N250 stress and coping

A nurse is discussing stress management techniques with a group of clients. Which of the following techniques mentioned by a client should the nurse recognize as the least effective? "I journal when I find it difficult to talk." "I pray when I begin to breathe fast." "I fix myself a pot of coffee when I get anxious." "I exercise when my neck is tense."

"I fix myself a pot of coffee when I get anxious."

Characteristics of dependent personality disorder

-High need to be taken care of -Submissiveness -Fears of separation and abandonment -Manipulating others to take responsibilities and to take care of them -Intense anxiety when left alone even briefly

What is the epidemiology and comorbidity for borderline personality disorder

10% suicide and mortality rate 70% will attempt suicide BPD patients often have another mental illness—Bipolar Substance use disorders: >50%

outcomes for antisocial personality disorder

Abusive behavior self-restraint Aggression self-restraint Coping, social interaction, social isolation knowledge Health promotion knowledge Health promoting behavior

What is ACES?

Adverse Childhood Experiences Sensitize people to stress in later life; These include: Any form of psychological, physical, and sexual abuse Violence against a parent, particularly the mother Living with people with substance use disorders, mentally ill, or ever incarcerated

What is general adaptation syndrome

Alarm or acute stress stage —Activates sympathetic nervous system —Activates HPA axis to stay on alert (putting the gas on—glucose pump) Resistance or adaptation stage —Sustained and optimal resistance to the stressor; recovery, repair, and renewal may occur. Exhaustion stage —Resources are depleted; the stress may become chronic

Characteristics of antisocial personality disorder

Antagonistic behaviors Disinhibited behaviors Profound lack of empathy Absence of remorse or guilt Symptoms peak mid-teens to 20s; symptoms may abate and improve on their own by age 40 May be charismatic/charming Not all are killers Males have a higher risk

What is the cluster C personality disorders (anxious)

Avoidant Dependent Obsessive-compulsive

A nurse is caring for a client who has paranoid personality disorder. Which of the following findings should the nurse expect? (Select all that apply.) A. Believes that others are deceiving him. B. Desires to be the center of attention. C. Views himself as inferior to others. D. Demonstrates a grandiose sense of self-importance. E. Persistently holds onto grudges.

Believes that others are deceiving him. Persistently holds onto grudges.

Managing Stress Through Relaxation Techniques

Biofeedback Deep breathing exercises Guided imagery Progressive relaxation Meditation Mindfulness Physical exercise Cognitive reframing Journaling Humor

Treatment Modalities for PTSD

Biological Treatment Pharmacotherapy: Antidepressants, SSRIs Psychological Therapies —Components of exposure and/or cognitive restructuring and EMDR therapy

Treatment Modalities for PTSD

Biological Treatments —Pharmacotherapy combined with EMDR therapy or CBT —Target symptoms and comorbidities like ADHD or MDD Psychological Therapies —CBT —EMDR

What is the fight or flight response?

Body prepares for situation that individual perceives as threat to survival —Increased blood pressure, heart rate, respirations, and cardiac output New research indicates that men and women have different neural responses to stress

What is the most common personality disorder seen in the hospital

Borderline Antisocial

What is the cluster B personality disorders (erratic)

Borderline Narcissistic Histrionic Antisocial

Planning and implementation for antisocial personality disorder

Boundaries, consistency, support, and limits Realistic choices Therapeutic communication vs. manipulation Teamwork and safety (prime) Pharmacological interventions (mood stabilizers)

Psychological therapies for BPD

CBT Dialectical behavior therapy (DBT) Schema-focused therapy

Post-traumatic Stress Disorder in Children and Adolescents

Clinical picture Posttraumatic stress disorder (PTSD) is seen even in preschool children Manifestations Reduction in play or play reflecting aspects of the trauma Self-blame, detachment, estrangement, loss of interest in significant activities Mood changes, sleep disturbances, hypervigilance, loss of concentration

