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5. A n infant* born with a d& plate.

I
?
& nursing 8-tegy
wodd be mst important to fBe parents' sucewM mping?
. G i i supPmt-af e the parer o hold and
cume the infar
0 3, kplain to the p~reptshaw cleft palam dmelop d-g
Prwancy.
.Tell the parents ot to look the
mt)uth.
U D.Show the parats a vidw about omcth.e $wg& for
d& palate.

Brie answer the full-


1-Name four 4ttew~sof pregnanc~rthat the teenap must
fhce.

2. Name tbree actiom essential to the bon- prow%


Moralistic nonnal is an ideal It concerns setting and a
goals that may be expected by soaety or by the person. h d ~ d
become conhtioned to a specific ided. For example, they may
ually tell themselves they are not allowed to become initable an
remain calm at all times.Setting unrealistic or hpossible goals
unnecessary sstress.

behavior is practiced by the majority of people, it is statisncally


There are many misconceptions concerning the word
4. To many people, the wordmeans weird or bizarre. Some p
expect to see a sharp difference between normal and a b n o m
there are many variations between the two.The disturbed person

Psychiatry categorizes patems of behavior. The nurse must


izethat clients do not fit neatly into these categories because their
terns of behavior are i n W d reactions to stress. A diagnosis in
ehiatry is not as clearly defined as a physical diagnosis. The n
should be fully aware that the client does not necessarily conform tions, end increased respirhtiuns. Ifthe anxi* is ievcre or proi~nged
set standard of diagnosed behavior. thcsc symptoms intensify and ihc person may need to be hospitalid
Antianxiety mcdicatinn may bc given Zhhle 9-1).
PSYCHOLO~ICALDISORDERS

major or minor attack, with anticipatory anxiety or situational panic.


Sudden anxiety attadcs occur witb little or no provocation. Some anxi-
ety episode o m when a person anticipates facing a fearful situation

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tional fear ofbeing in open spaav ;e.g..shopping malls and spurts are-
nas!. Symptoms of panic include diKiculty b m t h i..i rapid andlor
-:w. * ,m
, tk) ,a pain, &@&m--,.seaa* &&-

&ma& and so l& mnuoI ovw their beha%or.


Common psyddapic@dbordd@ am
BBI Psmif &disorder
PI W e t y disorder
B Phobic diwder
Maladapttve Behav~ors 2@1

When a phobia is limited the person can live a reasonably com-


fortable life simply by avoiding the object of fear. HOW-, phobias
TRADE GENERIC I often spread to include assodated objects. When this happens, it m y
be ditfidt or impossible to keep the phobia &om intafering with
daily !.it@, One treatment often used to help people overcome pho-
b i i is desensibtim
Phobias include exaggerated fears of death snakes, dogs, open
spaees, wnhnement, or heights. Table 9-2 lists some common phobias.

Obsessive-Compulsive Disorder
Although different in meaning, obsession and compulsion aften occur
togethm An obsession is a p d t e n t , recurring thought or fe&ng
that is overpowering.A COcomgtIlSi~nis an irresistible urge to engage
in a behavior. CompWion may be in the form of frecpent handwash-
ing or shoplifting. Whatever the compulsion may be, it has a symbolic
meaning. The behavior is engaged in because it lowers a r y d q . When
the anxiety I d builda up, tbe obsessive-compulsive act is performed
again This process is cyclic and may occupy the person's entire life
It is not unusual for a person to experience murrent thoughts
periodically or to engage in ritualistic behaviors (handwashing, count-
ing and recounting eheclciqg and rechddngl. However, in the person
with an obsessive-compulsivedisorder, these thoughts and ritualistic
actions interfere with daily Mug. The person is unable to controI his

FEAR OF PHOBIA

Acrophobla HelghtS
Agoraphobla open spacer

Androphobla Man I Ophfdophobia snake5


Claustrophobia Being closed in Pharmacophobia Medlcln $I
Cvnophobla Dogs Phasmophobia onosts ,t
Oemophob~a Crowds Ponophobla work F , I ' ~ P ~ I
&'I.
OamOphObla Marrlage Pyrophobla Flre . 8

HOdophObla wave1 Traumatophobla InJUN


Kalnophobla Chane- TrlSlfardeKaphobla Number 13
Kakorrhaphiophobla FallUr~ Vaccinophobla vaccination "
1 u Fn
1 L-
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Chapter 9 Maladaptive Behaviors

or her thoughts and actiom even though the person k n m they are ment disorder of mixed disturbance of mood and conduc~The dlient
irratondj however irrational, they release pent-up anxiety and tension. appears wonied and upset about an event that occurmi in the past
Obsessivecompulsive behavior is often caused by repressed thtee months and describes trouble handkg the SRSSOTS. Usually,
&oughts and feeltngs. It is an attempt to relieve anxiety and is another there is no personal or family history uf mood disorders, although a
example of converting anxiety into other symptoms. pmo* disorder needs to be ruled om

somatoform DiSOrder MOOD/AFFRCTIVe DISORDERS


Somatoform disorders are dmaaerized by a loss or an alteration of As the name may suggest affectivedisorders deal with emotions and
physical functionbg that has no physical basis. It is thought the phys- mood Included in this category are:
ical impairment is caused by a psycholopical conflict or need of the B Major Depressive Disorder (MDD)
peaon. However, & must be remembered thatthe symptoms are very dysthwa
A - t h e oerson aoes not have conscious control over them.
Somatoh- disorders are divided into s d sub- ?hro common Bipolar Disorder
subtypes are conversion &or& and hypochondtiasis. cydothymia
The National InsMute of Mental Health l N I ' estimates that
conversion Disorder 36 million Americans are depmsed at some time in their k.
Depressionis a major public health problem Research is indicating a
43nwmion disordet was fonnerly know as hpterid n e w a h In
corollary between depression and brain biochemicals (ie, norepi-
ronwneion &order, the person mnverts his or her overwhelmtng
nephrine and serotonin deficiaql. There is a pmblem with the m-
anxiety into physical symptoms. This is an unconscious response The
missions ofneurotransmitters m s s a brain synapse. Litemam puinta
person may experience paralysis of an exwemi@*blindness, de&~ess,or
to depression being bMogically determined and influenced by muhi-
numbness. The aisabfityhas no physical basis fndividuals usually com-
ple situational fhors.
plain about their pain and discomfo~but are calm and irdifbmt
Researchers are gath* data on seasonal affective &order
about their symptoms. The physical symptom is symbd-cof the unre-
[SAD), whereby anindividual is depressed in winter when there is
solved anxiety produring the conflict The symptoms enable people to
hght available
avoid actions tJ& are unacceptable Mthem. They also enable people to
get attention and support fromothers that t h m g h t notget otbautise.
Major Dspresshfe Disorder [MDD)
Hypochondriasis Wi major depression the symptoms have been present for a two
week period and q m e n t a change from m o w functioning.
Hypoohon- is an abnormaI anxiety about me's health. This Dep~essedm o d and anhedo* (a loss of intwmt or pleasure] are
disorder was formerly known as hypochonatiacal mum&. People present most of the day. Subjectively, the client reports feehg sad or
with hypoeho~&%~is are preoccupied with their bodies and Their empty or is o b s d by othm to be sad or tatrfdOther symptoms
imaginary illnesses.They have unrealistic feats or beliefs fhar they are indude s w c a n t weight loss, insomnisk hypersotnnh psychomotm
ill despitemedid assurance that this is not so. Such people ha* dB?- agitation, or retardation. Clients endorse feelings of worthlessness,
culty establishq meanine;ful relationships with others since much of excessive g3t and &minished ab'jty to think;they often have recur-
their time and energy is spent worrying about themselves. rent thoughts of death or suicide Depression over time that is chronic
Hypochondriasis can affect both social and occupational funatoning. Bnd recurrent can manifest as psychosis, which is an inability to re*
ogrrize reality and Communic~teor relate to othas.
Adlustment Disorder Eldezlypersons,o h expaience depression. The elderly person's
Maladaptive copin$ to a We event that is s@essfdis an adjustmmt h* eelfperceptianmaybecame distorted andhe or she may feel worthless
order. The DSM IV-TR lists several subtypes; the most commonly seen and ashamed A in selfmngdenceand loss ofself-esteemmay
are adjustment disorder with anxiety anam d e g m and adjust- o w A ne&ktWS@SnCept results ininitab*, apathy, and a lalack
Maladaptive fieliav~c~~s

