Nursing Concept of Personality Disorders

General Concept of Personality Disorders

1. Personality disorder primarily involves problems with interpersonal relationships.
2. Personality disorders are generally chronic, pervasive (affecting all areas of the client's life), and maladaptive (eg, personality disorders cause significant difficulty in life, work and family life).
3. Personality disorder involves a pattern of excessive or oddly normal personality.
4. Personality disorders can occur together with other severe psychiatric problems.
5. Personality disorders may be difficult to be treated or diagnosed.

Common Symptoms of Personality Disorders

1. Suspicious or do not believe.
2. Rigid thinking.
3. Distortion of reality.
4. Projection.
5. Afec limited or excessive.
6. Isolation.
7. Unstable interpersonal ties.
8. Limited or excesses of moral development.
9. Self-care deficit.
10. Somatic symptoms.
11. Thinking delusions.
12. Bad identity or excesses sense of self importance.
13. Potentially damaging to self or others.

Type of Pervasive Personality Disorder


Group A

1. Paranoid Personality Disorder: do not believe the total on others begins in young adulthood, indicated by at least four of the following conditions:

• Suspiciously, without cause, that people exploit or cheat.
• Busy with vague doubts about the loyalty or honesty of a friend or colleague.
• Finding hidden harassment or threatening meaning of a comment or trivial events.
• Always hurt or complain.
• Attacks (not visible to others) on the character or reputation of a person, followed by a fast reaction of anger or counterattack.
• Suspicious relapse.

2. Schizoid Personality Disorder: Patterns of separation settling of social relations and also the limited range of emotional expression in interpersonal relationships begins in young adulthood, indicated by at least four of the following symptoms:

• Lack of desire or inability to enjoy intimate relationships, including with his own family.
• The choices are almost always exclusive to a solitary activity.
• Few, if any, attention to sexual experience with another person.
• Experience the pleasure of little, if any, activity.
• Lack of good friends.
• Indifferent to praise or criticism.
• Cold emotion and flat affect.

3. Schizotypal Personality Disorder: Patterns of social and interpersonal deficits persist (acute discomfort, and reduced capacity for close relationships, cognitive or perceptual distortions and behavioral egocentricity) begins in young adulthood, indicated by at least five of the following symptoms:

• Ideas of reference (excluding delusions of reference).
• Odd beliefs or magical thinking that influences behavior.
• Unusual perceptual experience (Illusions body).
• Thinking and talking weird (not clear, circumstantial, metaphorical, excessive elaboration, stereotyped / repetitive)
• Suspicious or paranoid thinking).
• Afek Improper or restricted.
• Behavior or strange or eccentric appearance.
• Lack of good friends.
• Of excessive social anxiety that does not diminish with familiarity and usually including paranoid thoughts.

Group B


1. Antisocial Personality Disorder

• Evidence of conduct disorder before the age of 15 on the client at least 18 years old.
• The pattern is not settled appreciate and violate the rights of others since age 15, as indicated by three of the following conditions:

• Failed to comply with social norms or law-abiding behavior.
• Irritability or aggressiveness.
• Is not responsible for the employment history and financial obligations.
• Impulsive and fail to plan ahead.
• Traitor.
• Not respect the safety of self and others.
• Lack of feeling regret.

2. Borderline Personality Disorder: patterns persist instability in interpersonal relationships, self-image, affective, and impulse control begins in young adulthood, indicated by:

• Enterprises like crazy / hysterical to avoid waiver (not including suicide attempts and acts of self-harm).
• Unstable personal relationships and stiff.
• Settled identity disorder.
• Impulsive behavior, reckless, at least 2 of the following areas: spending, sex, substance abuse, driving, overeating.
• Behavior or signs or threats of suicide or self-harm relapse / recurrence.
• Manifestation of mood reactivity, usually for short periods rarely exceed a few days.
• Chronic feelings of emptiness and boredom.
• Angry stiff, Improper, lack of control of anger.
• Stress-related paranoid thoughts, temporary or disosiataif severe symptoms.

