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Mental Health > Schizophrenia: Exam 2 > Flashcards

Schizophrenia: Exam 2 Flashcards

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1
Q

What are the major behaviors regarding Schizophrenia?

A

perceptions
thought (cognitive): process and content
affect (emotions)
motivation

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2
Q

What a person feels is not in keeping with what one would normally expect.
What major behavior is this?

A

Affect (emotions)

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3
Q

What does the major behavior: affect (emotions) consist of?

A

Blunted
Flattened
Inappropriate
Over-responsive
Labile

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4
Q

What does the major behavior: motivation consist of?

A

Withdrawal
Regression
Ambivalence
Changes in motor behavior: catatonic, motor excitement, and impulsive behavior.

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5
Q

What are the positive symptoms of schizophrenia?

A
  1. Delusions
  2. Bizarre Behavior
  3. Paranoia
  4. Hallucinations
  5. Disorganized
    Speech
  6. Mutism
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6
Q

What are the negative symptoms of schizophrenia?

A
  1. Flat Affect
  2. Inappropriate Affect
  3. Poverty of Thought
  4. Lack of Energy
  5. Emotional
    Ambivalence
  6. Inability to
    Experience Pleasure
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7
Q

The onset of schizophrenia may be ______ or ________. Most clients slowley and gradually develop signs and symptoms.

A

Abrupt
Gradual

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8
Q

________ usually with more actively positive symptoms of psychosis. Regardless of when and how the illness begins and the type of ___________, consequences for most clients and their families are substantial and enduring.

A

Diagnosis
Schizophrenia

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9
Q

______ and how the illness develops seems to affect the _______. Age at onset appears to be an important factor in how _____ the client fares.

A

When
Outcome
Well

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10
Q

What do younger clients display?

A

Poorer premorbid adjustment
More prominent negative signs
Greater cognitive impairment

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11
Q

Those who experience ______ onset (about 50%) tend to have a _______ immediate and long-term course than those who experience an _____ and sudden onset.

A

Gradual
Poorer
Acute

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12
Q

Approximately 1/3 to ½ of clients with schizophrenia relapse within 1 year of an acute episode.

Higher relapse rates are associated with:

A

Medication noncompliance
Substance use
Caregiver criticism (stigma)
Negative attitude toward treatment

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13
Q

What are the 2 patterns of immediate-term course?

A

Ongoing psychosis (the person never fully recovers)

Episodes of psychotic symptoms alternating with episodes of relatively complete recovery

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14
Q

What is included in the long-term course?

A

Intensity of psychosis diminishes with age
Disease becomes less disruptive
Clients may live independently later in life
Many have difficulty functioning in the community

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15
Q

What are the related disorders to schizophrenia?

A

Schizophreniform
Catatonia
Delusional
Brief psychotic
Shared psychotic
Schizotypal personality

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16
Q

Neurological-anatomical:
Brain structure and functioning
-Changes in basal ganglia activity
-Structural brain abnormalities: what does the abnormalities include?

A

Cerebral atrophy
Decreased cerebral blood flow
Decreased brain volume

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17
Q

Findings have demonstrated that people with schizophrenia have relatively less brain tissue and cerebrospinal fluid than those who do not have schizophrenia

A

Brain structure and functioning

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18
Q

Reduced _______ metabolism in the frontal and temporal lobes as seen on imaging studies (CT, MRI, and PET scan).

Imbalance between _________ systems (dopamine, serotonin, PCP glutamate, norepinephrine, gamma-aminobutyric acid, and acetylcholine [GABA]).

A

Glucose
Neurotransmitter

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19
Q

What do the genetic factors include in regards to neurological-anatomical?

A

Increased risk for schizophrenia associated with a positive family history of schizophrenia

Increased risk for schizophrenia with first-degree relatives diagnosed with schizophrenia

No specific genetic defect identified that causes schizophrenia

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20
Q

Recent studies indicate that the genetic risk of schizophrenia is polygenic, meaning several genes contribute to the development (Kendler, 2015).

A

Genetic Factors

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21
Q

Intrauterine influences such as poor nutrition, tobacco, alcohol, and other drugs, and stress also are being studied as possible causes of the brain pathology found in people with schizophrenia (Sadock et al., 2015)

A

Environmental Factors

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22
Q

Viral exposure or the body’s immune response to a virus could alter the brain pathology of people with schizophrenia
Cytokines
Infections in pregnant women

A

Immunovirological factors

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23
Q

chemical messengers between immune cells that mediate inflammatory and immune responses

A

Cytokines
Specific cytokines play a role in signaling the brain to produce behavioral and neurochemical changes needed.

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24
Q

Describe the infections in pregnant women.