of hmor. Activives of daily hvtng become a problem, and hair and time and become preoccupied with feelings of ft Theymay com-
&thing may appear disheveled, Mmemenf5 are slow, posture is municate depression via facial expressions of sadness Qrnegatiae ver-
smoped, the bray is h w e d , and sp& maybe kcpent in bal renmks. Daily stressom encountered on the job may bave an
the depresed ddmk pemn, tbm is an intense preocapation with ]Increasinglynegative impact on their outlooks. The effects of the aging
heslth, Coniplaints ofvague acbes aBti pains, c0nStipationtand anorex- prodess on men m y also become cause for heightened coneern.
ia are e o m m The severely depressed w bemme @st- Social isolation and boredom may be symptoms of a dysthymic
ed and appear to€@ mberabk. +disorde~ The inmvidual has a facial expression of sadnw, a blunted or
:flat affectand decreased verbal communication W~th lessened e n w
1& and migratoly aches and pains, they frequenay withdraw kom
oysthymlc DlsOrdeK The pemn experiencing a dysthpic dbordw a&% With soclal imeractions mluced, feelings of guilt and sadness
has a prolonged feeling of .%Beme sadnw that is ammpanied by prevail. Some peopIe experience agitatian and restlessness that result
guilt feelingsI self-f-deprcmtion,and SOW withdrawal. The &order is In pacing the floor and wringing the hands.The menopausal persm
usually associated with a 10% such as loss of a Imed one, possessto& Who feels meless and less attractive turns feelings of refection inward.
ar s e l f -Tne pmon feels rejected. helpless, and wrthless. He or These feebgs of self-auger and destmction can make a person with a
she is wedshe and disinterested in the surroundings and unable to eerious dystlgmic disorder a real suicide ri& Any indieations of suiei-
"p"ience pleasme in life. He or she ha6 a low energy level and is dal hughts should be dealt with. (See Cha$er M ViDlence and
always tired The person may either be unable to sleep or mQ' sleep Diswed Behvior.)
mceh;sive.lyTbe depressed person dwells on &e negative aspects of Me, Some antidepressant medicanom are listed in Table 9-3. The
whjch otdy add to his or herfeekg8 &&pleasured @ t He or she selective serotonin reuptake inhibitors (SSRI) subdue h y p e m a 4
may cry oftea and wiIy and may have serious tho%& of sui& symptoms, decrease avoidance symptom, and decrease emotional
A dysthymic or depressive disorder o k &ts horn p q l e rtysconrtul symptoms: mger, hostility, and irritability. kamplw of
feeling 0) that they ham no mm1 over th& lives, [.2J l t they @e SSItIs include fiuoxetine (Prozacl),m a h e (Zoloft3, and paroxetine
ti$Iureeg bemuse 'they have been unable to attain desired goals, or (31 ipaxil]. The side &&s to be monitored are irritability, insomnia, and
i n t d anger. Critical periods in the Mb ycle when a d@&Jrmic dis- sehlre3.
order is more W y to ocnu are adolesmoe, menopaw, and old age.
D&g adolescencq depmion must be &@erea?iated&.omtem-
porary stam of sadness. AdoleseenB are .su$ject to emotional ups md
downs. However, when a lack of feelings or a sense of' emptiness
b e m e s s dominant mood, this is wmidered ac-d or depm- TRADE GENERIC
sive &order, The adolescem with a dysthNc disorder is unable m
dealwith or express his or her feehgs. Bm&m and resfl~$snesSran -TI--
- -
.~ . . .. ~ ~
~.
~ , ,
:~ ;. .
t Darg use and unwanted risk-taking can be symptom af hid-
~ ~~

d TTamntl
~ ~ f l ~ l ,.@&fb$&fmf;FBl.
den depression. Mori,rafln
Piorpramin &esiPra&e$@l
, .~
as
D u k g menopauser women must cope wi& pb@d
the aging proeess oan-6. Menopause may have pkpical symptoms
€rave
Etavu m~cr~l~.m ~ @ i
AvenM
A~ellM St
naPtrig@ilfir%.
,. ~ ,
such as hot and cold %sheI p w e headaches, h- palpitiom* Binequan titt$qtn Mgl
imomni&and wsrsbtent fatime Some of these symptom am cawd
Desyrel tr&u@pje, MU
byzhe changededbomonaf~%ce between estrogea and progesterone. Pro*
Prow fiuqx~tine,.Hcl
Depression can be caused by by percdwd loss of womanhood and ?al& .s,emnn~g'
ZOlOft
chiid- abilities.
Women are not the onlp people who must mhtend with the Paxll paromtifie:
& x t ~of tncnopause. Me11miy &<;experience menopausal changes,
i Celexa ,. cj~tai~prarn-

-
which accompany the normal dirnirlution of sexual activity that ocnlrs
nith advandng age They may reduce their social interadion at-- this I L'"m
fluM,m?mifie
Maladaptive Behaviors

h g stop-start syndzome dam not usntpibute to medication &availvail


ability and, thd5m good medication effects. Research is r&eting
h t medieatiena need to be taken a qiuimum of ninety days f a eE-
eaq and ph;rps men six month3 befom they a , t ~heticid,

Bipolar Disorders (BPD)