3. Histrionic Personality Disorder: patterns of emotional and behavioral excesses settled attention-seeking, beginning in young adulthood is indicated by at least 5 of the following symptoms:

• Feel uncomfortable when not the center of attention.
• Behavior or sexual seducing unnatural appearance.
• Emotional instability.
• Very concerned (excessive) to the physical appearance, using it to draw attention to themselves.
• Talk excessively impressionistic style and lack of detail.
• Self-dramatization, exaggerated expression of emotions and theatrical.
• Forcing.
• The mistaken belief that the relationship with other people is more intimate than a reality.

4. Narcissistic Personality Disorder: patterns of settling pretense, need for admiration and lack of empathy, beginning in young adulthood is indicated by five of the following symptoms:

• Strong sense of self importance.
• Preoccupied with thoughts of success, beauty, intelligence, power and infinite love.
• Convinced that he superrior (great) and just want to connect with people or institutions that great.
• Need admired and considered excessive.
• Strong feelings that are entitled to preferential treatment / special.
• Exploit others.
• Lack of empathy.
• Envious of others or believes others envy him.

Group C

1. Shy Personality Disorder: patterns of social barriers persist, and hypersensitive to criticism, beginning in adulthood, indicated by at least four of the following symptoms:

• Avoid work activities including significant interpersonal contact.
• Not willing to risk engaging in intercourse without certainty of success to be liked.
• Limiting intimate relationship.
• Busy with the fear of being rejected or criticized in social situations.
• Shame in a new relationship.
• Sure that could not socially, personally or lower unattractive to others.
• Not willing to risk personal or engage in new activities.

2. Dependency Personality Disorder: The need for excessive settling and treated / untreated, leads to submissive and dependent behavior and fear of separation. Starting in young adults is indicated by at least 5 of the following symptoms:

• Inability to make decisions every day without excessive advice from others.
• Need someone else to take over responsibility in life.
• Reluctant to disagree with others because of fear of rejection.
• Difficult to start a project and do everything yourself.
• Highly sought to gain emotional support from others (voluntary does not unpleasant).
• Feel uncomfortable or no expectations when alone.
• Trying to find a new dependency relationship when a close relationship ends.
• Busy with fear sendirri left to care for themselves.

3. Obsessive-Compulsive Personality Disorder: Patterns settled busy with regularity, perfection and mental and interpersonal control will cost flexibility, openness and efficiency, beginning in young adulthood is indicated by at least four of the following symptoms:

• Busy on the details, rules, lists, scheduling organization, causing inability to focus on the main point of an activity.
• Perfectionists who disrupt the completion of a task.
• Excessive loyal towards work and productivity by eliminating the activity fun and friendship.
• Very careful, meticulous and unusual klentur about morality, ethics and values​​.
• The inability to throw useless things.
• Reluctant to delegate tasks except the task will be done in accordance with the doing.
• Stingy with money.
• Rigid and stubborn.

4. Agresig-Passive Personality Disorder

• Registered as a non-specific personality disorder who have behavior more than 1 personality disorder but no full criteria for a single personality disorder.
• Common symptoms of passive aggressive behavior affect social interaction and work.
• Procrastination / Likes to procrastinate.
• Failed to perform a task or a bad job when do not want doing.
• Will hurt suggestions on how to improve performance.
• Failure to do part of the job fair yag.
• Excessive deride and criticize superiors.
• Improper claims that her demands and irritable and arguing when asked to perform a task.

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Nursing Management for Paranoid Personality Disorder

According to JP Chaplin, PhD. , Paranoid is a feature that psikotic disorder characterized by systematic delusions or delusions with little deterioration. This tends to settle and strong enough influence and incapacity.

Paranoid personality:
A personality is characterized by an attitude of suspicion, is very sensitive in the absence of deterioration or delusions.

Paranoid schizophrenia:
One type of schizophrenia characterized by delusions or symptoms highly suspicious attitude. This is due to dysfunction disorder thinking, hallucinations and deterioration.

According to James C. Coleman, Paranoia A characteristic of psychosis is characterized by systematic delusions.

Paranoid Personality:
Individuals who show behavioral symptoms such as defense mencahnism projections, suspicious, jealous, very jealous and stubborn.

Paranoid Schizophrenia:
One type of schizophrenia is characterized by delusions and hallucinations are usually quite strong.

