Mod. 5 ATI ch. 15 & 24

Question 1

Interventions schizophrenia

Answer 1

• assess safety
• reduce stimuli
• SME
• suicide assessment
• assess command hallucinations and if plan to follow them

Question 2

How will nurse be able to recognize and assess signs and symptoms of a psychotic disorder?

Answer 2

!!! recognize social withdrawal
!!! notice positive or negative signs
!!! cognitive findings
!!! Affective findings

Question 3

DSM Review

Answer 3

used for every mental dx

Question 4

Positive Symptoms

Answer 4

manifestations of things that are not normally present.

• hallucinations
• delusions
• alterations in speech
• bizarre behavior (walking backward constantly)

Question 5

Negative symptoms (anergia)

Answer 5

absence of things that are normally present. More difficult to treat successfully than positive ones.

• Affect- usually blunted or flat
• Alogia- poverty of thought or speech. May mumble
• Anergia- lack of energy
• Anhedonia- lack of pleasure or joy
• Avolition- lack of motivation

Question 6

Psychotic Disorders recognized by DSM-5

8

Answer 6

• Schizophrenia
• Schizotypal personality disorder
• Delusional disorder
• Brief psychotic disorder
• Schizophreniform disorder
• Schizoaffective disorder
• Substance- induced psychotic disorder
• Psychotic or catatonic disorder not otherwise specified

Question 7

Phases of care

Answer 7

Phase 1
Phase 2
Phase 3

Question 8

Some labs to consider

Answer 8

RPR: r/o for syphillus
HIV
Tox. screen

Question 9

Halol

Answer 9

tarditive dyskenesia is the big side effect we look out for

Question 10

Congentin

Answer 10

should be given with halol. to control the EPS

Question 11

What causes schizophrenia?

Answer 11

possibly results from a combination of;

• genetic
• neurobiological
• non-genetic (injury at birth, viral infection, nutritional factors)

Question 12

Typical age of onset of Schizophrenia

Answer 12

late teens and early 20s

• can occur in young children
• can occur in late adulthood

Question 13

Schizophrenia

Answer 13

client has psychotic thinking/ behavior for at least 6 months

significantly impaired areas of functioning; school, work, self-care, relationships

Question 14

Schizotypal personality disorder

Answer 14

impairments of personality functioning (self and interpersonal)

impairment not as severe as with schizophrenia

Question 15

Delusional Disorder

Answer 15

experiences delusional thinking for at least 1 month

self or interpersonal functioning is NOT markedly impaired

Question 16

Brief Psychotic Disorder

Answer 16

psychotic manifestations that last 1 day to 1 month in duration

Question 17

schizophreniform disorder

Answer 17

manifestations similar to schizophrenia, but duration is 1-6 months and social/ occupational dysfunction might not be apparent.

Question 18

schizoaffective disorder

Answer 18

disorder meets criteria for both schizophrenia AND depressive OR bipolar disorder.

Question 19

substance-induced psychotic disorder

Answer 19

experiences psychosis due to substance intoxication or withdrawal

however, psychotic manifestations are more severe than typically expected.

Question 20

psychotic or catatonic disorder not otherwise specified

Answer 20

PSYCHOTIC features (impaired reality testing) or BIZARRE behavior (psychotic) or a significant change in MOTOR ACTIVITY behavior (catatonic) but does not meet criteria for diagnosis with another specific psychotic disorder.

Question 21

Assessment: Cognitive Findings for psychotic disorders

Answer 21

• disordered thinking
• inability to make decisions
• poor problem-solving ability
• difficulty concentrating to perform tasks
• short term memory deficits
• impaired abstract thinking

Question 22

Assessment: Affective findings for psychotic disorders

Answer 22

involving emotions

• hopelessness
• suicidal ideation
• unstable or rapidly changing mood

Question 23

Assessment: alterations in thought (delusions) for psychotic disorders

Answer 23

• ideas of reference: misconstrutes trivial events and attaches personal significance to them. ex. thinking others are talking about them when they’re just discussing the next meal
• persecution
• Grandeur
• somatic delusions: believes that their body is changing unusually
• jealousy
• being controlled: believes someone outside their body is controlling
• thought broadcasting: believes their thoughts are being heard by others
• thought insertion: believes that others’ thoughts are being inserted into their mind
• thought withdrawal: believes their thoughts have been removed
• religiosity: obsessed w/ religious beliefs
• magical thinking: beliefs their thoughts/ actions can control others or situations

Question 24

Assessment: psychotic disorders

Alterations in speech

Answer 24

• associative looseness: unconscious inability to concentrate on a single thought. Can progress to a flight of ideas (one thought to another, incoherent)
• neologisms: made-up words w/ meaning only to the client
• echolalia: client repeats words spoken to him
• clang association: meaningless rhyming of words, often forceful
• word salad: words jumbled together with little meaning or significance to listener

Question 25

Assessment: psychotic disorders | Alterations in Perception

Answer 25

hallucinations are sensory perceptions that don't have any apparent external stimulus: - auditory: command: - visual - olfactory - gustatory: experiencing tastes - tactile: feeling bodily sensations

Question 26

Assessment: psychotic disorders | Personal boundary difficulties

Answer 26

disenfranchisement w/ one's own body, identity, and perceptions - depersonalization- nonspecific feeling that the client has lost their identity. Self is different or unreal - derealization- perception that the environment has changed, such as client believing that objects in their environment are shrinking - illusions- misperceptions or misinterpretations of a real experience

Question 27

Assessment: psychotic disorders | alterations in behavior

Answer 27

> extreme agitation >>> pacing and rocking > stereotypical behaviors >>> motor patterns that had meaning, are now mechanical and lack purpose > automatic obedience >>> responding in a robotic manner > waxy flexibility >>> maintaining specific position for a long time > stupor >>> coma-like, motionless > negativism >>> doing opposite of what's requested > echopraxia >>> purposeful imitation of movements from others > catatonia >>> increase/ decrease in amount of movement. Muscular rigidity, catalepsy > motor retardation >>> > impaired impulse control >>> reduced ability to resist impulse > gesturing or posturing >>> assuming unusual/ illogical expressions > boundary impairment >>> impaired ability to see where one person's body ends and another's begins

Question 28

Standardized screening tools for psychotic disorders

Answer 28

Abnormal Involuntary Movement Scale (AIMS)- used to monitor involuntary movement and tardive dyskinesia in clients taking antipsychotic medication World Health Organization Disability Assessment Schedule (WHODAS)- helps determine client's level of global functioning.

Question 29

Nursing Care: psychotic disorders | Milieu therapy

Answer 29

Milieu Therapy: in acute mental health facilities and in community facilities. It is a social environment controlled to help client. - provide a structured, safe environment (milieu) - Program of assertive community treatment (PACT): intensive case management and interprofessional team approach to assist clients w/ community-living needs.

Question 30

Medications for psychotic disorders

Answer 30

- First- generation/ conventional antipsychotics - Second- generation/ atypical antipsychotics - Third- generation antipsychotics - Antidepressants - Mood stabilizing agents and benzodiazepines