Bipolar mood disorders are complm Emexchhers me lao-
chemicals lie,melatonin, phmylethlymine.) that intI~encebrain
tio~ k d&deney of dopamme and s~~
*- at trio-

translllttqs hbas been


discomd in mania Internal b i ~ rh- l ~ i&mdian) ~ are be*
caref3Uy olmme4 Qther studies m fhcaaea on the &Tea oflig6t on
mood patterns. It hw ken beenund fhat peapla with mood disbrdm
ma/ haw ab~lomLalthyroid Studies bjh~dirrg,T3, T4, and TSE
Electroencephalograms @'EOsl mayfndicate a pi- of a m@ek or
par2i;ll &&are, Itl Q$and U.%E% EYA mkm faF hip* disorder
were located on chmmxrsome 2, fhwinaeasing our knowlem of the
role of genetics B.ipdat=disordm d d witb m o d s of ektion and
depmed01~.They are subegped w bipolar disorder, manic bipolar dis-
o r d e ~depmsed: and bipolar dia~rilw,mizced. Litbbn and anemn- -.-.--
vul&ub are mood-scabilikng medimw11~ f i q m t l y gigi\.enfor &oh
disordw Crable 9.41.
&.w dphase, wd* qpww and e&mB are
hppepa- ?liqp %pea* php3&%.me&e, and aotion&yj Thgr
g,e~erallyf&they m.tow hwyto &te lime on eating sfeepq]
The% thought proeases magbe so rapidd&t they arf, dir8icut,to
low; This is d e d &fightrrfi&gsttW~ people are hitm and
Their m ~ d & inay~ &m .eupb~&G ,&&tion m,4-
have @ei~ptimisri~ perhaps d & d q I dm:&&& p m , .
T h q d&n. meddle in the &airs df orhe@w&are
troeial ~~0~ Their r.w on@,&@,loudness, aa;l d p & &
ploys only increase fh@ sam ~ve.rload
The- depressed p h e is .&axaste&sd by moderaw s m
% d q r w o n'I% 1-1 of dep-n f l u a t e s]eontaneoUsIy
b u g h o u t the dar Thw &mfs are high suicide even though
&~~L%C a pJ Bp m rci be -mIrnderafe Du&g rke depression sage,
f h indiddual'$
~ @~ezii%inw & behaviop are h y p a a ; PaeIlllggc
&oughts, &@ I , $t@& a f e a b n d p d e m e d He or she c o m p b
Of being &@@y hctions slew, so an.- and !cons'tigatiinm
eoaC,a . n@
. < . , @@&Q :& an.d b&Je
; :.
~ ; ,and actions .a& b c -
* d b % $ ~ ~ i $ ; ~~ ~~ I ~; ~~ ~ f m m m t h e : h Be an&.
5r~b:h;7 ?k Qpmm@ S& =mQ&$, and &$&&, &
3.b epb.Bde?e?d$aw+&e:;-;gm~Y
-.
.-
, ..-.. *

Maladaptive Behaviors 2+;. . . ?~

A cyclothymic disorder is a mild form of bipok disorder. If the


person is not treated, the disorder canbecome more serious.

rRADE GENERIC I oissociative Disorders


Dissociative disorders were former1y ~lassifiedas hysterical neuroses.
This disorder is characterized by changes in mnsciousness and identi-
ty: Psychogenic amnesia p~ychogeni~fugue, multiple personality, and
depersomhation disorder are included in this category.

Psychogenic Amnesia. Theperson with psychogenic amnaia has


a sudden 105s Of memory regarding importam personal infontion
that is too extensive 'to be considered ordinary forgetfulness. There is
no damage to the nervous system, Psychogenic amnesk usuallg fol-
lows a stressfid went and is thought to be a way of escaping conftiw
and relievhg overwhelming tension.

Psychogenic Fugue. Psychogenic m e involves suddw d u n e x -


pected travel amy from home or work with Ue inability ta remeaber
the past The person experiencing p s y c h ~ g d cfugue mumes a new
identity, Pugue o h oc(:~fs ,followings'were s m s . Usually it lasts for
several h0.G tu several days and involves only limited travel In some
rare eases,h m , it may last for many man& and involve
traveL The recovery israpid and recurrences do not mually ocnn. This
disorder is more common after a n a t d disster or during &me.
No damage to the nervous system is involved

Dissociative Identity Disorder. DissohWe identiv (for-


merly d e d multiple personality disarderl refeps m the existence of
Newer MedidbnS .- - ~~ two or more &tin& personalities within the same in&dual. Each of
~epaKote qiiwl~rcltm these personarities is d~minantat a partkuh time. The p o n & t y
~amlctal l a w h e that is $ominant determines the behavior of the individd &&pa-
~aumntin ggbapqntln sondi@is complex and has its own h M o r p a t t w . The secondrvy

-
~gretol wraa*@@l#e. personalities are usually quire opposite to the oliginal personality.The
~opan9ax ' tupimmate original personality is not aware of the other personalities, although
?he seandary persgn.&ies are often M y aware of the thoqhts and
acrions ofthe original personality. Transition &om one persoM9 to
disordB another is sudden and usually f~IIowstress. This disorder is -me-
~yclothy'mlcDisorder. The person with a
expefimma-l* m a d s of depre~$i~ri
and &tion w
elationnsfee,the pmon is warm and Wdl% I)um the 6 e ~ f e s s ~ 0 ~
stage the emonj&ats himselfor herself d vdthdrW fromsgd DePersonalkation Disorder. Depers-tion disorder fnwlvesa
actiaiQ me person may apeilmoe n o d mods between: mi change in the p&sOn's perception of himself or herself:A sense ofthe
person's o
m reality is People are cut 05from a e W om aware-
ness. They feel disa9r;odated ~ I I their
I minds and bodies and my