Currently there are 2 types of paranoid psychosis belonging paranoid disorders, namely:

1. Paranoia, where the delusiyang develop slowly and then becomes complicated, logical and systematic and it is centered on feel persecuted delusions or delusions of grandeur. Despite the presence of delusions, the patient's personality is still intact, there are no serious disorganization and without hallucinations.

2. Paranoid state, a change in the paranoid and delusional thinking becomes ligis and emergence characteristics of paranoia, although it has not shown any strange behavior or deterioration such as that found in the case of paranoid schizophrenia. This condition is usually associated with strong stress and mortality may also be due to the phenomenon. Paranoid states often color the clinical picture of the type of other pathological disorders.

However, our main interest is currently focused on paranoia. Paranoia is relatively less common in patients treated in psychiatric hospitals, but this may occur due to mis-identification of mental disorders. Many of the inventor / inventors, teachers, business executives, reformers fanatical, jealous spouse, eccentric people who study a particular teachings are included in this category. However, they are uniquely able to maintain its existence in the society. In some cases some of the women who developed into a very dangerous man.


Clinical Manifestation of Paranoia

Individuals who experience paranoia feel alone, neglected, spied upon, and other false perception of the threat from 'the enemy.' Delusions are usually centered on one thing, for example concerning the financial problems, labor, ill trustworthy partner or other life issues . People who have failed in work will develop suspiciously like someone else cembutu on his performance so want to drop it.

A paranoia has a particular reason why they are suspicious and do not want to receive another reason which is more correct. Because of the suspicion he may conduct interrogations of those deemed enemies.

Many of these paronoia has delusions where he was a superior and has the unique capability. Sometimes they feel a mandate or revelation to run a sacred mission, social reforms, and modifiers. The paranoiac religious develop the confidence that he got a message from God to save people and do the sermons even invite does holy war.

In connection with the paranoiac delusions experienced can be performed with very perfect, speaks eloquently and has impressed emosian mature. Hallucinations and characterize other disorders rarely found in this paranoiac. They seek to justify the logical ways in order to be believed. In this case very difficult to distinguish where the facts or just images. They are working on making the people around him believe what he says. They fail to see the facts other than what they believe and are less able to prove his faith, kecurigaanya and they become communicative when asked about these delusions.

However this is not always harmful paranoic, but they still have a chance to do something that is detrimental to the perceived enemy.


Stages of thinking that led to paranoia:

1. Suspiciousness / Suspicious - people become distrustful of others, fear of hurt and be very alert.
2. Protective Thinking - selectively reviewing the actions of others and see it suspicious and start blaming others for his failure.
3. Hostility - very sensitive to perceived injustice is not true though, it responded in anger and hostility and suspicion is further increased.
4. Paranoid Illumination / Growing Paranoid - suspicious attitude has become part of him and he felt the presence of something strange, but he he has been immersed in a situation such suspicion.
5. Delusions - feel persecuted or absence of delusions of greatness, but he developed a logical reason and to develop actions that can be understood by others.



Treatment for Paranoid Personality Disorder

In the early stages of paranoia, corporately and individually handling is still effective, especially if the patient has a consciousness to obtain the help of professionalism.

Behavioral therapy techniques show promise such things, paranoid ideas arise due to various combinations of things that are not fun, the various factors of change in a person's life situation further strengthens maladaptifnya behavior and develop into a powerful way to resolve the problem.

Once settled delusional system, the handling will be very difficult. Usually difficult to communicate with paranoiac to tackle the problem in a way that is rational. In this situation the patient is reluctant to consult, but they are trying to find justification and understanding of other people on their mistakes.

At the time of initial identification of psychosis with schizophrenia and paranoia, it was agreed that the clinical manifestations of this case must be distinguished from neurosis or psychosomatic disorders. The hallmark of schizophrenia clearly a failure of understanding / contact with reality and personality disorganization occurs as disturbances in the function of thinking, affective / feeling or behavior problems.

