JULY 2010 NLEX RESULTS

TOP 10 July 2010 Nursing Board Exam Result

1.RAYAN ABOGADO OLIVA (ATENEO DE NAGA)- 86.80

2.AILEEN ANCANAN AUSTRIA DE LOS SANTOS(STI COLLEGE, INC.)- 86.40

3. ALLYCE JOANA TOLEDO DE LEON (UNIVERSITY OF SANTO TOMAS)- 86.00

ANNA VANESSA ANG GAN (UNIVERSITY OF SANTO TOMAS)- 86.00

4. ALYSSA LEONILA DELA SILVA GUIAM (CENTRO ESCOLAR UNIVERSITY-MANILA 85.80

5.CHARMAINE CAMACHO GAUIRAN (REMEDIOS TRINIDAD ROMUALDEZ MEMORIAL SCHOOL)- 85.60

VIDA THERESA SIBAYAN GUMANGAN (SAINT LOUIS UNIVERSITY)- 85.60

ABIGAIL DIAZ ICASIANO (ARELLANO UNIVERSITY-MANILA)- 85.60

WEENA MARIE BORDEOS LIM (UNIVERSITY OF SANTO TOMAS)- 85.60

JOHN JOSEPH MAYO MONTALBO (FAR EASTERN UNIVERSITY-MANILA)- 85.60

JAN MICHAEL GABIONZA ONG (OUR LADY OF FATIMA UNIVERSITY-VALENZUELA)- 85.60

JOAN DIOQUINO TEJADA (REMEDIOS TRINIDAD ROMUALDEZ MEMORIAL SCHOOL)- 85.60

6. ZYRUS RONN SAMSON BERNASOR (OUR LADY OF FATIMA UNIVERSITY)-VALENZUELA 85.40

ROUCHEL ANNE MAÑEZ BRIONES (UNIVERSITY OF THE PHILIPPINES-MANILA)- 85.40

7. PETER JAMES BONGOLAN ABAD (UNIVERSITY OF THE PHILIPPINES-MANILA)- 85.20

MERJORIE MAY MALICAY ADOLFO CEBU NORMAL UNIVERSITY (CEBU STATE COLLEGE)- 85.20

CLARENCE JOY LOZADA CUSTODIO (SAINT JOSEPH COLLEGE-CAVITE CITY)- 85.20

NICO PAULO MANIAGO DIMAL (ANGELES UNIVERSITY FOUNDATION)- 85.20

KRIS RAY ARCELO (DUMAGUIN VELEZ COLLEGE)- 85.20

STELA JOY RAMIREZ ENGADA (WEST VISAYAS STATE UNIVERSITY-LA PAZ)- 85.20

JAN CHRISTIAN GOMEZ FELICIANO (UNIVERSITY OF SANTO TOMAS)- 85.20

JOSE PAOLO JULIAN GALEON TARLAC STATE UNIVERSITY (TARLAC COLLEGE OF TECH.)- 85.20

PAULO KRISTOFFER LUMBA (MACASINAG DE LA SALLE UNIVERSITY-HEALTH SCIENCES INSTITUTE)- 85.20

JOY ANN ACIERTO TAN (NOTRE DAME OF DADIANGAS COLLEGE) 85.20

EMER JOY TAPIC VALE (UNIVERSITY OF BOHOL)- 85.20

8. HANA KIRSTIE SAN MIGUEL ABELLO (UNIVERSITY OF THE PHILIPPINES-MANILA)- 85.00

KEA TENA CAPIO (UNIVERSITY OF SANTO TOMAS)- 85.00

ANA FRANCESCA CABALLERO CENTENO (UNIVERSITY OF SANTO TOMAS)- 85.00

GRACE CECILE WE CO (UNIVERSITY OF THE PHILIPPINES-MANILA)- 85.00

MICHAEL PRINCE NOTORIO DEL ROSARIO (LORMA COLLEGE)- 85.00

ROUELLA CHRISTINA MARTIN FAJARDO (UNIVERSITY OF SANTO TOMAS)- 85.00

JOE MARI ABELLA FLORES CEBU NORMAL UNIVERSITY (CEBU STATE COLLEGE)- 85.00

DONNA MAY SISON FRONDA (SAINT JOSEPH COLLEGE-CAVITE CITY)- 85.00

RENAN JAMES SACE LIM (UNIVERSITY OF SANTO TOMAS)- 85.00

ROMINA TAN MANALOTO (OUR LADY OF FATIMA UNIVERSITY-QC)- 85.00

MARIAN SHERYL FLORES MILO (SAINT LOUIS UNIVERSITY)- 85.00

MARIA KRISELDA PEREZ ROSALES (LYCEUM OF THE PHILIPPINES UNIVERSITY-BATANGAS,INC) 85.00

CRISTINA GAN SATIADA (CHINESE GENERAL HOSPITAL COLLEGE OF NURSING & LIBERAL ARTS) 85.00

LAURENCE LESTER GAMBOA TAN (UNIVERSITY OF SANTO TOMAS)- 85.00

ELISE CARA KAW TENG TRINITY UNIVERSITY OF ASIA (TRINITY-QC)- 85.00