. . .
-chwr 9
order to meet a need of their o m Remember, manipulation can be
WIw a &wee.They fimction in a &~JEJstate or
frorn viewed aS a positive or negative action Individuh who engage in
sense;9 are dded, h a m a f e a of
manipulation fW&Iendyevoke anger in others, yet theu behavior is a
n d b a ~ complete coat& ~f their 9 6 md adOmh form of guarding a very fragile self by attempting to control others.
Tfiis bTdw &a S-e sires* depression ream-
i5 Therefore our goal is to strengthen itlditidua~~,' inner, personal coI1tro~.
fEc-tm W d t i u n , fa&@& tQ&c illness,af p W 1 4 P* staffmust approach clients with a firm,consistent
~ ias d d Beople with a d e ~ - * ~ ~ ~
r a P ~ b u t r & c Q Y@ ~ ~ id
my stp&nce m~ qgieryzk ~ o r h o ~ ~and
t sa ,distded acting in a ludgmend way toward chents; rather, recognize your om
s e w af&&Tbeymm fed fhattbey are&% iIx+~e~~cIie. feelin@ of ~esenbnentOur goal is directed toward maintaining the
seEesteem of our clients.
Begh by stating dearly Your own expectations of the client at an
i n t e n l i s ~ p h ameeting
~ where everyone should on one
care
~ur~in g planned approach. with the client if there is a reason for this
behavior and then state clealy why the behavior is unaaeptable
Cop% ~ f%8i hemdual a a peW10@
F a is
*Y
a dqer* Clearly state the team's expectation. OEer alteroativa by stating choic-
fm ~ n m eN-, my that d b
how-, fxz*dd needs es or options (eitherlor statements). By having choices, the client will
er or f&e &*co*d, begin to fee1more in control and will learn h m to choose a]t-tives
help. he. a-0 should =ever k n y -is denfs W w -PIainw
~ w Y S the best 'Ourre that work positively for him or her. The staffmustpra* attentive&-
sh& be -@&& 1 e p t e . The tenfng [what 3 this chmt really trying to say?).Help the client verbal-
dlfonaatioa A m&& -~on should be dm@.to ride oat*
fze or her feelings in a more appropriate way. Be alert fork e w e d
po~sibiIityofpbyhd jllaesS m e w and refocus clients when they become distracted. Remember
Nw care ofthe ~sy&~1op;iral Clierrt F o W an.
that you are working together to achieve a change in behavior.
ierJI; paon d& a @ol~@sal di~orderis often m& a ! Im 3- Freguently a writyea contract works best A. contract clearly states
e.4- psycho-" cljenm oibn fed
the uni't, psydh~be;iddim* need to 2~ the m u m y agreed upon expectations and the tyay to arrive at this
tarion flh q fiem ~n god Look at the clienfs strengths, resources, arid energy for change
fhek@SSsindl
$lW~&kmstkin& decis'i, Tbis Maybe the client is m t l y in just a survivdpattem that wil~ need to
be addressed We want fo make reasonable requests SO &t the client
be held accountable, and we want s m d success expeemc~so
that we can give the client positive feedback Areas to consider w h
Mmg a contract are personal safe@,amount of sleep and rest food
intakepstructured m e , aetiviaes of d a ~ living,
y probl-o]hg tech-
and the client's level of sacid hteradon.
The bipolar clients concentration is lessened, and he or she is
Q s u ~distracted and provoked. Sodd activities must be p h e d
this in m d Exerdse can be advantageous, but competitive acmtie

sbsm and ralkati-

I I I I,
Maladaptive Behaviors
,,

a@$
-2
....
&.. A

clients have been WelI-bahve&pd&pist youths wko restrleted Bne ofthe most important factom in a s c h h p b n i c disorda-is
loss of&-esteem. This may be manifested in.9yd-den and violent out-

-
their p w n a l s-f and did not v W y cotnmunicatte.A s&a&-
6ehg at6tude prevails. InitiaUpeatisg dim&%& clientsmwt be close bursts. It m y result in dissoaation or an exaggerated mnsem mer
ly evaluated Do thy need a hospltll sdmlssionto s a b h them met*? bo* hcriam and appmance. Dismbznces in tbhkhg may range
bolick@? Will dose observationwith a b&dv2mal approach be bend- from a h %of claatji in the personb ideas to t& incoherence. His or
cial? Coople or family therapy can be in&@ted.Bulimia appear her thorufkts are illogically cmaecte& so t h v are di86cult m under-
pmgres4 wi& group therapy Cornunity education pmgram5 am a
stand The person may m l e words SO they make no s a e i W is
&word salad. He Ox she may make up words to a p e s 8 con-
necessity in a time when eating &dram are of epidemic pmp0rrioIL
fused tltou&ts; tlwe arr cded neologbrm Echolalia is the pur-
poseless isep&tion ofa ward ox phmrse,
C-haxar3erktics of f h n i a indude dekxziam, ~~~
tiansI dbturbed thought pm%es.9es, and peculiar hehador. Delusions
are f&e id- rhet eannot be chwged by logid argument Delusions
a?e often aSsoQiated d t h hllua-. They may occur in any type of
psg.c$otic m a i o n
Delusional ideas may be in the form of guil.? or perseatian.
Clients may feel that they have anmitted grave sins or tbey m y
exaggerate a d e e d . Ptwple wih delusions of persecution
belime fhat an argankd g r a q htmds to harm them.They !nay per-
m i all happenings inrelation m t h e delusion,nsing eaentuxdated
events as proof of* delusion. Persons with s&impBr~& m y &Q
have deImfon8 of grandew:, be&- €hafThey have great power. Thw
may see t,bawdva as Napoleon or @us Ghfist
Halfa@h€ionsare pmeptiom that OWE in the &ma gf
stlmd and have no bash in Ilreyinelude hmhg nonexistent
VOW [audiforp],ha&pision$ [oimd),~mdkt~g (01.kctor3g or t w w
thjngs e;uStatbryl, or having 4 senwtion of being tcluehed (%Me).
C0nmzm.d haUui3n.at?om taa be very ~~g fox fhs: client and
may cpmmand the client to do somethin$ dangerous to seX or othe%s,
hinpmtant part of-dw dbtwbance of &en@with srhizo-
phrenia is their pmgfessive uiM.ragval 'They s&Wte faztasy fof
real life, Their actionsmay seem hqpmp14atetatlie sitnation beisuse
%ey be- incm&n&indifferent to their outside mvbonment a d
feel alienared and isolated
In an acute m e t af schizophrenia, them fs' usually normdIU a
normal hdin fuactioning, rhe absenee ofnegah symptom Cable
9%), and (i good response to anfipsyihofic mdicatiom. With a film
onset, there are enlarged anal ventricles, praminmtneg&?e s$mp
and a poor mpgnse to antipychoticp,.
m o t i c n'iedi8.W possw many side &mts that need to
be 856es9d by the nursing staffand repurred to the p-
Wt ITab1e 9-6).A 8erlous, Wrewsible side effect & tardfve rfy~kine
&a ITD). 'RJ detect TD at is e d & st-, an inwIun*ly
mamnent s d %W&fsl needs to @me ai a -lum of w r y six
months @-?I2
L
OSITIVE: NEGATIVE: ZbDE GENERIC

D~PQ'NEU~CILBPTI~%
Haldol demnoate halopesidoi decanoate
Prolixln decanoate fluphenai.[nedecanoate
Depot neuroieptlcsare Ueslgned fofindigduals who need anfTpsychotlc
medlcatlon yet have dim~ultyremembering totake it o,r paranoid
ideation. Medication is Wealoh form atid u$uallvgiven;eQ@y W o w e m
For P r o l i n decanoateand every four WeeKs for Haldol #@%noate.

impaired self-care,
BIrarre behaviors.
Elimination or signfircant redudtion of hai~u~inabans,
Poor Judement Poor delusions, anxiety, and troubleso.me thou$htS,
Poor lnnght Papr feelines; and behaviors

retentlon

matiies.la;sg~irming,.restlessness, fdgegng, A,.


agmubn
%dive civbnesia: SueHng movement9, invoiuntan/ chewing, tonaud
ProtFusron; this i s m e n Rreversibie
Do net use atcohol
Avoid prolonged exposure to sun; if outside, use a
sunscreen,wlth PABA-the. htgher the number, ti%
greater the protection.