What cluster is antisocial personality disorder

Cluster B

What cluster is borderline personality disorder in

Cluster B

What is the most common self harm in borderline personality disorder

Cutting

Critique of the GAS Theory

Different types of stressors bring different patterns of response It is the degree of stress that is important. GAS reflects male responses Females tend to respond by "tending and befriending"

Post Traumatic Stress Disorder risk factors

Epidemiology —About 60% of men and 50% of women have at least one trauma in their lifetime Comorbidity —depression —anxiety —sleep disorder —substance abuse Risk Factors —Similar to those seen for children

PTSD in Children

Epidemiology—90% children has had sexual abuse Comorbidity—ADHD, sleep problems, suicide, substance abuse Risk Factors —Biological —Environmental

What are the characteristics of histrionic personality disorder

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 No insight into disorder

Characteristics of narcissistic personality disorder

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

Assessment for PTSD

Flashbacks Sleep problems Nightmares Night terrors Numbing Avoidant behavior Behind developmentally

Post Traumatic Stress Disorder in Adults

Flashbacks: Re-experiencing the trauma Avoidance of stimuli associated with trauma Persistent symptoms of increased arousal (hypervigilance) Alterations in mood— anhedonia

Risk factors for PTSD

Genetic —How individuals react to trauma Neurobiological —Trauma dysregulates neural pathways that integrate emotional regulation and arousal —Triggers hypo-aroused state leading to dissociation —Polyvagal theory (parasympathetic can be activated with trauma) Environmental factors —Children's neuroplasticity: Dependence on adults and systems —External factors that support or add stress —Resilience

A nurse is planning care for a client who has dependent personality disorder. Which of the following actions should the nurse plan to take? Monitor the client closely to prevent self-mutilation. Set limits to prevent exploitation of other clients. Discourage flamboyant or seductive behaviors. Give positive feedback when client is assertive with staff or clients.

Give positive feedback when client is assertive with staff or clients

Assessment coping styles

Health-sustaining habits—exercise, reading healthy eating, sleeping Life satisfaction Social supports Effective and healthy responses to stress

What are the risk factors for borderline personality disorder

High genetic association Neurobiological—serotonin may be involved Cognitive: Separation-individuation

A nurse on a mental health unit enters the day room and observes a client hit another client. Which of the following statements should the nurse make? "Why did you hit another client?" "Hitting others is unacceptable behavior." "Your behavior will disappoint your provider." "I'm taking away your TV privileges and putting you in seclusion."

Hitting other is unacceptable behaviors.

A nurse is caring for a client who has borderline personality disorder (BPD). As part of the client's plan of care, the nurse reviews the day's schedule with the client each morning. As the nurse begins to review the schedule with the client, the client says, "Why don't you shut up already? I can read it myself, you know!" Which of the following responses should the nurse give the client? "We do this every day. Why are you so angry with me this morning?" "I don't like it when you address me with that tone of voice." "I know you can, but are you going to read it or not?" "Fine. Here is the schedule, and I will expect you to be on time to your therapies."

I don't like it when you address me with that tine of voice

A nurse is caring for a client who was involved in heavy combat and observed war casualties. The nurse should suspect that the client is suffering from posttraumatic stress disorder (PTSD) if the client makes which of the following statements? "I check any room I enter because the enemy is still after me and could be hiding anywhere." "My child was born with a birth defect due to an exposure I had overseas." "I killed four enemy soldiers with my bare hands and saved my entire battalion." "In my dreams, all I can see are the wounded reaching out and trying to grab me."

In my dreams, all I can see are the wounded reaching out and trying to grab me."

