NURS 344: 8 Personality Disorders

schizotypal personality disorder - nursing interventions

1. Problem 1 interventions: a. Respect patient's need for social isolation (Halter, 2013) b. Encourage participation in group therapy (Halter, 2013) 2. Problem 2 interventions: a. Use of music therapy (Patusky, 2012) b. Talk with patient to understand fears/concerns (Patusky, 2012)

schizoid personality disorder - evaluation

How would the nurse know if the above interventions were successful? Problem 1: Ineffective Individual Coping: Patient states 3 coping mechanisms and describes how, when, and why they are going to use them. Patient will be able to state the reason why they are taking the medication, what will happen if they stop taking the medication, and when they should take the medication. Problem 2: Impaired Social Interactions: Engage in at least one activity at least once a day Client is able to effectively communicate with others in their environment.

dependent personality disorder - evaluation

How would the nurse know if the above interventions were successful? The nurse would know the interventions to be successful by the patient implementing their own cares such as picking out an outfit. Client is able to work together in a group of individual playing games or activities. The client is able to respond well to criticism. The patient will use techniques in a stressful situation to calm themselves. The patient will understand the disease and the rationale behind their specific diagnosis

schizotypal personality disorder - evaluation

How would the nurse know if the above interventions were successful? (At least one for each problem) Calm demeanor may be observed after appropriate alone time. Improved social skills will be present with participation in group therapy. Decreased anxiety will be observed after music therapy. Increased insight of positive coping skills following therapeutic communication will be present in the patient.

avoidant personality disorder - evaluation

How would the nurse know if the above interventions were successful? (At least one for each problem. 1. The client attends therapy group sessions and participates in therapy 2. Client was successful in initiating and maintaining conversation with peers

histrionic - evaluation

How would the nurse know if the above interventions were successful? (At least one for each problem. Altered Thought Process-patient is alert and orientated X 3, behavior is within normal limits Risk for Self-Harm-patient denies self-harm ideation, patient identifies coping mechanisms

obsessive-compulsive personality disorder - evaluation

How would the nurse know if the above interventions were successful? (At least one for each problem. Problem 1 intervention: patient can identify 4 healthy coping mechanisms and identify two short term goals and two long term goals. Problem 2 intervention: patient will be an active participant in group therapy and will be able to identify 3 personal strengths and identify.

paranoid personality disorder - evaluation

How would the nurse know if the above interventions were successful? Fear Patient shares pertinent medical information to the nurse Insomnia Patient uses a sleeping journal and shows improvement in sleep habits Increases number of hours sleep nightly (Potter, Perry, Stockert, & Hall, 2013)

schizotypal personality disorder - assessment findings

What behaviors are exhibited? 1. Discomfort in social situations. (Mandabear1234, 2008) 2. Odd beliefs, fantasies or preoccupations. (Mandabear1234, 2008) 3. Odd behavior, appearance and speech. (Mandabear1234, 2008) 4. No close friends, inappropriate display of feelings. (Mandabear1234, 2008) 5. Severe social and interpersonal deficits (Halter, 2013) 6. Extreme anxiety in social situations (Halter, 2013) 7. Contributions to conversations tend to ramble with lengthy, unclear, overly detailed, and abstract content (Halter, 2013) 8. Mild paranoia that leads to over suspicion and anxiety (Halter, 2013) 9. Lack of warmth, aloofness, and indifference to the feelings of others (Halter, 2013) 10. Transient hallucinations (Halter, 2013)

narcissistic personality disorder - assessment findings

What behaviors are exhibited? As stated by Halter (2014): 1. Arrogance—unrealistic view of self-importance 5. Lack of compassion for others 2. Antagonism 6. Feel intense shame 3. Grandiosity 7. Fear of abandonment 4. Attention-seeking

histrionic - assessment findings

What behaviors are exhibited? (For the paranoid, schizoid, schizotypal disorders please differentiate between them for assessment findings.) 1. Be uncomfortable unless he or she is the center of attention 2. Dress provocatively and/or exhibit inappropriately seductive or flirtatious behavior 3. Shift emotions rapidly 4. Act very dramatically, as though performing before an audience, with exaggerated emotions and expressions, yet appears to lack sincerity 5. Be overly concerned with physical appearance 6. Constantly seek reassurance or approval 7. Be gullible and easily influenced by others 8. Be excessively sensitive to criticism or disapproval 9. Have a low tolerance for frustration and be easily bored by routine, often beginning projects without finishing them or skipping from one event to another 10. Not think before acting 11. Make rash decisions 12. Be self-centered and rarely show concern for others 13. Have difficulty maintaining relationships often seeming fake or shallow in their dealings with others Threaten or attempt suicide to get attention

schizoid personality disorder - assessment findings

What behaviors are exhibited? (For the paranoid, schizoid, schizotypal disorders please differentiate between them for assessment findings.) 1. Doesn't desire or enjoy relationships 2. Avoids social activities 3. Appears aloof and detached 4. May experience depersonalization (feelings of detachment from oneself and the world) 5. Unlike Schizotypal and Paranoid personality disorders they do not experience paranoia.