ATYPICAL ANTIPSYCHOTICS
'.', , . ,, .
-. .
, ..: . .,;
& .

, : ;.
Clozaril Icl~zauinel typical antiusychotlcs that %'b la^
RiSPerdai Irisperidone) dopamlne and serotonin-hlpeanntagonlsts ZJ)..:
zvprexa (olanzapine)
- -

2 s Chapter9 Maladaptive Behaviors 2&7~

by othm This is offen accompanied by musde twitching. EEchopr&a


involves imitathg the motions of others.
I CLIENT ACTION STAFF OBSERVATION
paranold Wpe. Clients uvith paranoid schizophrenia are suspi-
cious, aggressive, and hostile. They sufFer fiom mrspidon and jealousy,
konQW rw e ~ n s n t s and delusions of grandeur and persecution, EIalludnations are wm-
mon. Clients often hear voices commandmg them. They may become
n p mm&With eaon m~vemenk
~ac@!:andI ~ S ~ombativeFor eatample, they may break the teI&ion set bemuse they
Wer as ,mPWY tls ~Ossrblp. believe it is *s them bad messages or perhaps reading theirmind
6abprDx I&% SeGondsl
At the begin&& other symptoms maybe difficult todetect As the con-
~ e n hoch
q arms in nun&,I&, moue m~wm@b , dirton propses, behaviorbecomes more inappropriate and unpre-
front, wlms down dictable. Since their debions are o h bizme, they can be dangerous.
wglla s few paces, turn Hand Wld
and w k back Undtfferentiated m e . Undifferenfiated achkopbrenia is diag-
nosed when the symptoms do not fit in ather categaria for s&o
slt in shstr Wth hands En#rebod~F O rnovemW
~
phreda. Symptom may indude delusions, hanudaatiom incoher-
posittuned on knees,
ence, and grossly disdrganked Behavior.

Psychosis, NOS (Not Otherwise Specified)


A deterioration in Etlnctioning and a lack of recopition of reality is
termed psydzdtasis. Usually, psychosis, NOS is abriefpychotic &order
of no longer than one month. A serious stressor m q or may not be
Disorganized Type. This eatwry was formerly classified aq present Note whether delusions or hallucinations (specify auditoq,
heb~phrenics-hrmh The disorganhd schimphrenic &hi&, visual, oIEactaiy, or tadel are present and specify a general medid
inappmpriate behaviac smiling and ti-equentlly at mqtbhg# condition that may be present if the psychasis is substance-induced,
or nothing at all. There are gross fhoughi b b a n m , including rhe specify the substance that was used and whether the client is intoxi-
use of mrd salad and neologisms. Ddusiom and hallucinations mE cated or in withdrawal,
w m n , as is extreme social WithdrawaL
Catatolllc m e . The mtatonicperson's behamor varied, but thee %%
PARANOLD DISORDER

tion with wry rigid musdw ur possess

one, for a period of time).


-
mually an a w e onset Behavior m y taketheform of stupox ar excite
ment In mratonic stupor, the &ent is immobile, mate, and negativa
There is no interest in the envimment; thb apathy complerely cuts,
the dient oEfrom outside stimuli. He or she may -in in one posi-
flexibility fa wDditi~n
in which a hmb remains in one po&ion, even a veqy uacomfdke

Catatonic people &bit mpredictable behrsvior because their


behavior is con'tmkd by their delusions end hallucinations. h ' p ~ r
Clients with a paranoid disorder, like the &
fbr
atwith schizophrenk suf-
fmm perSistent delusions. These delusions rrrz generally delusions
of jealousy, pementtioa or sometimes grandem The paranoid client
does not have hallucinations but possesrtes a heightened suspicious-
ness that may progress to pspchosis. The client is fw6.l and guarded
and ases the defense mechanism of projection,
Clients with paranoid disorder usually da not show disoxganiza-
tion dtheirpersonalities, other than the delusions. Their actions seem
to be appropriate to their delusionaryaperknces.There is seldom fur-
may & q e zapidly and unexpectedly to excitement At these tlmes~ theh deterioration in their personaIity; They speak and act rationally
t h q are extremely rentless and may become violent The aenT Mth and are well oriented to time and place. They may be able to eany on
catatonic sdakmphrenia &bib two p e d h m n n e d s t n s - e c ~ ~ a prodaniw oeeupanan even when their condition is well developed.
and echopraria. Echolalia is an inwohntmyrepetition ~fwor& qokefl However, social wd m a l functioning are usually adversely affected.