MARIE KATHRINA TORRALBA TOJONG (UNIVERSITY OF THE VISAYAS-MANDAUE CITY)- 85.00

JAYLYN GABRILLO VILLAFANIA (SAINT LOUIS UNIVERSITY)- 85.00

9. JAMELA MONTOYA ARCILLA (FAR EASTERN UNIVERSITY-MANILA)- 84.80

CZARINA MYRNELLI MAMORE BUENAFE (NORTHWESTERN UNIVERSITY)- 84.80

ARCEL TIATCO CABIGTING (ANGELES UNIVERSITY FOUNDATION)- 84.80

ELAINE KATRINA SIGALAT CALA (UNIVERSITY OF SANTO TOMAS)- 84.80

JULIE ANN DEL ROSARIO CLARIN (UNIVERSITY OF SANTO TOMAS)- 84.80

ANCEL RIVERA DE GUZMAN (HOLY ANGEL UNIVERSITY)- 84.80

ELEANOR DELOEG DELA PAZ (SAINT LOUIS UNIVERSITY)- 84.80

RIA LEAH OROPESA ESPORLAS (UNIVERSITY OF PERPETUAL HELP SYSTEM DALTA-LAS PIÑAS)- 84.80

ELAINE MEDINA LAPAAN (SAINT LOUIS UNIVERSITY)- 84.80

A NICO NAHAR IDRIS PAJES (ATENEO DE ZAMBOANGA)- 84.80

ANA JESKA SANA PEÑARANDA (WEST VISAYAS STATE UNIVERSITY-LA PAZ)- 84.80

JAN ROLAND CASINTO POMUCENO (NOTRE DAME OF DADIANGAS COLLEGE)- 84.80

ANGELINE VILLAREY REMPILLO (OUR LADY OF GUADALUPE COLLEGES)- 84.80

NICAEL DELA CRUZ SALAZAR (PAMANTASAN NG LUNGSOD NG PASIG)- 84.80

FERIE ANGELICA YVAN SORIANO SILVINO (FAR EASTERN UNIVERSITY-MANILA)- 84.80

IVY BARRETE SUSVILLA CEBU NORMAL UNIVERSITY (CEBU STATE COLLEGE)- 84.80

KARA DENEICE SANTOS TUERES (OUR LADY OF FATIMA UNIVERSITY-VALENZUELA)- 84.80

ACE BRIAN SAMANIEGO VERALLO (OUR LADY OF FATIMA UNIVERSITY-VALENZUELA)- 84.80

10. ABEGAEL PANCILES BACOL (MANILA DOCTORS COLLEGE)- 84.60

RAMON CARLO ARPON BARING (CENTRO ESCOLAR UNIVERSITY-MANILA)- 84.60

ROBERT IBEN BARIT (MEDICAL COLLEGE OF NORTHERN PHILIPPINES)- 84.60

LIVIA DEDOROY BARRIESES (RIVERSIDE COLLEGE)- 84.60

MARIA VIRGINIA CINCO CUAYZON (OUR LADY OF FATIMA UNIVERSITY-VALENZUELA)- 84.60

KATHLEEN ANNE PALANCA DE LEON (CHINESE GENERAL HOSPITAL COLLEGE OF NURSING & LIBERAL ARTS)- 84.60

MARK ANTHONY SANTOS DE LUNA (OUR LADY OF FATIMA UNIVERSITY-VALENZUELA)- 84.60

EDWIN SUAREZ DEL ROSARIO II (UNIVERSITY OF SANTO TOMAS)- 84.60

EUNICE PABLICO EMPEÑO (UNIVERSITY OF SANTO TOMAS)- 84.60

GREG ELY CAMBAYA FLORES (OUR LADY OF FATIMA UNIVERSITY-QC)- 84.60

MARCIUS ANTONIUS BALCITA ( GACAYAN UNION CHRISTIAN COLLEGE)- 84.60

APRIL JOY DIANE GARING GALICIA (WESLEYAN UNIVERSITY-PHILIPPINES-CABANATUAN CITY)- 84.60

MARY JOY SARROSA GARBANZOS (UNIVERSITY OF SAINT LA SALLE)- 84.60

ANGELI PALISOC GARCIA TRINITY UNIVERSITY OF ASIA (TRINITY-QC)- 84.60

SARA JANE JAIDE LABBAY (ATENEO DE ZAMBOANGA)- 84.60

MICCA FLORES LAGLEVA (UNIVERSITY OF SANTO TOMAS)- 84.60

RAZEL MAE NACUA LIBOT CEBU NORMAL UNIVERSITY (CEBU STATE COLLEGE)- 84.60

ALEXANDRA BASAÑEZ MACALINTAL (ATENEO DE ZAMBOANGA)- 84.60

KRISTINE DE LA CRUZ MACASERO CEBU NORMAL UNIVERSITY (CEBU STATE COLLEGE)- 84.60

CELESTE IMPERIAL MADUEÑO (MANILA DOCTORS COLLEGE)- 84.60

SALLIE RIA DELOS SANTOS (MALAYAN LYCEUM OF THE PHILIPPINES UNIVERSITY)-MANILA 84.60

