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Mental Health Nrsg 126 > Ch. 14 & 15 > Flashcards

Ch. 14 & 15 Flashcards

1
Q

Schizophrenia is a disease that affects ______, _____, _____, _____, and ability to perceive _____ accurately.

A

Thinking, language, emotions, social behavior, reality

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2
Q

Does the prevalence of schizo vary by culture?

A

No.

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3
Q

What are the 4 subtypes of schizo?

A

Paranoid, catatonic, disorganized, undifferentitated, residual, schizoaffective.

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4
Q

What is the most common cause of premature death for schizo’s?

A

Suicide.

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5
Q

What is the most significant health risk to schizo’s?

A

Smoking. 75-85% smoke, bringing about many comorbidities. It actually helps with akathisia!

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6
Q

What is another common problem for schizo’s?

A

40-50% ave substance abuse disorders.

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7
Q

What is polydipsia?

A

Drinking 4-10 L of water a day. Higher incidence with schizo.

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8
Q

Describe the neurobiological factors that influence schizo.

A

Too much dopamine causes it. Amphetamines, cocaine, Ritalin, Levodopa can increase dopamine and cause symptoms.

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9
Q

Do genetics play a role in schizo?

A

Yes, but not a 1 gene scenario like Huntington’s. Multiple genes and environment combine to cause this.

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10
Q

What are some non-genetic factors that involved in schizo?

A

Prenatal toxins, infections, starvation, lack of oxygen, stress.

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11
Q

When is the typical onset for schizo?

A

Women = start of menses to 35. 25-35 is average. Men = 18-25

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12
Q

Paranoid schizo is pretty self-explanatory, but what is it most common defense mechanism?

A

Projection. This type has a later onset (20-30( and generally has a good outcome

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13
Q

What is the essential feature of catatonic schizo? Other features?

A

Motor dysfunction. Can be agitation or retardation. (Catatonic is rare). Bizarre posturing. Waxy flexibility (hold position for a long time), sterotyped behavior (obsessive routines), negativism/sutomatic obedience, echolalia (repeat words of others), echopraxia (mimic movements).

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14
Q

Which type of schizo is the most socially impaired and regressed?

A

Disorganized.

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15
Q

What are some s/s of disorganized schizo?

A

Loose associations (friendly-no tight bonds), bizarre mannerisms, inappropriate affect, incoherent speech, hallucinations. Early onset.

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16
Q

What is undifferentiated schizo?

A

Person has s/s, but doesn’t meet criteria for paranoid, catatonic, or disorganized.

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17
Q

What is residual schizo?

A

Active s/s go away, but lack of initiative, withdrawal, magical thinking remain.

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18
Q

What is schizoaffective disorder?

A

Schizophrenia symptoms with mood disorder, like either phase of bipolar.

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19
Q

What happens with each relapse in schizo?

A

Increase in residual dysfunction.

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20
Q

Name the 3 phases of schizophrenia.

A

Prodromal, acute, maintenance, stabilization

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21
Q

What are some s/s of the prodromal stage of schizo?

A

Withdrawal, decrease function, perceptual disturbances, hallucinations, speaking changes, more religious.

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22
Q

What are some s/s of the acute phase of schizo?

A

Neglect hygiene, hallucinations, apathy, withdrawal, lack of motivation. Florid positive symptoms plus negative symptoms.

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23
Q

What are some s/s of the maintenance phase of schizo?

A

Acute symptoms decrease in severity, particularly positive ones.

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24
Q

What are some s/s of the stabilization phase of schizo?

A

Symptoms in remission, although mild ones may persist.

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25
Q

What are some positive signs of schizo?

A

Hallucinations, word salad, delusions, paranoia, bizarre behavior, taste, smell, touch, ideas of reference.

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26
Q

What are some negative signs of schizo?

A

All A’s. Affect (flat), apathy (avolition), anhedonia (can’t feel pleasure), alogia (poverty of though, speech), attention deficit

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27
Q

What are the primary goals when treating schizo during the acute phase?

A

Safety and med stabilization. Least meds with least side effects.

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28
Q

How do you treat schizoaffective disorder?

A

With anti-psychotics.

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29
Q

What are the goals during the maintenance phase of schizo?

A

Patient and family education.

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30
Q

What are the goals during the stabilization phase of schizo?

A

Prevent relapse.

31
Q

How is implementation done in schizo?

A

It is geared towards patient strengths and healthy functioning, as well as weaknesses/symptoms.

32
Q

How do you communicate with a patient experiencing hallucinations or delusions?

A

Non-threatening/nonjudgmental. Clarify reality that patient is experiencing. Interact with concrete reality.

33
Q

How do you communicate with a patients that are paranoid?

A

Honesty/consistency. Only speak when they can hear. Be neutral. Don’t “like” or “dislike” anything.

34
Q

How do you deal with associative looseness?

A

Don’t pretend to understand. Emphasize “here and now”

35
Q

What are the 4 topics that schizo patient/family teaching should include?

