DONE-mental health lp5- schizophrenia Flashcards
Schizophrenia- Biological/Neurological causes
g
too much d/s
g
a
Genetic-
Too much dopamine or serotonin
Glutamate (PCP induces similar symptoms)
Acetylocholin
Schizophrenia cause- brain structure
disruptions in
might be differences in
Disruptions of communication w/ pathways
There might be structural differences with the brain
Schizophrenia cause
Psychological and Environmental
complications
i
what stress
older
hx of
toxins->
Prenatal complications (Folate and hypoxia)
Infections
Psychological stress to mother during pregnancy
Older father
Hx of sexual abuse, social adversity, trauma or social defeat
Toxins (Tetrachloroethylene)
Comorbidities
a
abuse
d
possible
health illnesses-5
p ()behaviors
Anxiety
substance abuse
Depression
Possible suicide
Health illnesses – HTN, obesity, CVD, DM, COPD
Polydipsia -constant thirst from meds— obsessive behaviors over water- can kill pt because of water intoxication and hyponatramia
schizo
course of disorder-common in
prognosis
prepare
course- starts usually 15-25 in males
prognosis- will always have disease and most likely relapses
prepare family for relapses
prodromal phase of schizo
alterations
person
well before
mild alterations in though and mood
person may not feel right or like something is wrong
wellbefore actual attacks
actue phase of schizo
what is it
may need
coping/ others
onset of s/s,
may need hospitalization
difficulty coping and symptoms become apparent to others
stabalization phase of schizo
symtoms
tx where
Symptoms diminishing- previous level of functioning
outpatient tx
maintenance phase of schizo
near baseline
positive symptoms are diminihsed
negative continue to be a concern
will be able to live independently
assessment in prodromal phase
what’s key
what can reduce risk
early assessment is key
reducing risk factors like stress or abuse can reduce risk of developing schizo
Schizophrenia- 4 a s
affect
associative looseness
autism
ambivalence
4-a’s affect
schizo classic signs
__or__ affect
this is
inappropriate or bizarre affect
This is the outward manifestations of a person’s feelings
4-a’s associative looseness
schizo classic signs
what kind of thinking
what kind of reasoning
Disorganized thinking
Jumbled, illogical and impaired reasoning
4-a’s autism
schizo classic signs
thinking
ANd
thinking is not reality
hallucinations and delusions
4-a’s ambivence
schizo classic signs
two
Two opposing emotions toward someone
positive symptoms definition in schizo
project very early and are usually very dramatic so they will be caught right away
what most people associate with mental illness
concrete thinking
Schizophrenia – 1st - Positive symptoms
very black or white
reality testing
positive symptoms
lose ability to determine what is real and what is fake
delusions
positive symptoms
false beliefs that are held despite a lack of evidence to support them.
Neologisms-Alterations in speech
words that
or create
Schizophrenia –1st - Positive symptoms
words that have different meaning to pt then to you
or create a new words that doesn’t make. sense
Echolalia-Alterations in speech
Schizophrenia –1st - Positive symptoms
Repeating words that the nurse says
Echopraxia Alterations in speech
Schizophrenia –1st - Positive symptoms
mimicking of movements
Clang association
chooses words
usually
chooses words based on sounds rather then what they mean
usually the beginning or end the same
“on track big mac”
Word salad
(Jumble of words that makes no sense
depersonalization
alterations in perception
Schizophrenia –Positive symptoms
- Their body is not their own
Derealization
positive symptoms
- Surrounding have changed
illusions
Schizophrenia Assessment –
Positive symptoms
alterations in perception
- Misinterpretations of realty
hallucinations
-types
visual-
boundary
Schizophrenia Assessment –
Positive symptoms
alterations in perception
types all 5 senses
-Visual- see things that do not exist/ are not real
-Boundary (don’t know where body end
command hallucinations
tell the person to take action
like pee in public or kill nurse
motor retardation
Alterations in Behavior
Schizophrenia – Positive symptoms
pronounced slowing of movement
catatonia
positive symptoms-alterations in thought
pronounced increase or decrease in rate of movement
most common is when person moves little to no
motor agitation
Alterations in Behavior
Schizophrenia – Positive symptoms
excited behavior like running to pacing in response to stimuli
negatism- a/p
Alterations in Behavior
Schizophrenia – Positive symptoms
-Active (doing opposite)
- Passive (not doing)
impaired impulse control
positive
- Reduced ability to resist one’s impulses
schizo assess 2nd
negative symptoms defintion
develop slowly and are life altering
Anhedonia
negative symtoms
reduced ability to expeircne pleasure
Avolition
negative symtpms
reduced motivation
Asociality
negative symtpms
decreased desire for social interaction
Affective blunting:
negative symtpms
reduced affect
Apathy
negative symtpms.