A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data?

A. Schizotypal personality disorder B. Histrionic personality disorder C. Compulsive personality disorder D. Manic personality disorder Correct answer: B. Histrionic personality disorder Rationale: Nurses should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention.

A nurse is teaching assertiveness techniques to a group of clients diagnosed with dependent personality disorder. Which of the following statements indicates that the teaching was not successful

A. "I appreciate the suggestion you made to me" B. "I decided to use one of the assertive techniques" C. "I learned so much I did not know before" D. "I'm going to the library to get the book you suggested" Correct answer: C Rationale: The patient is not completing an action preformed or accepting the criticism given to them and turn it into a positive outcome.

When performing an assessment on a 48 year old women who is diagnosed with Paranoid Personality Disorder, Which behavior should the nurse be most aware of when interviewing her?

A. Hostility B. Hypervigilance C. Reluctant to share personal information D. Projection -Correct answer: B. Hypervigilance Rationale: Hypervigilance is: "a state of extraordinary alertness that results in an exaggerated startle response,"

All of the following are behaviors exhibited by a person with a Narcissistic Personality Disorder except:

A. Lack of compassion for others B. Shyness C. Arrogance D. Attention-seeking Correct answer: B Rationale: People with narcissistic personality disorder exhibit arrogance, attention-seeking behaviors, lack of compassion to others, grandiosity, antagonism, fear of abandonment, and a feeling of intense shame. Narcissistic people are not shy, they try to impress people (grandiose).

A client with avoidant personality disorder tells the nurse that he is going to skip group therapy today because he does not feel like being around anyone and he finds therapy to be boring. What would be the best action taken by the nurse?

A. Let the group leader know that the client is not feeling well today and will be skipping group therapy. B. Encourage the client to attend therapy and offer to escort him there. C. Ask the client why he thinks therapy is boring. D. Give him an activity he could do by himself. Correct answer: B Rationale: Reference: Option B is the best option because the nurse is expressing the importance of therapy, while also making the client feel more comfortable by offering to walk him to therapy. Client's who have avoidant personality disorders are reluctant to form relationships with people and avoid activities that involve contact with others. The first option is incorrect because the nurse is allowing the patient to avoid therapy completely without trying to persuade him. The third option is incorrect because the nurse is addressing an invalid issue and is avoiding the real issue: the client's need for group therapy and socialization. The last option is incorrect because this allows the client to avoid therapy and the nurse is validating his behavior by enabling him avoid others.

narcissistic personality disorder - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors. NANDA's list of Nursing Diagnosis: 1. Decrease in self-esteem 2. Impaired interrelationships and social interaction

A patient is admitted to a medical surgical floor after a laparoscopic appendectomy. This patient has a history of schizoid personality disorder. What strategy would be most appropriate when communicating to this patient in regard to the patient's personality disorder?

Acknowledgement of the patient's frequent auditory hallucinations, but not playing into them. Using therapeutic communication to address the patient's extreme paranoia. Assess the patient when necessary and listen to patient's concerns, but do not constantly pressure communication or interaction. Trying to cheer the patient up with jokes, ask what is wrong with him/her when he/she isn't reacting to your attempts. Correct answer: C Rationale: The patient with schizoid personality disorder does not often experience psychotic symptoms or paranoia, ruling out options A and B. Common symptomology of a patient with schizoid personality disorder is reluctance to engage in social interactions, feeling comfort in being alone, and a perception from others as being without emotion. Therefore, as a nurse caring for a patient of this diagnosis, one should be respectful of their perception of social interactions and make assessments as necessary as to not overwhelm the patient. Continue to listen to the patient's concerns and follow up as necessary. Option D may overwhelm the patient and shows a lack of understanding for the condition.

A 21-year-old patient is admitted to the behavioral health unit exhibiting symptoms of perfectionism, emotional withdrawal, compulsivity, oppositionality, and lack of emotional expressiveness. Which is your priority nursing diagnosis?