JAN PAULA ESPIRITU MARTINEZ UNIVERSIDAD DE MANILA (CITY COLL. OF MANILA)- 84.60

KIMBERLY CHAN MENDOZA (SAINT LOUIS UNIVERSITY)- 84.60

MARIE PAZ LACANLALAY NOLASCO (MEDICAL COLLEGE OF NORTHERN PHILIPPINES)- 84.60

ROBELOU LIZANO ONG (FAR EASTERN UNIVERSITY-MANILA)- 84.60

JODELLENE FERNANDEZ PEROCHO (CENTRO ESCOLAR UNIVERSITY-MANILA)- 84.60

CLINTON ROSITA RABADON (BICOL UNIVERSITY-POLANGUI)- 84.60

ERIKA GENINA DAVID RONQUILLO (HOLY ANGEL UNIVERSITY)- 84.60

DIOLIZA MONTENEGRO SACIL UNIVERSIDAD DE SANTA ISABEL (COL DE STA ISABEL)- 84.60

KATHERINE MEJIA VIACRUSIS TRINITY UNIVERSITY OF ASIA (TRINITY-QC)- 84.60

and others...
NURS0710se225.

July 2010 NLE Top Performing Schools

July 2010 NLE Top Performing Schools Cool Buster

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SENSORY FUNCTION, TESTING STRETCH OR DEEP TENDON REFLEXES

Sensory Function

>>Sensation is tested by evaluating the patient’s ability to perceive a light touch, superficial pain (pin-prick), differences in temperature, vibration, position sense and motion. If any abnormality is found, it is important to identify the area of deficit clearly and find the point where the abnormal sensation becomes normal again. This point is referred to as a sensory level.

>>Touch the patient in various areas with cotton (light touch) and with the tip of a pin (pin-prick)

>>Typically begin with the face and move down the body, noting any asymmetry between the right and left sides.


Sensory Function: Stereognosis
-Test the person’s ability to recognize objects by feeling their forms, sizes and weights.
-With eyes closed, placed a familiar object (paper clip, key, coin, cotton ball, or pencil) in the person’s hand and ask the person to identify it.
-Normally, a person will explore it with the fingers and correctly name it.
-Testing the left hand assesses right parietal lobe functioning.
-Astereognosis – inability to identify object correctly. Occurs in sensory cortex lesions e.g. stroke

Sensory Function: Graphestesia

-The ability to “read” a number by having it traced on the skin.
-With the person’s eyes closed, use a blunt instrument to trace a single digit number or a letter on the palm.
-Ask the person to tell you what it is.
-

Inability to distinguish number occurs with lesions of the sensory cortex

Testing Stretch or deep Tendon reflexes

-Evaluation of deep tendon reflexes (DTRs) reveals the intactness of the spinal reflex arc at specific spinal levels as well as the normal override on the reflex of the higher cortical levels.
-DTRs are usually tested by tapping on a tendon with fingers or a reflex hammer. This causes a stretching of certain muscles and results in contraction. When damage occurs to higher centers (upper motor neurons), the spinal reflex arc is uninhibited and the DTRs are hyperactive.

