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Mental Health Nursing Exam 2 > WK5: Thought Disorders > Flashcards

WK5: Thought Disorders Flashcards

1
Q

Characteristics of Schizophrenia

A
  • break w/ reality
  • hallucinnations, delusions, disorganized thinking
  • poor self care
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2
Q

What is the most common psychosis related disorder?

A

schizophrenia

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3
Q

When is schizophrenia typically seen?

A

late adolescence/early adulthood

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4
Q

psychosis

A

pt experiences symptoms: hallucinations, delusions, disorganized thoughts, speech or behanior

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5
Q

Hallucinations

A

sensory disturbances (seeing hearing things that aren’t there

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6
Q

Delusions

A

beliefs about things that aren’t true

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7
Q

Types of delusions

A

grandiosity, nihilistic, persecutory, somatic

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8
Q

Describe the clinical course of schizophrenia (5 steps)

A
  • Prodromal period (often noticed in retrospect)
  • acute illness
  • stabilization
    maintenence and recovery
  • relapses
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9
Q

Diagnostic Criteria: (szh) “Positive symptoms” are and would include?

A
  • symptoms that exist but should not

- delusions and hallucinations

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10
Q

Diagnostic criteria: (szh) “negative symptoms” are and would include?

A
  • symptoms that should be present ut are not (flattening of emotion, withdrawl)
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11
Q 
Diagnostic Criteria (SZ)
Neurocognitive impairment is?
A

involving memory, vigilance, verbal fluency, and excutive function (ie disorganized symptoms)

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12
Q

Disorganized symptoms: Disorganized thinking - what are some examples of this?

A

echolalia, loose associations, flight of ideas, word salad, neologisms, paranoia, concrete thinking, pressured speech

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13
Q

Disorganized symptoms: Disorganized Behavior - What are some examples of this?

A

Aggression, agitation, catatonia/catatonic excitement, echopraxia, hypervigilance

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14
Q

Risk factors of sz

A

genetics/environment

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15
Q

SZ - gender differences?

A

earlier diagnosis and poorer prognosis in men

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16
Q

SZ - familial differences

A

1st degree biologic relatives w/ greater risk

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17
Q

SZ - pregnancy

A

viral infections during pregnancy according to newer research

18
Q

SZ: Comorbidity

A
  • substance use and depression
  • Type 2 diabetes
  • disordered water balance
19
Q

Why is DM2 a comorbidity of SZ?

A
  • The meds we put them on cause lots of metabolic changes and can cause weight gain (changes in blood pressure and changes in glucose metabolism)
20
Q

Social stressors contributing to changes in brain function

A

social stigma, absence of good, affordable, and supportive housing; frangmented mental health care delivery system

21
Q

No accepted psychosocial theories…what does this mean?

A

There’s no theory that can predict schz. Social stressors can contribute, but will not make you schz. by themselves

22
Q

Nursing Management: Biologic assessment components

A

Current and past health status and physical exam
Physical functioning
Nutritional Assessment
Fluid imbalance assessment
Pharmacologic assessment (meds, abnormal motor movements)

23
Q

Nursing Dx’s for the biologic domain

A

Self care deficit, disturbed sleep pattern, ineffective therapeutic regimen management, imbalanced nutrition, excess fluid volume, sexual dysfunction, constipation

24
Q

Interventions for the Biologic domain

A

promote self care activities, activity/exercise/nutritional interventions, thermoregulation interventions, promotion of normal fluid balance and prepvention of water intoxication
Pharmacologic interventsions: antipsychotics and anticholinergics

25
Q

Antipsychotics: Monitoring and administration

A

1-2 weeks to effect a cx in sympts; usually, trail of 6-12 weeks before a change

26
Q

Antipsychotics purpose

A

blockage of dopamine transmission

27
Q

2nd gen antipsychotics

A

effective in treating neg and positives symptoms (boxes 22.6 and 22.7)

28
Q

Extrapyramidal side effects of antipsychotics

A

table 22.3

29
Q

Parkinsonisms and anticholinergic effects (antipsychotics)

A

table 22.2

30
Q

Dystonic reactions

A

box 22.9

31
Q

Antipsychotics: side effects

A

OS HTN, hyperprolactermia, sedation/weight gain, new onset diabetes, cardiac arrhythmias, agranulocytosis, Drug/Drug interactions

32
Q

Case: Pt presents erratic, hallucinatory, and expressing sx of sz. What info do you want?

A

Where are his parents?
Labs (CBC, CMP (organ function), uranialysis, EKG, CXR, RPR (tests for siphilis) and HIV tests.)
Toxicology?

33
Q

Second Gen antipsychotics have:

A

better effectiveness profile and generally fewer side effects

34
Q

Complications: Neuroleptic Maligant Syndrome (rare/life threatening condition)

A
  • ## severe muscle rigidity, elevated temperature w/ a rapidly accelerating cascade of symptoms (box 22.`0)
35
Q

Complications: Neuroleptic Maligant Syndrome (rare/life threatening condition)

A
  • severe muscle rigidity, elevated temperature w/ a rapidly accelerating cascade of symptoms (box 22.`0)
  • Usually occurs 1-2 wks after meds started
  • Early recognition of symptoms; withholding of any antipsychotic meds
    Dopamine agonists (bromocriptine); muscle relaxants (dantrolene or benzodiazepine)
  • frequent vital sign monitoring
  • supportive measures
36
Q

Complications: Anticholinergic crisis (life threatening condition)

A

overdose or sensitivity to drugs with anticholinergic properties:

Signs/Symps: box 22.11
- “hot as a hare, blind as a bat, mad as a hatter, dry as a bone”

  • Self limiting - usually 3 days after drug discontinued
  • Tx: Discontinue med, physostigmine, gastric lavage/charcoal/catharsis for intentional overdoses
37
Q

Antipsychotics: side effects

A

OS HTN, hyperprolactermia, sedation/weight gain, new onset diabetes, cardiac arrhythmias, agranulocytosis (only carbimezole) , Drug/Drug interactions

38
Q

Psychological assessment includes

A

mental status/appearance

mood/affect

speech

thought processes and delusions/hallucinations/disorganized communication

cog. impairments

memory and orientation

insight/judgement

self concept

stress and coping patterns

risk assessment

39
Q

Interventions for psychological domain

A
  • development of trust/acceptance/hope
  • mgmt of distrubed thoughts and sensory preceptons
  • education about symptoms
  • teaching and coping with stress
  • pt/family education and pscytherapy
40
Q

Nursing mgmt social domain: social assessment

A

functional status, social systems, quality of life, family assessement

41
Q

evaluation and tx outcomes

A

successfull tx and management w/ significant improvement or recovery (not cure!)

Continuity of care as a major goal of recovery

mental health promotion with a positive support system for stressful periods

community tx - ACT teams

Mental Health Nursing Exam 2 (5 decks)

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