Altered thought process Altered self esteem Risk for violence other directness Risk for activity intolerance Correct answer: A Rationale: A person with OCPD suffers from an altered thought process.

schizotypal personality disorder - The nurse is developing a care plan for a patient that is diagnosed with Schizotypal personality disorder with a nursing diagnosis of social isolation. Which of the following would be an appropriate goal?

Attend and partake in a daily communication class Eat lunch at a table with other peers Play soccer for 15 min with peers Initiate and sustain a conversation for 5 minutes Correct answer: B. Eat lunch at a table with other peers Rationale: The nurse will want the patient to participate in low stress opportunities with other people. These situations could be anything from eating at a table with some other peers or drawing in an art group along with others. This patient will not want to socialize with others, but the nurse knows that this is very important for mental health patients.

narcissistic personality disorder - evaluation

How would the nurse know if the above interventions were successful? (At least one for each problem.) Problem: Decreased self-esteem Intervention: Help patient identify current behaviors that are a result of low self-esteem Successful when: Patient is able to verbalize situations throughout the day where she/he may have felt a lack of self-confidence, intense shame, abandonment, obsessive-compulsive or addictive behaviors, self-doubting, and afflicted with feelings and fears of inferiority. After he/she is able to verbalize these findings, he/she will be able to incorporate positive self-esteem behaviors to the same situation. If he/she is able to do the following, the intervention was successful. Problem: Impaired Interrelationships and social interaction Intervention: Help patient identify traits he/she feels are important in friendships or relationships developed with individuals Successful when: Patient is able to make a list of 5 or more appropriate, positive characteristics within friendships and relationships. Patient is able to verbally state rationale for listed traits, and how he/she will attempt to demonstrate such traits.

dependent personality disorder - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors. Risk for impaired social interaction Risk for anxiety

histrionic - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors. 1. Altered Thought Process 2. Risk for Self-Harm

obsessive-compulsive personality disorder - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors. 1. Ineffective coping 2. Impaired social interaction

avoidant personality disorder - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors. 1. Risk for suicide 2. Social Isolation

schizoid personality disorder - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors.--Tiffany 1. Ineffective individual coping 2. Impaired social interactions

paranoid personality disorder - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors. 1. Fear 2. Insomnia (Potter, Perry, Stockert, & Hall, 2013)

schizotypal personality disorder - nursing diagnoses/problems

Two nursing problems that are commonly seen with the behaviors. 1. Impaired social interaction 2. Ineffective coping

paranoid personality disorder - assessment findings

What behaviors are exhibited? (For the paranoid, schizoid, schizotypal disorders please differentiate between them for assessment findings.) 1. Longstanding distrust of others, suspiciousness of others 2. Belief that others want to exploit, harm, or deceive the person 3. Hypervigilant 4. Anticipate hostility 5. May provoke hostile responses by initiating a "counterattack" 6. Demonstrate jealousy 7. Demonstrate controlling behaviors/unwillingness to forgive 8. Difficult to interview because they are reluctant to share information about themselves 9. May have grown up in households where they were the object of excessive rage and humiliation, resulting in feelings of inadequacy 10. May use projection 11. Tend to reject treatment 12. Show cognitive and perceptual distortions (Halter, 2014)

avoidant personality disorder - assessment findings

What behaviors are exhibited? (For the paranoid, schizoid, schizotypal disorders please differentiate between them for assessment findings.) 1. May be easily hurt by criticism or disapproval 2. May show excessive restraint in intimate relationships 3. May be reluctant to become involved with people 4. May avoid activities or occupations that involve contact with others 5. May be shy in social situations out of fear of doing something wrong 6. May exaggerate potential difficulties

dependent personality disorder - assessment findings

What behaviors are exhibited? (For the paranoid, schizoid, schizotypal disorders please differentiate between them for assessment findings.) High need to be taken care of (avoidance of adult responsibilities) Fear of separation Insecurity of self Acting passive or helpless

obsessive-compulsive personality disorder - assessment findings

What behaviors are exhibited? (For the paranoid, schizoid, schizotypal disorders please differentiate between them for assessment findings.) Obsessions (persistent, recurrent thought, impulse, or image that causes distress or anxiety) Compulsions (repetitive behavior and/or though a person uses to diminish, neutralize, or ward off obsession) Perfectionism Emotional withdrawal if unable to control situation Lack of flexibility Lack of generosity Excessive devotion impairing normal life functioning Hoarding behaviors (unable to throw things away) Preoccupation with details, rules, lists Unwilling to give responsibilities to others

avoidant personality disorder - nursing interventions

What interventions should nurses know when encountering patients with this personality disorder in all healthcare settings? (Direct this back to assessment finding and primary problem(s). 1. Problem 1 interventions: a. Assess the patient for suicidal thoughts/plans. Ask if they want to harm themselves. b. Therapy group referrals 2. Problem 2 interventions: a. Have the client explore personal feelings about interacting with others. b. Give the client an opportunity to briefly interact with others in a non-threatening environment. Stay with client upon initial interaction. c. Help the client recognize social skills and seek to enhance comfort level with communication.