-- - A L-- - - - 7 . --.----
ChaNer 9 Maladaptive Behaviors

the client needs to go to the emergency mom of their hospitaL Each


a g s of anger and resentment are m ~ o with
n a paranoid client needs an emergency plan. for sevae relapse
di9order. These &inbr: dmgp~ou6as t h q strike out in s d -
HiIdegardeP @ L U 1l962)stated that to heIp clients is to remem-
&'knse. Bkme deteriofatio~or incoberens 3s mf seen in these b a and n n d m d fitllgwhatis happening to them in the present sit-
&eats. uation You want to assist clients m integrating this with other experperi-
ences in their lives. Avofd isolating the experience because that will
Nursing care only increase thought fragmentation. Assist clients to recognize mal-
W.ossing pm &r the t h e t suffkhg &mi a g & i m p M e or p"anoid adaptive behavior and its eauses, motives, and consequences. Assmt
disorder mu* be based on an as6essment of behavior and pmblem~ clients to look for alternate choices for their behavior and inmease
b e a u s the% &eats b v e an indMdWed arrap o E ~ @ @ o m ~ . their constructive productive &styIe. The n m e is building trust and
with & p W a have a ofisohtian m-edby fear of nurturing the client, which is called a corrective emotional experience.
&&a fas or her behavior refleets a la& of s&c~n4iden~e. Tfie
nurse needs to demo-ate a hopeful attitude c g m gf a*@ PEiRSaNALITY DISORDER
;m,,sewdty, and ca&enoe. Avoiding the elient o m n&fcms his
or her fedin@&ow self- The u r n shodd ob- The &ent Personality can be defined as an individual's character traits, attitudes,
w i d schiz0phrmh b r any $pedaliamests.InvolVhg him or ba: in a thoughts, behaviors, and habits. It encompasses the individual's behav-
v&&y ofactfvities saoh as checke~s,tad $ames, a& ts,hobWies Can ioral and emotional tendencies. It aIso &olw the individual's adapta-
be a method ofstipxnlating the senses. &mine pr@e rainfreinforce tion to internal and exrernal problems,
mfidenee. It may be tLrmpmtiet~ the env2ronmmt b&- Persnnality disorders are maladaptive patems of seeing, rrlatlng
io$ autdabrs or taking a ride inihe wuntty. to, and thinking about the endronment and relatiomhips with othem,
For a client wKh a paranoid ttimde~+ a fldble but coBsistent 5 i n e the patterns am inflexible and deeply ingrained, there is impair-
appma* should be m a i a M at oill tima. 'Izlis c l i d s in &- ment in adaptive functhirg. Disturbances in emotional development
ers mu& be ~ e It isimportant
h for the ~
nurse ta be aware of , and e m r i m are seen There is amalaqiustment to the social epvi-
his or &P ownb a v i o c W p e t i n g or pointing when in the &&SF ,
ronment Some personality disorders are -dated with changes in
e n w m t must be amkbd. P r o w questiom may pmwke p~@- the normal lwek of nemommsmitters
noid beh&w The parillraid elient reqDira G&X soothhg voice tan& The American Psychtmic Associarian's Diagnostic and S W d d
at alL =&ma. Munud CExt Revision) DSM-W-TR) M Several subdivisions under
m e num's gaalis to provide support d S~JW~XES &the &e~& the Category of Personal@ Disorders. W e subdivisions and charac-
in order to d e w s his or h a &ety and d e m ~ t i o fAl fism, taieties are shavn in TabIe 9-8.Person* disorders ean begin in
cp-t emiron~~entwriII ffidlitat~the client* reroeery fmrn a st&$ chidhood but ~lsuallyare ?mnihted at adOIes~enee,and interfere
of inner d i s o ~ ~ t i a p with social or mle funqkming.men, persons with personality disor-
In peparaton f9I a rera~nto the W y and their C O ~ - I ders do not seek mental health care.
with s&impMa m d ra be educated abmi the uYariltnp,
sylnptoms of a rekpse of tire disease. A @pof-*e c h e ~ d d Nursing Care
be ben&dal for clienm and their families and muId be an exc&%t People with personality dtsorden are very diBcnlt to deal with, and
m@d ofeda-n as p@i of discharge p l w W m signs & treatment mamag be ineifetiv~In caring for b e clients, the n m e
& p e include a lass ofWb%in doing w,
to aetivtties 9f daily k i n g trouble m c m @ aor~
eatin$,and
str* should be able fnhmdle the htxatiom caused by their behavi01: He
or she also slxluld be aware that some clients may be very manipula-
&st tho@ts; increased imubJe wtth decision amkW p w tive. Manipulative dients want aIl needs to be met immediately and
with religion; fear of' othm YLdg thw m that otbm may become aggressiva or hostile when the3 are not met Respond to
with their minds; increased W t a b W over W e tbi~@? manjpulation Wflsistentreinforcement of~mits.
h ~ o r k m l ~ s ~ a n d a n ~ ~ l n s e The n m e might directlydl clients with a personality disorder
war&$ & p s id&xxteWt a relapse ma^ that thek blaming accuhg, and intmd&tq m e r alienatespeople.
m a d s to seak pmkwianal help fnasreme p
... .
._
Chapter 9

q~ersvns&NWexaL3gbraUOn of
~IHicultlerInabUttv torelax, cold
end unemotional
of warm tenderfewnngs M r others zrculw ln malmnina
IndlweAe; few close friends; "IOnW &tbactow relatlonMIP5
%,cia1 isolation; oddltles of mlnbng ~ntrto
and speech: Illusion$ sU$P~CIOa
nypersenSmvihl
~vetlvdramtlc expressions of ~tamaticandemotional
motion, overreactton to eve*
seRlndulgsntr wnrrpnt drawlfig of
attentlon to 9et IrmtJonaloutbur*.
dncanslderatlonof othen; Vahland
demamllng: constant seem9 df C).q A small success experlence for cllents may be seeing
reassurance: lackof 8enulneneS;
mavlng of excitement tneW artwork displayed; this builds self-esteem.
maggeratedsense ofn-npfsQ
e%
lincIat
need fQr canstant attention and
admlratloII: preoowbledwlihfantarles; Ber pressure can fiequatry be used to modify behavior. Guidance in
asserkness is hdpM for same clients. T h e clients need positive
lacks abllityto reCOgNZe how othenfeel
oefective judament feedback for open, dbeet fflmunicatioa The nurse should enwrmge
$eels Immediate pleasure; selRsh;
p o ~ r o c c ~ p a ~ wrformance;
ona~ nt r~skofsubstance r e k d rather than hostile exchaqps. He or she should set appropi+
unablem mamtaln lasting relatlonshltcrr abuse and harm ate limits and be sure the client knows the limitations. Dimsional
poor sexual adlusimentifailure t o aaivities are important The nurse might help by presenting gmwth
accept social norms; Irritability anll opportunttiw, chances to assme responsibility, and small suecess
aggreslveness; fallura to Plan ?hUu
dkreeanlM I tnemth:
~impulslvevel: exp6enee.s mgure 3-11. There is now a move tnward special &dm-
recklessvlolatlon of the PTahts of ottheK Gal homes for some clients Mth persor&tydisorda
impulsiveand unpreMctable; umtable infer- Erratic
personal matlonshlps; hec(U8ntdkplays of
anger, ldentiw problems, shim In moods;
Impulse Control Disorder
Intense d~scomfcrtwhen alone: pnyslcally Clients with an impulse disorder have uncon~oU&leimpulses that
qelf.damaglng act%reoumngPeellngS
of boredom m d emptmess
result in hmfd behaviare to seIf or othw. Their poor insight and
HypersenslbWto relechon, Social AnXloUS
inability to Mect and think of an alternative beharrior rmults in exit-
withdrawal: low self-esteem ing, dangerous behaviors that redue their sense oftension and pleas-
Lac& 9elf.cOnfldence; avolds relying on self; Fearful nre. As a result thv experience relief: hpulsive behaviors hdude
allowsothersto assumeresponslbllltY klepto- pyromania, pathological gambIirig, trichorikmlania, and
Pre~ccUpaUon N t h trivial detallS; overly compulsive skin picking Csometimw to the point of excoriation). Some
conventional and serlous, InSlStS Oh of the literatwe also includes compulsiw buying as a n impulse &or-
own way; lndeoisive der. Comorbidtty Mtith other disarders, such as bipolar disorder, psy-
lndlreetly resists demands MI adeauats choactive sabstance Use, attention defidtihyperactive disorder
perfurrnance; Intenttonal Ii7efUClenW
foramml; stubbQ~ReSS, prauaSMrlaU0n. CaDHDJ, malor borderline and antisocial pemamlity disorders need
aawunna rwntful to be -sea
@&\I
Maladaptive Behaviors 3-a