A

Higher rates of schizophrenia among children born in crowded areas in cold weather or conditions that are hospitable to respiratory ailments

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25
1st discovered—Thorazine — have more effect on positive symptoms
Anti-psychotics (Neuroleptics) Typical
26
newer — effective in treating both positive and negative symptoms — fewer extrapyramidal side effects
Anti-psychotics (Neuroleptics) Atypical
27
Overview for Anti-psychotics (Neuroleptics):
Do not cure—control symptoms Reduce anxiety Decrease hallucinations and delusions Increase ability to respond to other forms of treatment. Atypical—decrease negative symptoms
28
What are the pharmacokinetics regarding anti-psychotics (Neuroleptics)?
Well absorbed by GI tract Metabolized by liver Food & antacids can ↓ absorbtion ½ life 18-20 hrs except deconates Passed onto fetus & in breast milk Rapid sedative effect—takes longer to get antipsychotic effect
29
Neuroleptics Typical (1st Gen.)
Thorazine Chlorpromazine Haldol Haloperidol Prolixin Fluphenazine Loxitane Loxapine Trilafon Perphenazine Mellaril Thioridazine
30
Neuroleptics Atypical (2nd Gen.)
Clozaril Clozapine Risperdal Respiridone Zyprexa Olanzapine Geodon Ziprasidone Abilify Aripiprazole Invega Paliperidone
31
What are the side effects of neuroleptics?
Sedation Postural hypotension Sexual dysfunctions Photosensitivity Allergic skin reactions Weight gain
32
What are the anti-cholinergic side effects?
Lowers BP Dry Mouth Blurred vision Constipation Urinary Retention Lowers Seizure Threshold
33
What are the severe side effects of Neuroleptics?
Agranulocytosis Jaundice Extrapyramidal Reactions -Pseudoparkinsonism -Akathesia -Akinesia or Bradykinesia -Dystonias Tardive Dyskinesia Neuroleptic Malignant Syndrome (NMS)
34
How do you control Extra-pyramidal symptoms?
Lower dose Change meds Meds and Nursing Interventions -Cogentin -Akineton -Artane Use of Antihistamines--Benadryl
35
What does Neuroleptic malignant syndrome consist of?
FEVER !!! Hyperthermia Parkinsonian rigidity Changes in BP Tachycardia Death
36
What is the nrusing diagnosis for Neuroleptic Malignant Syndrome?
hyperpyrexia
37
RX regarding neuroleptic malignant syndrome:
Stop antipsychotic Reduce temp Meds: Dantrium and Parlodel
38
What are the nursing measures in regards to neuroleptic medication?
Teach Client Acute observation for: -Effectiveness -Onset of side effects -Serious adverse effects Gain cooperation AIMS
39
What is the assessment for schizophrenia?
history general appearance, motor behavior and speech mood and affect thought process and content delusions censorious and intellectual processes judgement and insight self-concept roles and relationships physiological and self-care considerations
40
History assessment:
Age at onset, previous suicide attempts, current support systems, perception of situation
41
May appear odd, may exhibit psychomotor retardation, word salad, echolalia, latency of response
General appearance, Motor behavior and speech
42
Flat and blunted; anhedonia
Mood and Affect
43
Thought blocking, broadcasting, withdrawal, insertion
Thought process and content
44
Hallucinations (affect the senses) Depersonalization
Sensorium and intellectual processes
45
Impaired =
Judgment and insight
46
Loss of ego boundaries
self-concept
47
Social isolation, Frustration occurs in fulfilling family and community roles
roles and relationships
48
Poor hygiene and grooming Failure to recognize sensations polydipsia
Physiological and self-care considerations
49
Nursing Diagnoses for Schizophrenia
Social isolation Self-care deficit Disturbed Thought processes Communication, impaired verbal Disturbed Sensory Perception Violence, risk for Ineffective coping Coping, disabled family Identity, disturbed personal Health maintenance, ineffective
50
Outcome identification for schizophrenia
Focus on safety of client and others Contact with reality Interact with others in the environment Express thoughts and feelings in a safe, socially acceptable manner Adhere to interventions
51
What does social isolation consist of?
Build a trust relationship Don’t overwhelm Increase self-esteem Deal with regression Deal with ambivalence Deal with altered affect
52
Steps on how to build a trusting relationship:
Introduce yourself Explain your role (I’m your nurse, I’ll be passing your medications) Clarify client’s expectation's & your expectations. Be honest! – don’t make promises you can’t keep. Be consistent.
53
Step on how to NOT overwhelm the client:
Assign the same staff members (if possible). Be persistent in seeking client out, but don’t demand an immediate response. Attend to nonverbal communication (be aware for patients who are responding to internal stimuli). Observe client’s anxiety level. Allow client to sit at a distance. As the client can tolerate, introduce to small group situations
54
Steps on how to increase self-esteem:
Respect the client as a person. Provide opportunities for success (Identify any special talents). Acknowledge successes.
55
How do you deal with ambivalence?
Help client recognize the presence of ambivalent feelings. Help client connect behavior with feelings. Help weigh decisions (find factors that will weigh the decision to one side or other). Find a third course of action which will resolve the conflict.
56
How do you deal with anosognosia (lack of insight)?
Medicate without consent (in cases where the patient is court ordered involuntary treatment) Understand that anosognosia is neurological and beyond a patient’s control. LEAP: Listening to the patient Empathizing with the patient Agreeing with the patient Partnering with the patient
57
How do you deal with regression?
