4.3 Schizophrenia and The Nursing Process Flashcards
Assessment
- Why did they come to the hospital?
- Patient history (age, onset, s/s, level of function, recent/past stressors, medications/substance abuse)
- Look for positive/negative symptoms of schizophrenia
- Mental Status Exam (LOC, Physical Appearance, Behavior, Cognitive/Intellectual Abilities)
TIPS
- Be gentle and calm
- Make them comfortable to share what’s going on
- Focus on what’s troubling them
- Emphasize with their situation (This must be scary for you)
- Focus on their feelings (not the actual facts of the story)
- Ask if they need help
- Ask what they enjoy
- Emphasize Strengths (Wow you skipped your cigarette this morning)
Words of Encouragement
- Immediate goal of maintaining a relationship, building trust, and having the opportunity to listen.
- Watch for early signs of relapse or episodes
- Keep an eye on medication compliance, side effects, physical health
Positive Disturbance in Thought Content (Schizophrenia)
Delusions - Fixed false beliefs that are irrational
Erotomaniac - Jennifer Lopez is in love with me
Somatic - The doctor say’s I’m not pregnant but I know I am
Jealous - I know you’re sleeping with the neighbor
Grandiose - I am Jesus Christ
Persecutory - Throw the groceries out someone poisoned them
Disturbances in Thought Processes Manifested in Speech
Neologism - Made up words that only have meaning to the person who invented it
“She wants to give me a ride in her new uniphorum”
Clang Association - Choice of words is governed by rhyming
“I am cold and bold. The gold has been sold”
Word Salad - Group of words put together in a random fashion
“Most forward action grows life double play circle uniform”
Concrete Thinking - Literal interpretations of the environment
“What brought you to the hospital? The car”
Loose Association - Shift of ideas from one unrelated topic to another
“We wanted to take the bus but the airport took all the traffic”
Circumstantiality - Delay in communication due to need for unnecessary detail. The point is usually met but by numerous interruptions from the interviewer to keep the person on track regarding the topic being discussed
Tangentiality - Inability to get to point of communication due to introduction of many new topics. Person never gets to the point
Preservation - Persistent repetition of the same word or idea in response to different questions
Mutism - Inability/refusal to speak
Disturbances in Perception
Hallucinations - False sensory perceptions not associated with real external stimuli
Auditory - Most commonly voices but also clicks, music, etc. Most common type of hallucination. Voices tell them what to do. Milder cases may be mumbling. Voices may also call out names of people who are not there.
Visual - Formed images such as people or unformed images such as flashes of light. Almost always people though.
Tactile - False perceptions of touch most often something under the skin. May include delusions of parasitic Infestation
(Formication - Something crawling under the skin)
Gustatory - False perceptions of taste. Generally a bad taste sometimes accompanied by patient thinking they are being poisoned
Olfactory - False perceptions of smell. EXTREMELY UNCOMMON. Usually patient does not know what they are smelling but states its unpleasant.
Illusions vs Hallucinations
Illusions - Misperceptions of real external stimuli
Hallucinations - Misperceptions not based off real external stimuli
Echopraxia
- Individuals imitate or repeat movements that are observed/made by others
Negative Disturbances in Affect
- Behavior associated with individual feeling state or emotional tone
Inappropriate Affect - Emotions incongruent with the circumstances
Bland - Weak emotional tone
Flat - Void of all emotional tone
Apathy - Disinterest in environment
Schizophrenia often causes disinterest in the environment
Emotional apathy causes bland/flat affect
Avolition
- Inability to initiate goal directed activity (no motivation, interest, or ability to choose a course of action)
Ambivalence - Opposite emotions towards the same object which can interfere with patient making simple decisions
- Personal hygiene and grooming may be neglected
- Slower cognition so they have issues problem solving and concentrating
Lack of Interest/Skills in Interpersonal Interactions
Impaired Social Interaction
- Social isolation, emotional detachment, lack of regard for social convention. May cling to others and intrude on personal space of others.
Social Isolation
Anosognosia
- Lack awareness of having an illness/disorder even if apparent to others.
- Predicts nonadherence to treatment and higher relapse rates. Also predicts aggression
Anergia - Deficiency of energy to carry out day to day activities or interact with others
Anhedonia - Inability to experience pleasure. Increases risk of suicide
Lack of Abstract Thinking
- Represents regression to earlier level of cognitive thinking (concrete thinking instead of abstract)
- Has difficulty interpreting metaphors “It’s raining cats and dogs”
Associated Features
Waxy Flexibility - Remains in uncomfortable/bizarre positions for long periods of time
Pacing/Rocking
Regression - Primary defense mechanism of schizophrenia in attempt to reduce anxiety.
Eye movement abnormalities - Difficulty maintaining focus on stationary object or moving smoothly with objects.
Diagnosis
- Disturbed sensory perception (auditory or visual) related to panic anxiety, extreme loneliness, and withdrawal into self.
- Disturbed thought processes related to inability to trust, panic anxiety, or hereditary/biochemical factors.
- Low self-esteem related to social withdrawal and expression of fear of failure
- Risk for violence
- Impaired verbal communication
- Self-care deficit
- Disabled Family Coping
- Ineffective Health Maintenance
- Impaired Home Maintenance
PLANNING
Disturbed Sensory Perception (auditory/visual)
- Discuss hallucinations
- Help client define and test reality
- Verbalize understanding that their hallucinations are a result of their illness
Interventions
- Observe for signs of hallucinations
- Help client understand correlation between anxiety and hallucinations
- Distract client from hallucinations
- Avoid touching the client