Grading Scale – Reflex (4 Point Scale)-Reflexes are graded on a scale of 0 to 4.

-4+ Very brisk, hyperactive with clonus, indicative of disease
-3+ Brisker than average, may indicate disease
-2+ Average, normal-1+ Diminished, low normal
-0 No response

Definition of terms:

Clonus – is a set of short jerking contractions of the same muscle, is a repeated reflex muscular movements. A hyperactive reflex with sustained clonus (lasting as long as the stretch is held) occurs with upper motor neuron disease.
Hyperreflexia – is the exaggerated reflex seen when the monosynaptic reflex arc is released from the influence of higher cortical levels. This occurs with upper motor neuron lesions. e.g. stroke
Hyporeflexia – which is the absence of a reflex, is a lower motor neuron problem. It occurs with interruption of sensory afferents or destruction of motor efferents and anterior horn cells e.g. spinal cord injury

Dermatomes
-A circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve.
-The dermatomes overlap, which is a form of biologic insurance. That is, if one nerve is severed, most of the sensations can be transmitted by one above and the one below.

Dermatomes Landmarks
-The thumb, middle finger and fifth finger are each in the dermatomes of C6, C7 and C8.
-The nipple is at the level of T4.
-The umbilicus is at the level of T10.
-The groin is in the region of L1.

Biceps Reflex (C5 to C6)

-Support the person’s

forearm on yours; this position relaxes, as well as partially flexes, the person’s arm.
-Place your thumb

on the biceps tendon and strike a blow on your thumb.
-You can feel as well as see the normal response, which is contraction of the biceps muscle and flexion of the forearm.

Triceps reflex (C7 to C8)


-Tell the person to let the arm “just go dead” as you suspend it by holding the upper arm. Strike the triceps tendon directly just above the elbow.
-The normal response is extension of the forearm.
-Alternately, hold the person’s wrist across the chest to flex the arm at the elbow, and tap the tendon.

Brachioradialis reflex (C5 to C6)


-Hold the person’s thumbs to suspend the forearms in relaxation.
-Strike the forearm directly, about 2 to 3 cm above the radial styloid process.
-The normal response is flexion and supination of the forearm.

Quadriceps reflex “Knee jerk” (L2 to L4)


-Let the lower legs dangle freely the knee and stretch the tendons.
-Strike the tendon directly just below the patella.
-Extension of the lower leg is the expected response.
-For the person in the supine position, use your own arm as a lever to support the weight of one leg against the other leg.
-This maneuver also flexes the knee.

Achilles reflex “Ankle jerk” (L5 to S2)

-Position the person with the kn

ee flexed and the hip externally rotated.
-Hold the foot in dorsiflexio

n, and strike the Achilles tendon directly.
-Feel the normal response as the foot plantar flexes against your hand.
-For the person in the supine position, flex one knee and support that lower leg against the other leg so that it falls “open.”
-Dorsiflex the foot and tap the tendon.

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Somatoform Disorders

Disorders that involve physical symptoms

Conversion Disorders - anxiety converted into a physical symptom (a là Freud)
Hypochondriasis - normal sensations interpretedas symptoms of scary sicknesses

Somatization is the transference of mental experiences and states into bodily symptoms.
Somatoform disorders are the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them.

☺The three central features of somatoform disorders:

>Physical complaints suggest major medical illness but have no demonstrable organic basis
>Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms
> Symptoms or magnified health concerns are not under the client’s conscious control

☺Five specific somatoform disorders:

>Somatization disorder: multiple physical symptoms; combination of pain, GI, sexual, and pseudoneurologic symptoms
>Conversion disorder: unexplained deficits in sensory or motor function associated with psychological factors; attitude of la belle indifference (lack of concern or distress)
>Pain disorder: has primary physical symptoms, pain unrelieved by analgesics; psychological factors influence onset, severity, exacerbation, and maintenance
>Hypochondriasis: preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia)
>Body dysmorphic disorder: preoccupation with imagined or exaggerated defect in physical appearance

Ω Onset and Clinical Course
* Symptoms usually onset in adolescence or early adulthood
* All the somatoform disorders are either chronic or recurrent
* Clients will go from one physician or clinic to another, or they may see multiple providers at once in an effort to obtain relief of symptoms

