Personality Disorder part 2

Angela is 7 years old. Suddenly, about the same time as her sister's birth, she began wetting the bed again. Which defense mechanism is she using? 1)Suppression 2)Undoing 3)Regression 4)Splitting

Regression

Dependent personality disorder may tolerate

verbal, physical, and sexual abuse to prevent abandonment from a person they depend on.

A nurse should always in a patient with obsessive personality disorder

-Show acceptance of the patient and separate behavior from the person. -Set limits on the patient's intolerance of other patients and discuss feelings associated. do not accept gifts with the specific situation. -Set limits on inappropriate behavior resulting from anger. Also, monitor nurses for reactivity. Approach each patient from the front.

when caring for avoidant personality disorder, nurses should

-show acceptance toward the patient at all times and gradually introduce them to non- threatening, non-competitive activities. -Follow-ups to help promote trust and establish contact, and engage in conversation. -Introduce the patient to activities that build self-confidence.

DEPENDENT PERSONALITY DISORDER:

-submissive and clingy -Tolerate abuse to prevent being left alone -Avoid responsibility and express helplessness -need reassurance and fear separation

•What are the cluster C personality disorders?

Avoidant, dependent, obsessive compulsive (anxiety/fear)

•Jane is a 24yo female who can't maintain relationships for very long. Her friends say they don't know what to expect from Jane. She is either very nice to them or does mean things to them behind their back. As her nurse, you would not give her a PRN she requested. She later told your co-worker that you said she was not a good nurse. She has superficial cuts on her left forearm. Which personality disorder best matches Jane's behavior? SATA •Schizotypal •Paranoid •Schizoid •Histrionic •Narcissistic •Borderline

Borderline

avoidant personality disorders

Feel inadequate, Expect rejection, Avoid work, school, or social situations if possible, Avoids making friends, and withhold feelings of intimacy

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER:

Have difficulty relaxing, Preoccupation with rules and trivial details, Very controlling/guarded, hostility over mistakes, intolerant of other emotions

•Mr. Smith is a patient on your unit and this is your first day back from vacation. Mr. Smith walks up to you and states "well hello pretty lady, I haven't seen you here before". What is your response?

I'm your nurse today and my name is ___, let me know if there's anything I can do for you

•Keisha has interviewed for a job and knows the other applicant for the position. Before the other person's interview today, Kisha went to her house and slit the tires on her car so she would miss the interview. Keisha thinks she should always get what she wants and can't imagine the other person, who does not have Keisha's superior qualities, getting the job. Which personality disorder best matches Keisha's behavior? •Schizotypal •Paranoid •Schizoid •Histrionic •Narcissistic •Borderline

Narcissistic

•His department always produces the best work in the company, yet no one can satisfy him. He and his wife often separate and get back together. They have had problems with their children. While his office is immaculate, his wife says his bedroom is a total mess. •Which PD does Mr. Lopez likely have?

OCD, C type and odd/eccentric

Micah has a fear of the drill used at his dentist's office. He is always forgetting his dental appointment. Which defense mechanism is he using? 1)Suppression 2)Regression 3)Repression 4)Undoing

Repression

You met your new co-worker two weeks ago and she has been very friendly to you, almost too clingy. Yesterday, she began avoiding you and telling your co-workers what an incompetent person and nurse you are. Which defense mechanism is your co-worker using? 1)Regression 2)Undoing 3)Splitting 4)Repression

Splitting

Marcus lost his job last week but states he will worry about paying his bills next week. Which defense mechanism is he using? 1)Regression 2)Suppression 3)Undoing 4)Splitting

Suppression

Sarah has an argument with her husband, then cooks his favorite foods for the next few days. 1)Repression 2)Splitting 3)Regression 4)Undoing

Undoing

Why do you suppose people with borderline personality disorder may sometimes prefer a transitional object instead of a person?

transition objects may be stuffed that they always have bc doesn't talk bad about them and represents a constant

•Within a few hours, Mr. Smith has given some of the techs free movie passes and they have given him coffee with caffeine (when others got de-caf). What do you do?

