis? Select all that apply. a. Preoccupation with disease process and organ function. b. Long history of "doctor shopping." c. Physical symptoms are managed by using the defense mechanism of denial. d. Depression and obsessive-compulsive traits are common. e. Social and occupational functioning may be impaired.

a, b, d, e

Which of the following would the nurse expect to assess in a client diagnosed with PTSD? Select all that apply. a. Dissociative events b. Intense fear and helplessness c. Excessive attachment and dependence towards others d. Full range affect e. Avoidance of activities that are associated with the trauma

a, b, e

selective dissociative amnesia

ability to recall only certain incidents associated with a traumatic event for a specific time period following the event

derealization

alteration in the perception of the external environment

cluster B

antisocial, borderline, histrionic, narcissistic; behaviors described as dramatic, emotional, or erratic

what two diseases cause a high co-morbidity?

anxiety and depression; *increased risk for suicidal ideation*

S/S of depersonalization-derealization disorder

anxiety, depression, fear of going insane, obsessive thoughts, somatic complaints, and disturbance in subjective sense of time

learning theory for trauma related disorders

avoidance behaviors and psychic numbing in response to a trauma are mediated by negative reinforcement (behaviors that decrease the emotional pain of the trauma)

cluster C

avoidant, dependent, obsessive-compulsive; behaviors described as anxious/fearful

A client diagnosed with OCD has been hospitalized for the past 4 days. Which intervention would be a priority at this time? a. Notify the client of the expected limitations on compulsive behaviors. b. Reinforce the use of learned relaxation techniques. c. Allow the client the time needed to complete the compulsive behaviors. d. Say "stop" to the client as a thought-stopping technique.

b

A client diagnosed with a personality disorder insists that a grandmother, through reincarnation, has come back to life as a pet kitten. The thought process described is reflective of which personality disorder? a. Obsessive-compulsive personality disorder b. Schizotypal personality disorder c. Borderline personality disorder d. Schizoid personality disorder

b

A client diagnosed with borderline personality disorder coyly requests diazepam (Valium). When the physician refuses, the client becomes angry and demands to see another physician. What defense mechanism is the client using? a. Undoing b. Splitting c. Altruism d. Reaction formation

b

A client diagnosed with somatization pain disorder has a nursing diagnosis of ineffective coping R/T repressed anxiety. Which is an appropriate outcome for this client? a. The client will verbalize a pain rating of 0/10 by the end of the day. b. The client will substitute one effective coping strategy for on physical complaint by discharge. c. The client will express a realistic perception of his or her distorted self-image by discharge. d. The client will rate anxiety as less than 3/10.

b

A client diagnoses with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that the outcome addresses? a. Ineffective coping R/T lack of control b. Altered nutrition: less than body requirements R/T decreased intake c. Self-care deficit: feeding R/T fatigue d. Anxiety R/T feelings of helplessness

b

A client diangosed with OCD is newly admitted to an inpatient psychiatric unit. Which cognitive symptom would the nurse expect to assess? a. Compulsive behaviors that occupy more than 4 hours per day. b. Excessive worrying about germs and illness. c. Comorbid abuse of alcohol to decrease anxiety. d. Excessive sweating and an increase in blood pressure and pulse.

b

A client experiencing a panic attack would display which physical symptom? a. Fear of dying b. Sweating and palpitations c. Depersonalization d. Restlessness and pacing

b

A client has been diagnosed with a cluster A personality disorder. Which client statement would reflect cluster A characteristics? a. "I'm the best chef on the East Coast." b. "My dinner has been poisoned." c. "I have to wash my hands 10 times before eating." d. "I just can't eat when I'm alone."

b

A widow is diagnosed with adjustment disorder with depressed mood. Symptoms include chronic migraines, feelings of hopelessness, social isolation, and self-care deficit. Which nursing intervention would be most appropriate? a. Present the reality of the consequences of impulsive behaviors. b. Encourage independent completion of activities of daily living. c. Discuss the effects of behaviors that guarantee immediate gratification. d. Teach techniques to improve positive body image.