Identification of most types such as acute schizophrenia, paranoid, catatonic, hebephrenic and simple show clinical differences for each type. Various factors cause remains elusive why it can thrive. However experts notice any significant role of genetic factors that cause schizophrenia. Perhaps because neuropshysiological or biochemical changes that disrupt the normal functioning of the brain, including the failure here is in the selection mechanism. The exact cause of these changes must be ascertained to determine whether due to genetic factors or because of a mental disorder. However, it should also be noted that a significant cause of psiikologis other. Besides that psychosocial factors play an important role to consider such innovative pula.Penanganan chemotherapy, psychosocial therapy, post-treatment program would make people better condition.

Paranoid disorder usually do not experience severe personality disorganization compared to other types of psychosis, but they are very resistant / reject any given therapeutic action.

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Treatment for Victims of Physical Abuse and Violence

Common actions for victims of abuse

1. Give first aid as needed.
2. When violence or abuse is very prominent, separate the victims from the perpetrators.
3. Report any abuse in child protection services and the elderly, as required by law.
4. In the case of the persecution of women, reporting is required if the injury was caused by a gun, knife or other weapon.
5. If sexual abuse is suspected, follow the laws and institutional procedures for collecting and storing evidence admitted in evidence a series of procedures.
6. Ensure that victims receive sensitive care and compassionate.
7. Give full support to the victims not to tolerate abuse.
8. Listen with empathy explanation about the victims of persecution now and past.
9. Record all injuries incurred and treatment rendered.
10. In collaboration with a team approach, including inter-agency referral initiate and participate in case conferences.

Action for victims of physical abuse and violence on children

1. Make sure the child is comfortable with making the right introductions and do not touch a child without permission when conducting interviews.
2. Use play activities, including drawing, to encourage children to tell or express feelings, for children who are reluctant or unable to express the trauma they experienced.
3. Describe all tests and medical procedures in terms that can be understood, before the procedure is executed.
4. Improve the child's relationship with parents; nurses can not be a substitute for separating parents with the child's biological parents.

Action for victims of physical abuse and violence on women

1. Communicate acceptance, warm and non-judgmental; do not deliver though indirectly that he is guilty of not leaving the abusive environment.
2. Improve the safety and awareness of his right to be free from persecution.
3. Discuss the various options available, including shelter, legal protection to report abuse and seek protection from persecution through the courts.
4. Respect the victim's decision, including the decision to return to the abusive situation or the decision not to report the abuse.
5. Help her to make plans to ensure safety, including home and auto hide duplicates; asking neighbors to report to the police when violence began to occur; store documents such as birth certificates, bank account numbers, social security numbers, and rental receipts or purchases of goods available; maintains a list of telephone numbers of emergency shelter, legal aid, police, counselors and support groups.

Action for victims of physical abuse and violence on elderly

1. Give it time and patience to be able to make the elderly discuss the situation.
2. Respect the dignity of the client and should not be judge.
3. Discuss the options available to ensure safety, such as temporary hospitalization, placement in a home that is safe and protective orders from the court.
4. Provide a list of resources and support services, including adult protective services, legal aid, victim resource agencies, local units of elderly and 24-hour hotline number for the issue of persecution of the elderly.

Measures for Post Traumatic Stress Disorder

1. Use the implementation associated with anxiety (eg, relaxation techniques, encourage expression of feelings, limiting caffeine and nicotine.
2. Validation on the client that they experienced traumatic events cause enormous stress.
3. Help clients disclose all aspects of the traumatic event, including thoughts and feelings.
4. Teach the client about coping strategies to manage anxiety symptoms that accompany memories of trauma.
5. Encourage clients to participate in a support group or self-help groups.
6. Refer clients to alcoholic anonymous or narcotics anonymous if alcohol or drug abuse problem for clients.

Action for abuses committed against

1. When actors threatening persecution or being under the influence of drugs or alcohol, the nurse should call security or police to ensure the safety of themselves and others.
2. Notify molesters on duty to report maltreatment to the designated agency.
3. Get help from a team of experienced health workers (eg, clinical nurse specialists, social workers, representatives of protection agencies, mental health crisis workers) to start the intervention.
4. In situations of child abuse, the nurse can be helpful with regard parents as clients as victims of abuse and their children.
5. If persecution is recognized by the culprit, encourage him to be responsible for violent behavior does.
6. Communicate belief that violent behavior can be controlled and that there are other functions that could be more appropriate and possible.
7. Advise and refer perpetrators of the abuses to the community resource agencies, such as mental health services, parent education courses, self-help groups, and nursing home.