s e w is consistent Personal respect and cooperationmodeled bythe


staffinaaes the seIfanfidence and sense of autonomy of the dient
Sympu~ms of ADHD include a pesistent pattern of inattention hyper- The eventual g d for the client is inawed motivation andsocializa-
activty, and i m p W t y wfth the fcllcdng obsemabk behaviom: fidg- tion The milieu aids in the mgnition of m a l a d a m behaviom and
& d i t y , intenupthg inattention, d diEculty with wait- allows for confrontation of the dient when these behavim are
ina, folbwing instructions, sustaining attention and remaining task- observed.
fo-wed The physical environment needs to be clean and safe.
A neuropsychalopid ass-ent for a differential diagnosis is Harmonious colors and comfortable andsafe finmshgs contribute to
important asthe complexity of a multiple &agnosis or dnd Wnosis the Overan sense of well-hemg Milieu ineludes manfr&aw modal-
&I inauence the use of medicatim and matment in-tiom fie.% gmup therapy art and music therapy (a means t o socialize and
Cornorbiditis include learning disorders, mood disordem, and sub- smctnre free time and increase seIf-confidenceJ, pet therapy [comfon
stance abuse or use. Manyyouths with ADHD have conmu~entsocial wiih the expression of mrhg rhrough touCb@, h o r t i d t w (garden-
and b&aviotd problems that pbce thm at risk for co~lX&tbg ing and its re~ponsibiEtie8)~nulritia~ courseling, 0ccupationaI theram
' '
and becoming iw01w.din the aimid justice system. ( g swngths and one's response to the environment), vaca-
Medicatiom presded ~IE R h h @l&ylph&date) and Cylem tional m r k (counselor explores work and job options), and educa-
@emoline).However, the subject of mediatim usage forforafmmt of tional groups (communication s$iUs, selfatem social interaction,
N E D is eontrowrsia1.and the d a n c e on drugs for children and ado- h c i a I pIanningl. A n mteniisapIinary team coordinates these mt-
-1 is being questioned. Con- research in gmetia, brain ment actidtie8 and evaluates the clients partidpation and p r o m at
i n j q , and psychophamacology is lik* to conhibute to a better weekly team m-s. An i n W t d h d care plan fadbates the
undatanding of this disorder md effective treatment a p p m a b . dient's participation throq$ the client's review of fhe plan and con-
sent (eitherdal OF written3 thathe or she accepts the treatment plan,
Another aspect of the milieu is the communigr meeting. A corn-
s L e m DISORDERS munigmeeting is a schedaled meetbg with a set time and pre&er-
mined dedsion that there will be no interruptions by staff or clients.
Mare than 30 million Americans wiU be affectedby ins- at some
On admission to the unit the client is an observer at the meeting but
point in theirlives. Hauri [I9883defmed three types of insomnia: tm-
then becomes a participant The cammunity meting gives everyane a
sient i n s o d caused by a brief p d o d of stress or vjben one travels
from different timenes, insamnia caused by pmr sleeping habits or voice in d e d s i making. It pmvides a time to review pmMems and
tensions an the ward and decreases m d c t through discussion Unit
drug and dmhol dependencp, and chronic insonmia.If ex- loud
rules and roles are clarified irnd enforced in a consistent manner.At
snoriog is present the client needs to be evaluated by the p S n w times, unit upkeep may be the meeting focus, with assignments of
depment, which assesses breathing bctions and then consults
with a sleep disorders clinic. Many people expeace shaIlOwOW w- chores or tasks. The m a h concept is to increase client mpons1Wly
and acu)unWtyand therebyincrease selfawpeness and selfesteem.
merited sleep and n m feel rested or refreshed S N d b suggest s&p
protocols that involve no naps; arising kom bed when you cannot PrequentIy requests for a therapeutic pass are generated at the
W n u n u d y meeting. .A thempeutie pass is a leave of absence WAl
sleep and doing some quiet a&!$' for appmda* ninqminutes, h m the hospital for two or more h o w It is authorized by the physi-
then retiring to the bebed;Ieaming and practicing relaxatfm techniWI?S.
- ... dan.Before the pass is issued, a m b a of the team meets with the
.. dient and they decide on the purpose of the leave. Papas are Ned out
MiLlIU THERAPY handed in on mum that reflect the positive and negathre aspects
ofthe LOB The clientmay visit vvith family, nm erran& or seek after-
Uet
l includes all s
nrr
ou nm in the physical emir~nrnentand care placement This is an important part ofthe discharge p h because
those interpersonal intaactim that contribute to the individualfap& it promotes the client's resociallzation and assists him or her to identi-
sonal growth and adaption The environwmt is structured to p&de fy and cope wEh stressors and begin ta utilize cornmu@ support
securig and safery. Qn admission to the udt+the stimuli m y be %y third-pa@ feimbursernent agenda do not &ow therapeutic
decreed while trust is b 3 t but g r a d e in-ed resp&jJig passes.
and inwolvanent is encouraged. The envimnmt is fldbIe,pet limit.
234 Chapter 9

SUMMARY
Maladaptive behavim can develop anytime &om ihfancy through as tbry relate to
old age. Three critical times are adolescence, menopawe, and old
age. Coping acthity is required throughout the life cycle. D In a &s discuwion, mmlate the developmental stage of ado
The word m m l can be viewed in a sod& W c
a L m o d or leswce with the d e v d o p m t o f m mring dkorrler.
statistical way There is no sharp distinction between normal and D Investigate the a d m h h n p~cedma$0a day-freattllentcent*
abnonnd Psychiaay categorizes patterns ofbehavior, but it must be ar mental h d t h &tin ydtr coamm~@l%pon your kdhgs
remembered tbat &en@do not fit neatly into these categories.Each to the cla~3.
client has an individual reaction to stress and therefore an individ-
uaI pattern of behauior. Wain and review pamphlets from:
Psychological disorders are disturhanm characterized bymal- M c m PeytWatric h a ,Division nf Riblic
adaptive behavior aimed at dealing with high levels of d t r : L*OO K S*et NW
Arydety disorders, somatoform disorders, affective disorders, and Wa8bqton, DC. 20005
diswociative
- disddm are some common psychological disorders. 1-202m-62.20
Nursing m e focuses on reducing anxieq
Affective disorders deal with mood and emotions. This cat* m e f y m r d e r s Assadation of America @DA'Q
gory d u d e s dysthymi~depressive major, cyclothymic and bipolar UaOU Parlam Drive, bib 1.00
disorders, Bipolar disorders are subwed as m a n i ~depressed, or R d d & MD 2085d-2-
1-301-2313350
mixed Dissocfative disorde~sare characterized by changes in con-
sciousness and identi@ This category includes psychogenic amne- wwwxka.org
eia, psychogenic fugue, multiple personality, and d e p e r s o ~ o n CMdren a i d Adults with Atiwdirn DefW Dipordw [ C w . . D . )
disordm Schizophrenia is characterized by delusions, hallucina- 499 N.% 70th Avenue, SSuite 101
tions, disturbed thought processes, and peculiar behavior. Persons P W t i Q PI, 33317
with schiz~phreniaexperience conaiding feelings and demonstrate 1-800-2334050
inappropriate affect word saIa& neologism, delusions, and haIluci- -chaddq
nations. The m e s of schizophrenia are disorgdzed catatonic,
Pood and DrugAhinbmtion WA]
paranoid, and undEerentiat-ed. The client with a paranoid disorder
s d e n h m persistent delusions, generally of jealousy, persecution, 5800 Elshem, Lane
R o M e , MD t Q B 7
or grandeur. Personality disorders involve an indivi&alalsadaptation
1-800-3320178
to internal and external problems. The disorder interferes with
social or role functioni~g~ Med Warch: 16iJ0-33~-1088
Many psychia'tric clients are lugh risk for suicide. The www.vrn.~dagoli
depressed client is the client most likely to commit suicide. The NationaI Alkane for the Men* Ill @AMD
nurse should he able to recognize indirect cues that the client may; 200 Noah Glehe Roa& 3ta 1015
be considwing suicide Talking about suicide is a plea for help and Arhgroq, VA 22203-9754
must be recognized as such. (See Chapter 10, Violence and 1-800-950-NAMI
National Dqressive and M&c Dlepmwiae Disorders A s s o W n
730 N. FXankb S t w s S e e 501
chicage, 6UQO
1400-826-3G32
Chapter 9 Maladantbe Behaviors