Assist client with learning social skills. Be aware of own feelings (In some cases, nurses will react to regressed behavior with anger of disgust). Don’t misinterpret regressed behavior as a sexual advance
58
How do you deal with altered affect?
Attempt to find out what the person is experiencing. Explore your own feelings (you don’t want to reject the person). Accept expressions of anger (this may be a sign that the client feels comfortable enough with you to express their feelings).
59
How will you evaluate improve in the client’s social isolation?
The client: demonstrates an ability to relate satisfactorily with others. has not harmed self or others. maintains anxiety at a manageable level. demonstrates the ability to trust others. uses appropriate verbal communication in interaction with others.
60
Assist with ADLs Direct activities Maintain adequate nutrition Teach ADLs What is this considering?
Self-care deficit
61
What is the outcome for schizophrenia clients?
The client performs self-care activities independently
62
How do you describe altered thought processes?
Autistic thinking Clarify communication -Automatic knowing -Unclear connections -Global pronouns -Overgeneralizations Use simple concrete language Clarify any magical thinking Watch for ideas of reference Deal with delusions
63
Disturbed Sensory Perceptions and Disturbed Thought Processes are handled similarly. HOW WILL YOU HANDLE THESE?
Recognize that they may not know the boundaries of their body. Orient the client to their surroundings. Ask the client for his perceptions and then give feedback.
64
Nurse: dealing with hallucinations/delusions.
Act as bridge to reality - Trust Clarify reality Do not belittle / challenge State your perception and Focus on their feelings Maintain contact Decrease Anxiety! Set limits Distract Encourage reality based events Concrete tasks Hallucinations increased with Isolation
65
Outcomes regarding hallucinations:
The client: will discuss the content of hallucinations. will be able to define and test reality, reducing or eliminating the occurrence of hallucinations (may not be realistic with severe and persistent illness). will verbalize understanding that the voices are a result of his or her illness and demonstrate ways to interrupt hallucination.
66
Describe paranoia:
Not confined to schizophrenia Sees world has hostile Often have a façade of self-sufficiency Often acts superior Very suspicious Develop trust Offer Choices Avoid competition Release hostility Diversional activities Decreased stimulation & anxiety Verbalize hostility Set limits Self esteem Look for themes Plant seed of doubt
67
Describe disturbed personal identity.
Recognize—may not know body boundaries Orient to surroundings Give feedback May want to touch
68
What is the goal in regards to decreasing violence?
Goal: Decrease the hostile behavior with the least amount of external control.
69
What are the principles in regards to decreasing violence?
Motor behavior is predictor Is a defensive stance against helplessness. Reason & logic intensifies anger. Often terrified of losing control.
70
Describe hostile behavior interventions/prevention's:
DO NOT act authoritarian DO NOT use reason & logic Allow distance Offer food or fluid Call by name Allow to vent Short precise sentences Try not to leave alone.
71
Describe how to handle physical violence:
Get more staff Surround Client Physical restraint is last resort, & if used must explain why.
72
Describe the evaluation for a hostile behavior, violent behavior, or physical violent behavior environment.
The nurse must consider evaluation of the care plan in the context of each client and family Ongoing assessment provides data to determine whether the client’s individual outcomes were achieved The client’s perception of the success of treatment also plays a part in evaluation -Even if all outcomes are achieved, the nurse must ask if the client is comfortable or satisfied with the quality of life
73
Describe Patient, Family, & Community Education:
Teaching the client and family -Coping with schizophrenia is a major adjustment for both clients and their families -Key issues include (The need for medication continuation and follow up) (The uncertainty of prognosis or recovery) -Clients and families need help coping with the emotional upheaval caused by schizophrenia (see Videbeck CLIENT AND FAMILY EDUCATION FOR SCHIZOPHRENIA, p. 276) -Self-care, proper nutrition, social skills, and medication management (This is associated with fewer and shorter hospital stays and reduces the likelihood of relapse)
74
Describe community-based care:
Clients with schizophrenia are no longer hospitalized for long periods and return to the community with -Housing (family or independently) -Assertive community treatment programs -Behavioral home health care -Community support programs -Case management services
75
Describe the goal of psychiatric rehabilitation:
Work with clients to -Manage their own lives -Make effective treatment decisions -Have an improved quality of life Early intervention – an emerging goal of research investigating the earliest signs of the illness -Initiatives of early detection, intervention, and prevention of psychosis have been established to -Recognize prodromal signs predictive of later psychotic episodes -Provide individualized interventions and treatment to enhance self-mastery
76
Describe self-awareness issues:
Recognize client’s suspicious or paranoid behavior -Is part of the illness -Do not become offended Nurse may be frightened -Acknowledge these feelings -Take measures to ensure safety Don’t take client’s success or failure personally Focus on the amount of time client is out of hospital Visualize the client as he or she gets better

Mental Health (23 decks)

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