You sit down with tech and talk to patient about being manipulative

•You notice in his chart that he has a history of illegal activities and has been incarcerated twice. •He was diagnosed with conduct disorder at age 6. •Prior to this admission, he destroyed two rooms in his brother's house by using a shovel and spray paint. •He feels no remorse for hurting his wife during abusive periods. •On the unit, he smiles a lot and the other patients really like him. •Which personality disorder does he likely have?

antisocial disorder

•What are the Cluster B Personality Disorders?

antisocial, borderline, histrionic, narcissistic

Histrionic

attention-seeking and loud

•She looks at you, shocked, that you said she did a good job. You ask her "what keeps you from doing these kinds of projects more often?". She replies, "I'm just not good at anything and I don't want people to say anything bad to me". • •Which personality disorder does she likely have?

avoidant PD, Cluster C and high anxiety

•Overall, what behaviors are seen in Cluster B?

behavior is dramatic and erratic, highly emotional and manipulative

dependent personality disorders precipitate

caregiving behaviors in others and come from thinking they are unable to take care of themselves.

•Which cluster of personality disorders responds better to antidepressant drugs that are effective for the treatment of anxiety disorders? •Cluster A •Cluster B •Cluster C

cluster C

patients with obsessive compulsive disorder

dedication to work leads them to exclude personal & leisure activities.

•Ms. Jones has been hospitalized several days now. You start your shift. Ms. Jones runs up to you in a panic and states "Oh no, has the other nurse from the previous shift left? He told me to tell you that if he didn't have time to get my notebook for me before he left, for you to get it". "You know you have always been my favorite nurse. I was just telling the doctor how sweet you are" •What behaviors are you observing? •What is your response to her?

don't want them cutting themselves

Dependent

evoke care taking behaviors in others, unable to make decisions

There is a pervasive pattern of excessive submissive and clinging behavior that is

fear of separation.

Borderline

fears abandonment, unstable identity and relationship, self-mut8ilates, is labile and uses splitting

Antisocial

lack of responsibility's or guilt for actions deceitful unlawful

•Which drug reduces anger and suicidal thoughts in people with Borderline Personality Disorder: •Haldol •Zoloft •Tegretol •Lithium

lithium

People with dependent PD have problems

making everyday decisions, such as, what to wear, which ink pen to use at work, or what color socks to wear. and rarely disagree with others in fear that others

a client with antisocial personality disorder is admitted to a chemical dependency unit. the nurse should expect which of the following behaviors.

manipulative, charming, exploitative, aggressive and impulsive

Schizoid

not affected by praise of criticism, emotionally detached

safety is always

number 1 safety related to sharp equipment's etc

•What type behaviors are seen in Cluster A personality disorders?

odd and eccentric

•Which personality disorders make up "Cluster A"?

paranoid schizoid schizotypal

•A nurse would not give a client a razor to shave her legs with. The client says, "That is why I can't stand day shift! The nurses are terrible. The best nurses who work at this hospital are the evening shift nurses. They are nice to me". This is an example of •A. regression •B. splitting •C. undoing •D. identification

splitting

•It is the same shift and Ms. Jones is very angry because she didn't get her notebook. The patient representative just called you stating Ms. Jones had called stating you were treating her unethically and giving other patients preferential treatment. Ms. Jones now walks up to you and says "I want to change nurses. I need somebody who is a real nurse and actually cares about me" I want to speak to your supervisor". •As her nurse, how do you respond? •What defense mechanism is she using?

splitting

•You notice that Ms. Jones has a history of drug abuse, self-mutilation, and suicide attempts. She tells you "If I can't get some Ativan for my nerves, I'm afraid I'll cut myself". As her nurse, what do you do?

talk to her, be calm, and say lets walk down the hall to talk

nurses must assess there own needs

to take care of others and demonstrate behavior that promotes independence in their patients