Related Disorders
>> Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs

>> Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention
(In malingering and factitious disorders, people willfully control the symptoms. In somatoform disorders, clients do not voluntarily control their physical symptoms.)
>> Munchausen by proxy occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a “hero” for saving the victim

ΩCultural Considerations
>> Somatization disorder is rare in men in the U.S. but more common in Greece and Puerto Rico
>> Men in India often have that, which is a hypochondriacal concern about loss of semen
>> Koro occurs in Southeast Asia and may be related to body dysmorphic disorder
>> Falling-out episodes, found in the southern U.S. and the Caribbean islands, are characterized by a sudden collapse
>> Hwa-byung is a Korean folk syndrome attributed to the suppression of anger and includes insomnia, fatigue, panic, indigestion, and generalized aches and pains
>> Shenjing shuariuo occurs in China and includes multiple symptoms

☺Etiology
1. Psychosocial theories:
* Unconsciously expressing internalized stress through physical symptoms (somatization)
* Primary gains are achieved when the direct external benefits of being sick provide relief of anxiety, conflict, or distress
* Secondary gains are obtained when the person receives internal or personal benefits from others because one is sick

2. Biologic theories:
* Familial tendencies
* Differences in the way body stimuli are regulated and interpreted

∞Treatment∞
 Treatment is focused on managing symptoms, improving quality of life, and improving coping skills
 Antidepressants are sometimes used for accompanying depression
 Referral to a pain clinic is helpful in pain disorder
 Involvement in therapy groups to improve coping and express emotions verbally has shown some benefit

Application of the Nursing Process

Assessment
 Investigate the client’s physical health status to thoroughly rule out underlying pathology requiring treatment
 History: client likely provides a detailed medical history; quite distressed about his or her health status (except the client with conversion disorder, who displays la belle indifference)
 General appearance and motor behavior: normal
 Mood and affect: may be labile, shifting from sad and depressed (describing physical ailments) to bright and excited (describing trips to health care providers)
 Thought processes and content: intact; content is about physical symptoms; vague in their description but use colorful, exaggerated terms
 Sensorium and intellectual processes: alert and oriented
 Judgment and insight: little or no insight; judgment may be affected by exaggerated responses to physical health concerns
 Self-concept: low self-esteem, lack of confidence, difficulty coping
 Roles and relationships: difficulty fulfilling family roles; few friends or social activities; may report lack of family support
 Physiologic and self-care concerns: legitimate health concerns may include disturbed sleep patterns, poor nutrition, lack of exercise, overuse of prescription medications

Data Analysis
Nursing diagnoses include:
 Ineffective Coping
 Ineffective Denial
 Impaired Social Interaction
 Anxiety
 Disturbed Sleep Pattern
 Fatigue
 Pain

Outcomes
The client will:
 Identify the relationship between stress and physical symptoms
 Verbally express emotional feelings
 Follow an established daily routine
 Demonstrate alternative ways to deal with stress, anxiety, and other feelings
 Demonstrate healthier behavior regarding rest, activity, and nutrition

Intervention
 Providing health teaching
 Assisting client to express emotions
 Teaching coping strategies
 Emotion-focused coping strategies (progressive relaxation, deep breathing, guided imagery, and distractions)
 Problem-focused coping strategies (learning problem-solving methods, applying the process to identified problems, and role-playing interactions with others)
Evaluation
 Is the client making fewer visits to physicians with physical complaints?
 Is the client using less medication and more positive coping techniques?
 Are the client’s functional abilities increased?
 Does the client have improved family and social relationships?

Community-Based Care

 Make appropriate referrals, such as a pain clinic for clients with pain disorder
 Provide information about support groups in the community
 Encourage clients to find pleasurable activities or hobbies

Mental Health Promotion

 Assist clients to deal with emotional issues directly
 Assist clients to continue gaining knowledge about themselves and their emotional needs

Self-Awareness Issues

 Deal with feelings of frustration
 Be realistic about small successes
 Validate client’s feelings
 Deal with feeling that client “could do better if he tried”

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Apply Now and GET a chance to WIN an Apple iPAD

*Convergys Philippines*, the BIGGEST & the BEST call center in the country today, is currently hiring candidates for a leading worldwide communications provider in the US. These Customer Service Experts will be housed in the lifestyle & fashion center of Makati, Glorietta 5.

