Question

History

Clark is a 20-year-old white American male who was raised in the “poor section” of town. His father was rarely home and took no responsibility for either the children or the bills. When Clark’s father did get a job, he either quit or was fired within a week. After doing time in prison, he died of alcoholism. Clark’s mother works two jobs. Clark has been in and out of trouble since he was 11 years old. His first incident involved drowning a neighbor’s cat. Clark explained, “I was just seeing if the cat could swim.” Subsequently, Clark was accused of damaging neighbors’ property and stealing, Clark, who doesn’t get along well with authority figures, broke all the rules when he was in school (e.g., skipping school to drink beer and smoke pot). He usually convinced his mother to take his side against the authorities. He talked his mother into other things, too (e.g., “borrowing” her brother’s credit card and buying Clark expensive tennis shoes and a motorcycle without any thought of repayment). When Clark was age 15, he was caught in a neighbor’s home when the neighbor returned in the middle of the day. The neighbor called the police. Clark was sent to a residential treatment center for adolescents. He was diagnosed as having Conduct Disorder. After a six-week stay, he was released to his mother. Clark committed several burglaries at age 17 and was incarcerated. He used his one phone call to reach Trisha; a former classmate; Clark convinced her of his innocence. Trisha borrowed money from her mother and put up bail. Later, Clark served a short sentence and was released on probation. Clark talked Trisha into leaving her parents, getting a job and an apartment, and marrying him. Clark tried several jobs but always had a good reason for leaving them. He scared his wife by driving recklessly and verbally threatening people in bars. He got a couple of speeding tickets and frequently wrote bad checks to pay them. Over a twelve-month period, Clark lied to his wife about looking for work, ran up her credit card, disappeared with her car, and had affairs with other women. He used her credit card to pay for the hotel. Trisha was stuck with the credit card debt and a car payment for a car she no longer possessed. She decided to divorce Clark. She characterized him as indifferent and uncaring about hurting or mistreating others. She could not recall Clark ever saying he was sorry for anything.

Case Study

Clark is in jail for scamming an elderly couple out of their money. As the jail’s evening nurse makes her rounds, she stops to see if Clark has any health problems. He tells her, “You’re too pretty to be a nurse. You should be a model.” He engages the nurse in conversation and then asks, “If you would make a phone call for me, I’d give you $60. It’s just between us. Don’t tell anyone about this.” The nurse schedules Clark for a visit with the psychiatrist who comes daily to the jail. After examining Clark and getting a history, the psychiatrist writes a diagnosis of Antisocial Personality Disorder (APD). He adds Alcohol Abuse and Marijuana Abuse. Clark has a pending driving while intoxicated (DWI) charge, and his drug screen is positive for marijuana. The psychiatrist writes an order for carbamazepine (Tegretol XR), with vital signs taken every shift.

Questions

1. As the nurse, how would you respond to Clark’s comments about your looks and his proposition regarding the phone call?

2. What criteria must the client meet to qualify for a diagnosis of APD? Does this client’s history support this diagnosis?

3. Why did the psychiatrist prescribe carbamazepine? What do you need to teach the client about carbamazepine?

4. Do clients with APD get better or is it impossible to change antisocial personality traits?

5. What nursing interventions would you implement for Clark?

Answer 1

1.Being a nurse ,the ability to communicate is a very important skill and a vital part of the job.So i would speak to him in an effective and caring manner.I would try to speak slowly and carefully that the duty of nurse is to take care of the patient and follow doctors order.Nurses have certain ethical and moral obligations to the society and performing such acts could result in legal liabilities.

2 A distinctive characteristic in a patient with antisocial personality disorder is disregarding the rights of others.Individuals with antisocial personality disorders have no concern for what is wrong or right or for the rights of others.They frequently violate others rights and frequently break laws in their" me first" thinking.These individuals exhibit no guilt or remorse,show no improvement from antipsychotics and walk all over anyone who is not able to set firm limits.Yes ,the clients history support the diagnosis.Antisocial personality disorder is included in the cluster B personality disorders.in this disorder there is a pervasive pattern of disregard for and violation of the rights of others.

3 Antisocials with bipolar disorder may respond to carbamazepine which help stabilize moods and lessen antisocial behaviour as well.

Advice the client to take the medicine as directed and notify MD if more than 1 dose missed. Tell the patient to report thoughts of suicide,new or worsening.Use sunscreen while taking the drug.

4 Abstinence from drugs and alcohol helps in reducing antisocial behaviours.Marriage and family counselling may benefit the people with antisocial personality disorder.For patients in prison incarceration maybe the best way to control the most severe and persistent cases of antisocial personality disorder.

5 Nursing interventions are

• Monitor platelets,iron,and WBC,increased BUN,urine protein,glucose and calcium.
• Limit setting;confrontation
• Teach patients to solve problems effectively and manage emotions of anger or frustration.