Action for families

1. Teach the family about the importance of individual responsibility for the behavior of each.
2. Teach the family to recognize stressful situations.
3. Teach the family to develop strategies for problem solving or coping strategies.
4. Teach families about effective parenting skills.
5. Teach the family to use community resources and professional assistance to improve family functioning.

Action for community

1. Seeks to reduce violence-related conditions (eg, poverty, inadequate housing, dysfunction attitudes towards violence, substance abuse). For example: joining volunteer organizations, lobby with local officials.
2. Trying to develop and maintain a family of resources (eg, child care services, nursing homes, educational programs, support groups)
3. Support and enhance the legal and legislative efforts to eliminate domestic violence.

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Sample of NCP Basic Human Needs: Personal Hygiene

ASSESSMENT

1. Client Identification

• Name:
• Address:
• Age:
• Gender:
• Level of education:

2. Health History

• Assess individual patterns of daily hygiene.
• Assess the factors that influence individual hygiene include:
• Culture: for example, the myth that being sick should not shower because it will aggravate the disease.
• Socio-economic status: to fulfill that adequate facilities and infrastructure.
• Religion: beliefs affect individuals within executing daily habits.
• The level of knowledge or the development of the individual to health.
• Health Status: will affect an individual's ability to perform self-care.
• Habit: the habit of using certain products in self-care.
• Physical disability:

3. Physical Assessment

• Hair: look dull? is there a loss?
• Scalp: dandruff, bald and signs of inflammation (redness, swelling)
• Eyes: observe signs of jaundice, pale conjunctiva, discharge on the eyelids, redness and itching of the eyelids.
• Nose: assess for sinusitis, nasal bleeding, signs of a cold that does not go away, the signs of allergy.
• Mouth: observe the presence of lesions, mouth sores, dry or chapped.
• Teeth: observe signs of tartar, caries, cracked teeth, incomplete and false teeth.
• Ear: observe the presence of cerumen, lesions, infections, changes in hearing.
• Skin: observe the texture, turgor and moisture and skin hygiene: Strie, wrinkled skin, lesions, pruritus.
• Hands and feet nails: nail observe cleanliness.
• Genetalia: observe cleanliness.

Etiology

1. Physical fatigue
2. Impairment of consciousness
3. Factors predisposing

• Developments: Family too protect and pamper clients.
• Biological: chronic disease.
• Ability reality down: Mental disorders.
• Social: less support and self-care skills training environment.

4. Factors precipitation

• Less / decreased motivation.
• Impairment in cognition or perceptual.
• Anxious.

5. Partial or total paralysis, secondary to (specify)
6. Coma
7. Visually impaired secondary to (specify)
8. Extremity malfunction
9. External equipment (casts, splints, advocates, IV)
10. Fatigue and post-operative pain
11. Pain


Signs and Symptoms

1. Subjective data

• Patients feels weak.
• Lazy to move.
• Feel powerless.

2. Objective data

• Filthy hair, unkempt.
• Bodies and clothes dirty and smelly.
• Mouth and teeth dirty with stink.
• Skin dull and dirty.
• Long nails and unkempt.
• Untidy appearance.

Psychologically: Lazy, no initiative, self Attractive, self-isolation, Feeling helpless, low self-esteem and feel humiliated.

Social: less interaction, less activity, not able to behave according to normal, eating irregular way, urinate and defecate in any place, brush your teeth and shower are not able to be independent.


Nursing Diagnosis

1. Self-Care Deficit: Bathing / hygiene (Less self care (bathing) is an impaired ability to perform activities of bathing / personal hygiene). relate to:

2. Self-Care Deficit: Wearing apparel / ornate.
Self-Care Deficit (wearing clothes) is an impaired ability to wear their own clothes and dress up activities.

3. Self-Care Deficit: Eat
Self-Care Deficit (eating) is an impaired ability to demonstrate the activity of eating.

4. Self-Care Deficit: toileting
Self-Care Deficit (toileting) is an impaired ability to perform or complete the toileting activity itself. (Nurjannah: 2004, 79).

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