There is an on-going online job fair which started August 13 and will last until September 11. These candidates will have a chance to win an *16gb Apple iPad* by registering

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Going Home (A short film on Dementia)

Watch this prize-winning video produced by Vinn Bay and Tee Boon Leng for a video competition as part of the ADI (Alzheimer's Disease International) conference in March 2009.

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Personality Disorders

Personality: an ingrained, enduring pattern of behaving and relating to self, others, and the environment; behaviors and characteristics are consistent across a broad range of situations and do not change easily
Personality Disorders-disorders characterized by inflexible and enduring behavior patterns that impair social functioning
-usually without anxiety, depression, or delusions
Personality disorders: When personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress; usually not diagnosed until adulthood; maladaptive behavior can be traced to early childhood or adolescence

Cluster A: people whose behavior is odd or eccentric (paranoid, schizoid, schizotypal)
Cluster B: people who appear dramatic, emotional, or erratic (antisocial, borderline, histrionic, narcissistic)
Cluster C: people who are anxious or fearful (avoidant, dependent, obsessive-compulsive)Disorders being considered for inclusion are depressive and passive-aggressive


☺Cluster A Personality Disorders

*Paranoid personality disorder
Clinical Picture
Mistrust and suspiciousness, aloof and withdrawn, guarded or hypervigilant, restricted affect, use the defense mechanism of projection

Nursing InterventionsApproach in a formal, business-like manner, keep commitments, be straightforward, involve them in formulating their care plans, help them learn to validate ideas before taking action

*Schizoid personality disorderClinical Picture
Detached from social relationships, restricted affect, aloof and indifferent, no leisure or pleasurable activities, do not report feeling distressed about lack of emotion, intellectual and accomplished with solitary interests, indifferent to praise or criticism, dissociate from or no bodily or sensory pleasures

Nursing InterventionsImprove functioning in the community, make referrals to social services, provide care that accommodates the desire for solitude

*Schizotypal personality disorder

Acute discomfort in relationships, cognitive or perceptual distortions, eccentric behavior, bizarre speech, affect flat and sometimes inappropriate
Nursing InterventionsPromote self-care, social skills, and improved functioning in the community



☺Cluster B Personality Disorders

*Antisocial Personality Disorderdisorder in which the person (usually male) exhibits a lack of conscience for wrongdoing, even toward friends and family members
may be aggressive and ruthless or a clever con artist
Clinical Picture
Pervasive pattern of disregard for and violation of rights of others, deceit and manipulation
the person (usually male) exhibits a lack of conscience for wrongdoing, even toward friends and family members
may be aggressive and ruthless or a clever con artist
*Borderline Personality Disorder
Clinical Picture
Pervasive pattern of unstable interpersonal relationships, self-image,affect, and marked
Change Between Anger & Anxiety or Depression and Anxiety

*Narcissistic Personality Disorder

Clinical Picture
Grandiose; lack of empathy; need for admiration; arrogant or haughty attitude; disparage, belittle, or discount the feelings of others; view their problems as the fault of others; hypersensitive to criticism and need constant attention and admiration

Nursing InterventionsUse self-awareness skills to avoid anger and frustration; use matter-of-fact manner; set limits on rude or verbally abusive behavior

*Histrionic Personality Disorder

Excessive emotionality and attention seeking; colorful and theatrical speech; overly concerned with impressing others; emotionally expressive, gregarious, and effusive; emotions are insincere and shallow; self-absorbed; uncomfortable when they are not the center of attention and go to great lengths to gain that status

Nursing Interventions
Give feedback about social interactions; teach social skills through role playing


☺Cluster C Personality Disorders

*Avoidant Personality Disorder
Social inhibitions; feelings of inadequacy; hypersensitivity to negative evaluation; avoid situations or relationships that may result in rejection, criticism, shame, or disapproval; strongly desire closeness and intimacy but fear possible rejection and humiliation

Nursing Interventions
Explore positive self-aspects and reasons for self-criticism; practice self-affirmations and positive self-talk; cognitive restructuring techniques, such as reframing and decatastrophizing; teach social skills

*Dependent Personality Disorder
Submissive and clinging behavior; excessive need to be taken care of; pessimistic and self-critical; other people hurt their feelings easily; report feeling unhappy or depressed; difficulty making decisions; seek advice and repeated reassurances