obsessive-compulsive personality disorder - nursing interventions

What interventions should nurses know when encountering patients with this personality disorder in all healthcare settings? (Direct this back to assessment finding and primary problem(s). 1. Problem 1 interventions: a. Encourage patient to be involved in care and scheduled activities b. Help patient develop coping mechanisms c. Provide activities within patient's abilities d. Encourage moderate exercise e. Help the patient set realistic goals for improvement 2. Problem 2 interventions: a. Identify strengths b. Role model accepted social behaviors c. Group Therapy d. Identify precipitation factors/stressors e. Encourage sharing of feelings f. Discuss negative self-talk

dependent personality disorder - nursing interventions

What interventions should nurses know when encountering patients with this personality disorder in all healthcare settings? (Direct this back to assessment finding and primary problem(s). 1. Problem 1 interventions: a. Increase coping skills by motivational interviewing b. Group therapy to allow patient to open up to others c. Have the patient identify the cause and habits they have with social interactions 2. Problem 2 interventions: a. Identify effective coping mechanisms b. Decrease stimulation by non-pharmacological interventions c. Use of pharmacological interventions to decrease anxiety symptoms

histrionic - nursing interventions

What interventions should nurses know when encountering patients with this personality disorder in all healthcare settings? (Direct this back to assessment finding and primary problem(s). 1. Problem 1 interventions: a. Keep environmental stimuli to a minimum b. Reorientation c. Maintain consistent structured routine d. Avoid touch and proximity e. Use distraction rather than confrontation f. Set limits on negative behavior (Continue lettering as needed) 2. Problem 2 interventions: a. Maintain safe environment b. 15 minute checks c. Educate patient on consequences d. Identify coping strategies (Continue lettering as needed)

schizoid personality disorder - nursing interventions

What interventions should nurses know when encountering patients with this personality disorder in all healthcare settings? (Direct this back to assessment finding and primary problem(s). 1. Problem 1 interventions: a. Nurse will have patient will state 3 coping techniques before discharge from facility b. Nurse will have patient state the importance of medication compliance with relation to disease process 2. Problem 2 interventions: a Help the client identify appropriate diversional activities to encourage socialization. b.Establish trust one on one and then gradually introduce the client to others.

narcissistic personality disorder - nursing interventions

What interventions should nurses know when encountering patients with this personality disorder in all healthcare settings? (Direct this back to assessment finding and primary problem(s). 1. Problem 1 interventions: Decrease in self-esteem Help patient identify environmental factors which increase the risk for low self esteem Help patient identify current behaviors that are a result of low self esteem Encourage creative problem solving through writing exercises Encourage patient to maintain highest level of functioning, including work schedule. Encourage patient to verbalize thoughts and feelings about their current situation. Help patient to identify what has helped maintained positive self-esteem in the past. Help patient identify resources and social support networks available to them Help patient find self-help or therapy groups focused on self esteem Assess for signs of anxiety and depression. 2. Problem 2 interventions: Impaired interrelationships and social interaction a. Help patient identify traits he/she feels are important in friendships or relationships developed with individuals b. Help patient identify drive behind actions and emotions (distrust, cutting people down, disgust for themselves) c. Help patient to understand emotions and how to regulate them properly d. Help patient identify behaviors that may be stressful or strenuous to the relationship e. Encourage participation in group therapy f. Build a trusting relationship with the patient that encourages full disclosure

paranoid personality disorder - nursing interventions

What interventions should nurses know when encountering patients with this personality disorder in all healthcare settings? (Direct this back to assessment finding and primary problem(s). 1. Problem 1 interventions: Fear Give clear and straightforward explanations of tests and procedures beforehand Use simple, clear language, avoid ambiguity Project a neutral but kind affect Work to establish rapport with the patient (Halter, 2014) 2. Problem 2 interventions: Insomnia a. Establish a bedtime routine and sleep schedule b. Avoid caffeine, nicotine, and alcohol before bedtime c. Help patient identify stressful concerns that are keeping them awake d. Control temperature, level of sound, and light in the environment e. Encourage exercise and energy-using activities f. Muscle relaxation before bedtime (Potter, Perry, Stockert, & Hall, 2013)