A nurse is teaching a class about physical manifestations that occur during the fight-or-flight response to stress. Which of the following manifestations should the nurse include? Decreased blood pressure Bronchial airway constriction Constricted pupils Increased blood glucose levels

Increased blood glucose levels

What does chronic stress cause in the body

Increased risk of sickness High BP High HR

Immune System Stress Responses

Interaction between nervous system and immune system during alarm phase of GAS Negatively affects body's ability to produce protective factors Links exist among stress (biopsychosocial), the immune system, and disease

What are the characteristics of paranoid personality disorder

Long-standing distrust and suspicion of other May be apparent in childhood Social anxiety in childhood Jealous, controlling as adults Unwillingness to forgive and projection of feelings

Characteristics of avoidant personality disorder

Low self-esteem Shyness that increases with age (extreme shyness) Feelings of inferiority Reluctance to engage with new people Subject to depression, anxiety, and anger Preoccupied with rejection, humiliation, and failure

Outcome identification for PTSD

Manages anxiety Experiences enhanced self-esteem Exhibits an enhanced ability to cope

Nursing management of stress response

Measuring stress Social Readjustment Rating Scale (Holmes and Rahe) Measures level of positive and negative stressful life events over a 1-year period Recent Life Changes Questionnaire

Post-Traumatic Stress Disorder in Adults: Examples of PTSD-Inducing Events

Military combat or hostage situations Crime-related events Natural disasters Human disasters (accidents) Heath care workers— 1st responders Person taking care of patient

What is distress

Negative draining energy that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue.

Treatment modalities for antisocial personality disorder

No specific medications Mood-stabilizers may help with aggression Also possible: SSRIs, benzodiazepines, or Ritalin

What is Eustress

Normal physiological positive energy that motivates individuals and results in positive feelings and purposeful movement

Outcomes and planning for BPD

Nursing Outcomes Classification (NOC) scales for measuring improvement Importance of the therapeutic relationship Avoid manipulative behaviors

A nurse in a mental health clinic is discussing guided imagery with a newly licensed nurse. Which of the following clients should the nurse suggest offering the therapy to? Post-traumatic Stress Disorder Schizophrenia Pedophilia Paranoid personality disorder

PTSD

What is the cluster A personality disorders (eccentric)

Paranoid Schizoid Schizotypal

Assessment for antisocial personality disorder

Patients with antisocial PD become defensive and do not tend to answer honestly Self-assessment

What is the nursing diagnoses for PTSD

Post-trauma response Anxiety (moderate, severe, panic) Ineffective coping Social isolation Insomnia Sleep deprivation Hopelessness Chronic low self-esteem Self-care deficit

Assessment for PTSD

Primary Care PTSD Screen (PC-PTSD) PTSD Checklist (PCL-5)

A nurse in an acute mental health facility is creating a plan of care for a new client who has histrionic personality disorder. Which of the following is the priority intervention for the nurse to make? Promote appropriate behavior during group therapy sessions. Encourage client input in the treatment plan. Communicate with the client using concrete language. Demonstrate assertive behavior.

Promote appropriate behavior during group therapy sensations

Implementation for BPD

Provide clear and consistent boundaries Use clear, straightforward communication Calmly review therapeutic goals Teamwork and safety Respond matter-of-factly to superficial self-injuries—okay I'll let the doctor know (do not reward behavior with attention)

Biological treatment for BPD

Psychotropics geared toward symptom relief

What are the s/s that someone with antisocial personality disorder is becoming assaultive

Rigid Glaring Fist clenching Shouting

Characteristics of obsessive-compulsive personality disorder

Rigidity; inflexible standards for others and self Constant rehearsal of social responses Excessive goal-seeking that is self-defeating or relationship-defeating Strict standards interfere with project completion Unhealthy focus on perfection Completely happy with what they're doing

Nursing diagnosis of BPD

Risk for self-mutilation Risk for suicide Risk for violence Social isolation Impaired socialization Disturbed personal identity Difficulty coping