Nursing Interventions
Help identify strengths and needs; use cognitive restructuring; assist in daily functioning; teach problem solving and decision making; refrain from giving advice

*Obsessive-Compulsive Personality DisorderClinical Picture
Preoccupation with orderliness, perfectionism, and control; formal and serious demeanor; constricted emotions; stubborn; preoccupied with details, rules, lists, and schedules; believe they are right; problems with judgment and decision making

Nursing Interventions
Help accept or tolerate less-than-perfect work; use cognitive restructuring techniques; encourage to take risks; practice negotiation


Related Disorders

*Depressive Personality Disorder

Sad, gloomy, or dejected affect; persistent unhappiness, cheerlessness, and hopelessness; inability to experience joy or pleasure in any activity; cannot relax; do not display a sense of humor; brood and worry over all aspects of daily life; thinking is negative and pessimistic

Nursing Interventions
Assess risk for self-harm; encourage to become involved in activities; give factual feedback; use cognitive restructuring techniques; teach effective social skills


*Passive-Aggressive Personality Disorder

Negative attitudes; resent, oppose, and resist demands expected by others; express resistance through procrastination, forgetfulness, stubbornness, and intentional inefficiency

Nursing Interventions
Help examine the relationship between feelings and subsequent actions; teach appropriate ways to express feelings directly

Onset and Clinical Course

-Personality disorders occur in 10% to 13% of the general population

-Incidence is even higher in lower socioeconomic groups

-40% to 45% of people with a primary diagnosis of major mental illness also have a coexisting personality disorder that significantly complicates treatment

Clients with personality disorders have:

-Higher death rates, especially as a result of suicide
-Higher rates of suicide attempts, accidents, and emergency department visits
-Increased rates of separation, divorce, and involvement in legal proceedings regarding child custody
-Increased rates of criminal behavior, alcoholism, and drug abuse

Etiology

Genetics
Temperament

Psychosocial factors
-Character
-Self-directedness
-Cooperativeness
-Self-transcendence


Cultural Considerations
-Guarded or defensive behavior may be displayed as a result of language barriers or previous negative experiences and should not be confused with paranoid personality disorder
-People with religious or spiritual beliefs, such as clairvoyance, speaking in tongues, or evil spirits as a cause of disease, could be misinterpreted as having schizotypal personality disorder
-An emphasis on deference, passivity, and politeness should not be confused with a dependent personality disorder
-Cultures that value work and productivity may produce citizens with a strong emphasis in these areas; this should not be confused with obsessive-compulsive personality disorder
-Social stereotypes about gender roles and behaviors can influence diagnosis of certain personality disorders

Treatment

-Many people with personality disorders do not seek treatment because they don’t believe they have a problem
-Individual and group therapy may be helpful to those desiring change, but any changes are slow
-Improvement in relationships, improved basic living skills, relief of anxiety may be goals of therapy
-Cognitive-behavioral techniques such as thought-stopping, positive self-talk, and decatastrophizing can be effective

Pharmacologic treatment is based on the type and severity of symptoms rather than the particular personality disorder itself.

Four symptom categories include:

Cognitive-perceptual distortions including psychotic symptoms
Affective symptoms and mood dysregulation
Aggression and behavioral dysfunction
Anxiety

Pharmacologic Treatment for Symptoms

Cognitive-perceptual disturbances (magical thinking, odd beliefs, illusions, suspiciousness, ideas of reference, and low-grade psychotic symptoms)
-Low-dose antipsychotic medications
Mood dysregulation (emotional instability, emotional detachment, depression, and dysphoria)
-Lithium, carbamazepine (Tegretol), valproate (Depakote), low-dose neuroleptics, SSRIs, MAOIs, atypical antipsychotics
Aggression (predatory or cruel behavior, impulsivity, poor social judgment, and emotional lability)
-Lithium, anticonvulsant mood stabilizers, benzodiazepines, and low-dose neuroleptics
Anxiety
-SSRIs, MAOIs, or low-dose antipsychotics


Individual and Group Psychotherapy

Focus is on building trust, teaching basic living skills, providing support, decreasing distressing symptoms, and improving interpersonal relationships.

-Cognitive-behavioral therapy

-Basic living skills for people with cluster A personality disorders

-Inpatient hospitalization to provide safety for people with borderline personality disorder

-Assertiveness training groups for people with cluster C personality disorders

-Relaxation or meditation techniques for people with cluster C personality disorders

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