A

Disease process, meds, prevention of relapse, and stress management.

36
Q

Where can milieu therapy take place?

A

Hospital, partial hospital (home at night), halfway house. Structure is good!

37
Q

What is PACT?

A

Program for assertive community treatment. A 24/day, 7 day/week team approach to care. Aim is to prevent relapse, help adapt, provide support. For poorly functioning patients. Form of psychotherapy.

38
Q

What are some other forms of psychotherapy for schizos?

A

Family, CBT (cognitive behavioral therapy), and social skills training.

39
Q

How long does it take for antipsychotics to take full effect?

A

6-8 weeks.

40
Q

Name some first generation antipsychotics?

A

Haldol, prolixin, thorazine.

41
Q

Name some atypical antipsychotics?

A

Clozaril (clozapine), Risperdal (risperidone), zyprexa (olanzapine), seroquel (quetiapine), Geodon (ziprasidone), Abilify (aripiprazole)

42
Q

What are some advantages of atypicals? Disadvantages?

A

Advantages = Less EPS symptoms, address negative as well as positive symptoms. Disadvantages = agranulocytosis, weight gain, seizures, high lipids, cost

43
Q

What are some advantages of conventional antipsychotics? Disadvantages?

A

Advantages = Cost. Disadvantages = agranulocytosis, NMS, EPS symptoms, only address positive symptoms.

44
Q

How are conventional antipsychotics given?

A

Z-track method

45
Q

What are some adjunct therapies for antipsychotics?

A

Antidepressants, lithium, benzodiazapines

46
Q

What is the difference in action between conventional and atypical antipsychotics?

A

Conventionals are dopamine antagonists and atypicals are dopamine agonists and effect serotonin levels.

47
Q

What are some s/s of NMS?

A

Severe EPS symptoms, elevated temperature, HTN, tachycardia, diaphoresis, and incontinence.

48
Q

What organ does agranulocytosis effect?

A

Liver.

49
Q

What scale is used to recognize early EPS symptoms?

A

AIMS scale.

50
Q

Which symptoms of schizo, positive or negative, has a worse prognosis?

A

Negative.

51
Q

Which symptoms of schizo, positive or negative, respond better to meds?

A

Positive.

52
Q

What are the 3 main cognitive disorders?

A

Delirium, dementia, and amnestic disorders.

53
Q

Delirium is always _____ to another disease and is _____.

A

Secondary. Reversible. Comes on quickly and resolves quickly.

54
Q

How would you describe primary dementia?

A

No known cause or cure.

55
Q

What is the most important risk factor for dementia?

A

Age.

56
Q

How do genetics effect AD? Ethnicity?

A

Early onset (30-60) is usually familial, while late onset has no genetic component. No effect.

57
Q

A common effect of both delirium and dementia, _____ _____ occurs in the evening.

A

Sundowner’s syndrome.

58
Q

Is delirium more common in older patients, or younger patients?

A

Older.

59
Q

What are some s/s of delirium?

A

Angry, hyper vigilant, disturbed consciousness (person, place, time), nd labile emotions.

60
Q

What are some causes of delirium?

A

Meds, medical conditions, and sometimes unknown.

61
Q

What are it’s essential features?

A

Disturbed consciousness with cognitive difficulties.

62
Q

From a medical perspective, what is done for delirium?

A

Find cause, short phrases, same staff, keep distractions to a minimum.

63
Q

What will you assess for on a patient with delirium?

A

Vitals, LOC, neuro signs, risk for injury, comfort

64
Q

What is the most common form of dementia, besides school induced cataonia?

A

Alzheimer’s disease. Long, slow progression, 4th leading cause of death in the US

65
Q

What are some examples of executive function?

A

Planning, organizing, abstract thinking, memories, command muscles, and emotions.

66
Q

What happens in stage 1 of dementia?

A

Forgetfulness. First short term memory, then long. Not diagnosable in this stage.

67
Q

What happens in stage 2 of dementia?

A

Confusion, progressive memory loss, withdrawal, denial, ADLs decline, depression increases, need day-care.

68
Q

What happens in stage 3 of dementia?

A

Ambulatory dementia, ADL loss, depression resolves, institutional care.

69
Q

What happens in stage 4 of dementia?

A

End stage. Nonambulatory, loses recognition, forgets how to eat, swallow, etc.

70
Q

What is the first thing you assess for with dementia? Next?

A

Any medical conditions that may be contributing to it. Suicide/aggression, family knowledge and coping skills.

71
Q

With dementia, care is based on the patient and families _____ _____.

A

Immediate needs.

72
Q

How do cholinesterase inhibitors help with dementia?

A

They increase available acetylcholine, which is though to help with memory function.

73
Q

What other meds are used in dementia?

A

Namenda, Excelon, Arocept, SSRIs, antipsychotics.

74
Q

How are these meds for dementia prescribed?

A

With extreme caution. Low and slow.

Mental Health Nrsg 126 (2 decks)

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