Nursing diagnosis for antisocial personality disorder

Risk for violence Impaired impulse control Impaired social interaction

What is the priority for antisocial personality disorder

Safety

Assessment of BPD

Semi-structured interview Use of MMPI Self-assessment

What is the clinical picture for borderline personality disorder

Severe impairments in functioning Emotional lability Impulsivity Self-destructive behaviors Antagonism Splitting (defense mechanisms) : Inability to view both positive and negative aspects of others as part of a whole

Psychological therapies for antisocial personality disorder

Some evidence that this patient population may bond with psychotherapists CBT, MBT, or DBT

Implantation stages for PTSD

Stage 1: Provide safety and stabilization Stage 2: Reduce arousal and regulate emotion through symptom reduction and memory work Stage 3: Catch up on developmental and social skills; develop a value system

Mediators of the Stress Response

Stressors —Physiological (environmental/physical) —Psychological (stressful events) Perception Individual temperament Social support —Support groups Culture Spirituality and religion

What are the characteristics of schizoid personality disorder

Symptoms appear in childhood and adolescents Loners, poor academic performance Increased prevalence of disordered family life Avoid close relationships Depersonalization, detachment

A nurse is caring for a hospitalized client who tells lies about other clients. The other clients on the unit frequently complain to the nursing staff about the client's disruptive behaviors. Which of the following initial actions should the nurse take? Talk to the client and identify the specific limits that are required of the client's behavior. Discuss the problem in a community meeting with the other clients on the unit present. Escort the client to her room each time the nurse observes the client socializing with other clients. Tell the other clients to ignore the client's lies.

Talk to the client and identify the specific limits that are required of the client's behavior

A client is admitted with post-traumatic stress disorder following a fire in his home in which family members died. Which of the following should the nurse recognize as an adaptive defense mechanism? The client begins reading a book when he experiences hand tremors in response to loud noise. The client makes a decision to postpone a needed surgery. The client focuses on discussing his daily routine when asked about the fire. The client develops stomach pains when fire is seen on television.

The client begins reading a book when he experiences hand tremors in response to loud noise.

Outcome evaluation for PTSD

The patient... Recognizes symptoms as related to the trauma Uses learned strategies to manage anxiety Has no flashbacks or intrusive thoughts Sleeps adequately without nightmares Assumes usual roles Has satisfying interpersonal relationships

Trauma related disorders

Traumatic life events associated with a wide range of psychiatric and other medical disorders Understanding of long-term effects of trauma expanded —Effective treatments available —People in need of treatments do not always get the care they need Trauma-informed care

Evaluation for Child with PTSD

Treatment is effective when: —Safety is ensured. —Anxiety is reduced, and stress handled adaptively. —Emotions and behavior are appropriate for the situation. —Child achieves normal developmental milestones. —Child is able to seek out adults for nurturance and help when needed (even if they are not in immediate family)

Interventions for a Child with PTSD

Use interactive process Establish trust and safety Use developmentally appropriate language Teach relaxation techniques before trauma exploration to restore a sense of control Use art and play to promote expression of feelings Involve caretakers in 1:1s, unless they are the cause of trauma Educate child and caretakers about grief process and response to the trauma Assist caretakers in resolving their own emotional distress about the trauma Coordinate with social work for protections

Implementation for PTSD

Use same stage model of treatment used for children Health teaching & promotion

A nurse is assessing a client who is experiencing chronic stress. Which of the following findings should the nurse expect? Hypotension Viral infection Increased energy Increased cognitive awareness

Viral infection

Evaluation for antisocial personality disorder

is difficult and may be unknowable Motivation patients may learn to change behaviors

What is the most common personality disorder

obsessive-compulsive personality disorder

What are the characteristics of schizotypal personality disorder

severe social and interpersonal deficits extreme anxiety in social situations ramble in conversations paranoia (overly suspicious, anxiety, distrust) Brief, intermittent episodes of hallucinations or delusions Can be made aware of their own odd beliefs May be vulnerable to involvement with cults or unusual religious/occult groups They know there is something wrong Cannot debate their delusions