b

During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states "I'm thinking about suicide." Which nursing intervention takes priority? a. Teach the client relaxation techniques b. Ask the client, "Do you have a plan to commit suicide?" c. Call the physician to obtain a PRN order for an anxiolytic medication. d. Encourage the client to participate in group activities.

b

When confronted, a client diagnosed with narcissistic personality disorder states, "Contrary to what everyone believes, I do not think that the whole world owes me a living." This client is using what defense mechanism? a. Minimization b. Denial c. Rationalization d. Projection

b

When treating individuals with PTSD, which variable is included in the recovery environment? a. Degree of ego strength b. Availability of social supports c. Severity and duration of the stressor d. Amount of control over recurrence

b

PTSD symptoms

begin within first 3 mo. after trauma up to months/years later -Re-experiencing the traumatic event -sustained high level of anxiety/arousal -general numbing of responsiveness -Intrusive recollections/nightmares -Amnesia to certain aspects of the trauma -Depression -Survivors guilt -Substance abuse -Anger/aggression -Relationship problems -Irritability/sleep disturbances -Detachment from others -Repression

psychotherapy for anxiety related disorders

behavior therapy cognitive therapy psychologic first aid

predisposing factors to adjustment disorders

biological theory -individuals with neurocognitive or intellectual developmental disorders -genetics psychosocial -maladaptive response caused by early childhood trauma, increased dependency, and retarded ego development. -constitutional factor, or birth characteristics that contribute to stress response. -influential factors may relate to developmental stage, timing of the stressor, and available support systems. -dysfunctional grieving process transactional model of stress/adaptation -interaction between the individual and the environment -type of stressor: Continuous stressors more likely than sudden-shock stressors to result in maladaptive response -situational factors (economic conditions, support systems) -intrapersonal factors (temperament, social skills, coping strategies)

A client with a long history of bulimia nervosa is seen in the ER. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is the most likely cause of this client's symptoms? a. Mood disorders, which often accompany the diagnosis of bulimia nervosa b. Nutritional deficits, which are characteristics of bulimia nervosa c. Vomiting, which may lead to dehydration and electrolyte imbalance d. Binging, which causes abdominal discomfort

c

Clients diagnosed with OCD commonly use which mechanism? a. Suppression b. Repression c. Undoing d. Denial

c

Which client situation requires the nurse to prioritize the implementation of limit setting? a. A client making sexual advances toward a staff member. b. A client telling staff that another staff member allows food in the bedroom. c. A client verbally provoking another patient who is paranoid. d. A client refusing medications to receive secondary gains.

c

personality traits

characteristics with which an individual is born or develops early in life -influence the way in which one perceives and relates to the environment and are quite stable over time

adjustment disorder w mixed disturbance of emotions and conduct

characterized by emotional disturbances (depression/anxiety) and disturbances of conduct

systemic desensitization

client is gradually exposed to the phobic stimulus, either in a real or imagined situation

nursing dx for adjustment disorders

complicated grieving risk-prone health behavior anxiety

A client diagnosed with an obsessive-compulsive personality disorder has a nursing diagnosis of anxiety R/T interference with hand washing AEB "I'll go crazy if you don't let me do that." Which short-term outcome is appropriate for this client? a. During a 3-hour period after admission to the unit, the client will refrain from hand washing. b. The client will wash hands only at appropriate bathroom and meal intervals. c. The client will refrain from hand washing throughout the night. d. Within 72 hours of admission, the client will notify staff when signs and symptoms of anxiety escalate.

d

A client diagnosed with post-traumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing? a. Denial b. Social isolation c. Anger d. Survivor's guilt

d

A newly admitted client diagnosed with PTSD is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? a. Postrauma syndrome R/T a distressing event AEB flashbacks and nightmares. b. Social isolation R/T anxiety AEB isolating because of fear or flashbacks. c. Ineffective coping R/T flashbacks AEB alcohol abuse and dependence. d. Risk for injury R/T exhaustion because of sustained levels of anxiety.