National Foundation for Depmiive 11l0e$$ I= 3. Ap Irresistible urge to engage In a behavior is d e d @an
PO Box 2557 0 A. obsession.
Nw?Cork,M! 10.116 0 B. compuIsion.
1-800$39;1265 U C phobia
rndep1%95iOmg a D. psychosis.
i??a'ti.osdm t e o f h M H d r h 4. The @pesf schhphrenic disorder characte&ed by stupor
6001 Executive B o d e d and waxy E d i l i t y is d e d
Rrrom &MSG I$ &
9663 P A. dimganizsd
aethesda, MD 20892 U B. atatonic
1-301-443-4519 n C unMwatiat.ed.
r n a a . g O v R D. parmaid
National Menral He&& &sO&tiOn 5.The affective dismdef that deals with altemste moods 6f
l 0 &6&
~ swet depression and elation is the
&mdria, VPI 23314 D A d@We ctisurder,
1-800-968-6645 Ci B. depersmahtion disarde.
m e w 0 C. ppchogeenie f5gue.
ObsessivpCxrm~ive Foundation D D. bipolar disorder.
337 No& Hin Paad 5. For o r s t bWdnals, uBe of compulsive behdyior results in
Nor@Bradkrd, CT 064n which ofthe folowing7
1-203-315-ZI90 P A occupybg the mind
~.ocfounda&&arg D B. manipulating the envbnment
Croup &c&wion on folkwing 0 C. lowe* &eq
0 D. preventing mist&e6
M D S ~~Communic~on
, Swim Communicating with €%ents
j30mD3fferent @ l t W , B96. '7.Psychogenic amnesia is M das dan
D A f l e c k disorder.

-
REVIEW
KNOW ARID C O ~ E ~
D B.pasonaNtjr disoder.
0 C. dissociative &arrler.
Q D. wnvemion disorder.
A Mdtipie choice Select the one be& mWWm 4. The pereon with a conmion disorder
fear ofa s p e a c stmation or object is
Z Anabnonnal, aces~ive Q A wnverts anndetJrto b o w symptoms.
ealled 4m Q B. expwienm.seven: m o d swings.
Q A obsession . . . Q C,is cut off from bis or her a v e e m
Q B. wmpulsion. . . .. R D. word@ about self obsessively.
Q C. phobia 9. Behavio~ that the person with an ar~tisodalpetsondffgi s like-
a n. pv&oss. ly tp display is
2. A reaming 0wzp-g tharght or fedhg is calld tJan D A withdra- &om p n p activity
A Q~WS~UIL D B. medmical obedience.
n B. ~ampu]sion. D C. ~ u l a r i a of n others.
P G. phobia D, ritwhtic behavior.
U D. p&osis.
Maladaptive Behaviors

10.W c h of the Mowing clients would hawe the a;gh&strisk kr 4. The nlnse prepares to administer fluphenzine d e w a t e
suidde? A client ctiapaed ~ 4 t aian
h (Prolixin d8canoate3 3E5 mg IlM to a dim diagnoed &h
d A @genic mesk paraoid s&mphr& Whtch needle should the hurse
P B. antisocial per6onality disorda. edect?
0 C major depressim r;l A 18 g, l/b
D cych&puc disorda. D B,20&142'
o c. 22 g, 31a
a D. 26 g, 2"
APPLY mm LEARWrnG $. The W e pxepaed to administtr hatcJ@dol d ~ ~ ~
B. MnZtipIe cho1ce. Seled f&eone, be& amwe% CEaldol deanoatel Ihd ta a &ent d B g ~ 0 6 with
d parnoid
1. A &ent diagnosed with paranoid a ~ tells the p ~ sddmphreniaa.The n m e could usa any ofthe follow@
n m &"I"m JuusCbrirrt pour Lord and Smior, Codeas your *s escqt:
alns to ma" Which response by.the n m e would be most Q A the ahdoma
~ P P ~ P ~ W Cl B. deltoid.
P A. "I am of the Jewibb f&th and do not accept Jesus as Lord P C.gIut9w -w.
and Sadosd 12D. bteralis.
0 B.Tour admission p a p a do nor Iist pour run%?as Jesw? Q;.The nmSe gathers informafion hr a nmly admiW &ent
P C. "You are out oftouch with red*. Your belief is a symp diagn~sedwith an eaiing &order. What info~mationwould
Tom of your illness? haw the highest priority to obtain?
R D. Y respectgour beliefbut 1do net share thebelieP D &age
a. A &atinith w t a t o n i c s c h k p ~ isa mute and sits for 0 B. heaa rare HLld rhythm
h m in a rigid posture. l%kb Cimmldmtim s t r a t e 0 62. m a w p m
would be most appmpxkie far the m e to use? P D. body m g e
0 A. PrqueriTl$ pat the & i t ' s shovMer to demonstrate car- W: A clldnt with hipolar disorder takes li.thinm Which h d i
in& would prompt the nlnse to mitthold the hedose and
0 B. Anoid verbd inferadan untiltke antips+&c metifa- ptoqtlp the &aician?
tion takes e f f e c t 9 A mstipation
0 C. Ask the dien'tls &@ant other to obtain infamatian 5 B. inffequent udnatton
fmm the &mY, 0 C. 1-and coRfusic9~
Q D. Offer short caring pbrases to ccmmd* mnsm for Q D, fncmaved dbt
the client
8. The nurse finds a dent, who is diagnosed with ma% depres-
3. A client has a medial &a@.& of bipolar disodm, manic sion,done aqi qing. Which r e s m e by the nurse would be
phase and a diagnosis ofhbalancednuDitio~less most therapeutic?
than body r-ents. Which n m b g interamtianmuld D. A. Administer the clfent's antidepressant medkatioa
be most imp~rtant? 5 B. Offer to sit quietly with the slient
0 A Reeord how much the dietit eats a€each mad. Ll C. A& the ellent, %at% the matter7".
Q B. Ask the client to keep a journal about eat@ ham. 0 D. Qffer the clfen't-arecrational actiuity,
Q C. Record the clie11tSintake and output
0 D. Frequen€Ir offerthe d i a t ma& dbevePagpSt

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