d

The nurse is teaching a client diagnosed with somatization disorder ways to assist in recognizing links between anxiety and somatic symptoms. Which client statement would indicate that the intervention was effective? a. "My anxiety is currently 2 out of 10." b. "I would like you to talk with my family about my problem." c. "I would like assertiveness training to communicate more effectively." d. "Journaling has helped me to understand how stress affects me physically."

d

When assessing a client diagnosed with histrionic personality disorder, the nurse might identify which characteristic behavior? a. Odd beliefs and magical thinking b. Grandiose sense of self-importance c. Preoccupation with orderliness and perfection d. Attention-seeking flamboyance

d

projection

disavowal; attributing strong conflicting feelings or faults to another person

denial

disavowal; unconsciously refusing to acknowledge some painful reality or subjective experience that others identify

dissociative disorders

disruption in the usually integrated functions of consciousness, memory, and identity

depersonalization

disturbance in the perception of oneself

Munchausen syndrome

factitious disorder; involves conscious, intentional feigning of physical or psychological symptoms individuals pretend to be ill in order to receive emotional care and support commonly associated with the role of "patient."

T/F Obesity is considered an eating disorder

false; it is not because not all cases involve psychiatric illness

Mysophobia

fear of dirt and germs

acrophobia

fear of heights

xenophobia

fear of strangers

implosion therapy

flooding; therapeutic process in which the client must imagine situations or participate in real-life situations that he or she finds extremely frightening for a prolonged period of time

etiology of eating disorders

genetic vulnerability, personality factors, cultural values, role of the family, cognitive factors -female -adolescence -high mortality rate -amenorrhea -*high risk of suicide* -coexist w depression, anxiety, and substance abuse

predisposing factors associated w dissociative disorders

genetics neurobiological -dissociative amnesia may be related to neurophysiological dysfunction -EEG abnormalities have been observed psychodynamic theory -Freud; amnesia = the result of repression of distressing mental contents from conscious awareness -behaviors such as amnesia, depersonalization, and derealization are a defense against unresolved painful issues psychological trauma -set of traumatic experiences that overwhelm the individual's capacity to cope by any means other than dissociation -usually take the form of severe physical, sexual or psychological abuse by a parent or significant other in the child's life -serves as survival strategy

Trichotillomania

hair pulling disorder

personality characteristics of somatic symptom disorder

heightened emotionality, strong dependency needs, and a preoccupation with symptoms and oneself.

suppression

high adaptive level; avoid thinking about problem areas *intentionally*

sublimation

high adaptive level; channeling maladaptive thoughts and feelings such as aggression into socially acceptable behaviors

humor

high adaptive level; using humor assists the person with the management of everyday stressors

what are somatic symptom disorders identified as?

hysterical neuroses; thought to occur in response to repressed severe anxiety

Body Dysmorphic Disorder (BDD)

imagined or slight flaws of the face or head, such as wrinkles or scars, the shape of the nose, excessive facial hair, and facial asymmetry -focus on excessive grooming, checking in the mirror, skin picking, and multiple cosmetic surgeries -Important to determine if the media has influenced the perceived deficit -high risk of completed suicide -Important to ask if patient has any worries about his/her appearance -Ask direct questions about the concerns -Determine the amount of time the patient spends thinking about the perceived deficit -Determine what actions have been taken in attempt to alter the perceived deficit -Determine how the preoccupation has affected daily functioning

difference in PTSD and ASD

in ASD: 1) the individual experiences at least three symptoms indicating dissociation 2) the time frame of the development and duration of symptoms is shorter 3) the dissociative symptoms prevent the individual from adaptively coping with the trauma

dissociative fugue

in which there is a sudden, unexpected travel away from home with the inability to recall some or all of one's past

localized dissociative amnesia

inability to recall all incidents associated with the traumatic event for a specific time period following the event (usually a few hours to a few days)

generalized dissociative amnesia

inability to recall anything that has happened during the individual's entire lifetime, including personal identity

tx for somatic symptom disorders

individual psychotherapy group psychotherapy behavior therapy psychopharmacology

tx for personaity disorders

individual psychotherapy psychoanalytical psychotherapy milieu/group therapy cognitive/behavioral therapy dialectical behavior therapy medication

tx for eating disorders

interdisciplinary treatment team behavior modification individual therapy family therapy refeeding/monitoring weight gain pharmacological therapy

Splitting of the self-image or of the image of others

major image-distorting; inability to integrate positive and negative aspects of the self or others or to integrate own strengths and weaknesses; viewing self, others, and situations as being either all good or all bad

psychological factors affecting medical conditions

may play a role in virtually any medical condition -evidence of a general medical condition that has been precipitated by/is being perpetuated by psychological or behavioral circumstances

Repression

mental inhibition/compromise formation level; *unintentionally* pushing back disturbing thoughts, desires, or experiences from the conscious

dissociation

mental inhibition/compromise formation level; an alteration in an awake state during which the person feels detached from his or her surroundings

displacement

mental inhibition/compromise formation level; transferring a feeling or response toward one person onto another less threatening person or object

devaluation

minor image-distorting; attributing negative qualities to self or others, always finding a fault

bulimia nervosa

more prevalent -cycles of starvation, binge eating, and purging -episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food of a short period of time, followed by inappropriate compensatory behaviors to get rid of calories

schizotypal personality disorder

more severe than schizoid -aloof and isolated -behave in a bland/apathetic manner -no psychosis -caused by genetics; anatomic deficits or neurochemical dysfunctions in the brain; early family dynamics of indifference, impassivity, formality which leads to pattern of discomfort w personal affection and closeness

interdisciplinary tx team for eating disorders

nurses, psychiatrists, medicine, psychology, pharmacology, dietary, education, social work, occupational therapy, and spiritual guidance

cluster A

paranoid, schizoid, schizotypal; behavior described as odd/eccentric

hoarding disorder

persistent difficulty discarding or parting with possessions, regardless or their actual value

personality disorders occur when?

personality traits become inflexible and personality functioning becomes individually and interpersonally impaired

hysteria

polysymptomatic disorder that usually begins in adolescence, chiefly affects women, and is characterized by recurrent multiple somatic complaints that are unexplained by organic pathology; thought to be associated with repressed anxiety

nursing dx for trauma related disorders

posttrauma syndrome complicated grieving

what is the treatment of choice for histrionic personality disorder?

psychoanalytical psychotherapy

agoraphobia

recurrent, unexpected panic attacks, with at least one attack followed by one of the following for a month 1) persistent concern about having additional attacks; 2) worry about the implications of the panic attacks; 3) a significant change in behavior as a result of the attacks *fear when perceiving that he or she is unable to escape from a situation that is restricting such as a moving automobile, or from an embarrassing situation* -avoids agoraphobic situations or has anxiety about having a panic attack -panic attacks are not caused by the direct effects of a substance, a medication, or medical condition

compulsions

repetitive behaviors that a person feels driven to perform in response to an obsession

anxiety

state of tension, dread, or impending doom that results from external influences that threaten to overwhelm the individual

group/family therapy for trauma related disorders

strongly advocated for clients with PTSD

somatic symptom disorder

syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long-term seeking of assistance from health care professionals -chronic; anxiety, depression, and suicidal ideation are frequent -drug abuse/dependence are common complications

defense mechanisms

the ego's protective methods of reducing anxiety by unconsciously distorting reality

personality

totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time

T/F somatic symptom disorders affect men and women equally

true

prolonged exposure therapy for trauma related disorders

type of behavioral therapy similar to implosion therapy or flooding

How did Freud view dissociation?

type of repression, an active defense mechanism used to remove threatening or unacceptable mental contents from conscious awareness

dissociative identity disorder (DID) is more common in?

women

is PTSD more common in men or women?

women