decreased interests in activities
Alogia
negative symtpms
reduction in speech
–Interfere most with person’s ability to cope–
c
e
d/f
h/g
schizo negative symptoms
Conversations- cant really talk to people
Employment- cant hold a job
Decisions and follow-through
Hygiene and grooming- might have to do everything for them
flat affect
schizo negative symptoms
(Blank)
Blunted affect
schizo negative symptoms
(minimal emotional response)
Inappropriate affect
schizo negative symptoms
(doesn’t match the situation)
Bizarre affect
tell them
schizo negative symptoms
(odd, illogical)
tell them what is reality- tell the voices to go away
3rd- cognitive
concrete thinking-only
memory-has/ needs lots
information processing has//reduce
dm, j, p
Schizophrenia –cognitive symptoms
concrete thinking-only thinks in black and white
Memory- have short term memory- needs lots of repetition
Information processing-has delayed responses- reduce stimuli
Decision making, judgment and planning- not really functional
4th - Affective
d
s a
risk
Schizophrenia affective symptoms
Depression
Substance abuse
Risk for suicide
Schizophrenia Self Assessment
strong
n
Strong emotional reactions in healthcare workers
Negativism-might bring out anxiety and fear in nurses
assessment guidline
ensure a full
asses for anything __
assess what disorders
complete a
assess
assess risk of
assess prescribed
ensure a full medical workup
assess for medical problem that might mimic
assess fir substance or alc disorders
complete mental status examination
assess hallucinations and delusions
assess suicide risk
assess prescribed meds
assess family knowledge
acute phase goal
how to
want them to
Goal is patient safety and stabilization
how to keep patient safe and away from harm
want them to recognize hallucinations are not real
Stabilization
goal
Goal is to adhere to tx and meds
1 risk factor
Maintenance goal
goal is to
will happen
Goal is preventing relapse
relapses will happen and be aware of it to catch it before it gets out of control
noncompliance is #1 risk factor for relapse
partial
residential
houses
day
looking for
Schizophrenia implementation acute settings
Partial hospitalization
Residential crisis centers
Halfway houses
Day treatment programs
looking for activities and safety
p t
s
l s
e
Schizophrenia implementation Interventions
Pharmacological treatments
Supervision
Limit setting
Evaluations
Stabilization and Maintenance Phases
provided through
types
Schizophrenia implementation
provided through community health centers
med support, monitoring, activités,
Milieu Management
a therapeutic
environment that
a therapeutic milieu provides structure and boundaries
environment that maximizes safety and opputrinity for practicing skills
therapeutic communication
lowers
build
encourages
enchases
Counseling and Communication
Lower anxiety
Building trust
Encouraging interactions
Enhancing self-esteem
understand what
do not/offer
focus on
also need to//call/speak/convey
how do you help with pt experiencing hallucinations
understand what they are seeing to know severity
do not negate expierence- offer your perspective and empathy
focus on here/now- conversations
also needs to call pt by name and speak simple and convey support
how do you help with pt experiencing delusions
get
do not
build
focus on
use
get pt to describe beliefs
do not debate
build trust
focus on the feelings of the delusions
use reality based interventions
nurse needs
tell
sum
speak
how do you help with pt expeircne associative looseness
nurse needs to be the one having trouble understanding, not the patient
tell the patient what you do understand
summarize pts communications
speak clearly
family and pt teaching
regular
take
minimize
maintain
keep
regular contact with supportive individuals
take care of ones health
minimize tobacco
maintain a stable weight
keep active
First generation/ conventional /typical Antipsychotic agents
what type of med
treats
used less why
cost
Dopamine receptor antagonists-haloperidol
Treat positive symptoms- delusions and hallucinations
Used less because of failure to treat negative symptoms
Less $
low potency first generations
c
t
Chlorpromazine
Thioridazine
medium potency first generations
l
p
loxapine
Perphenazine
high potency first generations
h
f
p
t
t
haloperidol
Fluphenazine
Pimozide
Thiothixene
Trifluoperazine
2nd Generation/atypical (serotonin-dopamine antagonists)
why first line
takes
little to no
Antipsychotic agents
First line due to treating positive and negative symptoms
Take 2-6 weeks to work
Little or no EPS
examples of second generation antipshycitocs
3 types of meds
‘one’
“prazole”
“ine”
dry mouth
encourage
also give what
dont want to take
is it Lethal
side effects of antipsychotic medications
encourage ingestion of ice chips/water
sugarless candy/gum
dont want any caffeine, alcohol
nonlethal
urinary retention and hesitancy
what scan/ possible what
what schedule
running what
is it lethal
side effects of antipsychotic medications
bladder scan// posible catheter
bathroom schedule
running water and a warm moist towel
nonlethal
constipation
ensure
promote
consider
is it lethal
side effects of antipsychotic medications
ensure adequate fluid/fiber intake
promote physical activity
consider laxitives
nonlethal
blurred vision
lasts
use
if intolerable
is it lethal
side effects of antipsychotic medications
lasts 1-2 weeks
use reading or magnifying glasses
if intolerable may cause med change
nonlethal
sexual dysfunction
consult for
artificial
is it lethal
side effects of antipsychotic medications
consult prescriber for alterative medicine to help for ed
artificial lubricants for dryness
nonlethal
anticholinergic toxicity s/s
reduced
urinary
hyper
d
cardia
unstable
reduced peristalsis
urinary retention
hyperpyrexia-hot skin
delerium
tachycardia
unstable vital signs
anticholinergic toxicity
is it life threatening
meds
emergency
if needed
adminster
what is the reversal agent
side effects of antipsychotic medications
life threatening
hold all meds
emergency cooling measures
urinary Cath if needed
admisnter benzos
phygostimine -reversal
pseuodparkinism s/s
pill rolling posture
tremors
stiff and stooped posture
Pseudoparkinsonism
administer
if intolerable
provide
is it lethal
side effects of antipsychotic medications
adminster antiparkisnons
if intolerable consult about dosage change
provide towel or handkerchief
nonlethal
acute dystonic reactions s/s
eyes roll back
laryngeal dystonia-airway
spams causing backwards arching
painful contractions
acute dystonic reactions
monitor for
reassure
admisnter
stay
assist pt
side effects of antipsychotic medications
monitor for open airway
reassure that they are non life threatening
adminster antiparkinsons
stay with pts
assist pt to keep up with meds
akathisia s/s
motor restlessness
akathisia
consult
give
whaat meds help
in severa cases
usually subsides when
side effects of antipsychotic medications
consult about med chnage
give antiparksinons agent
propranolol, lorazepam, diazepam
in severe cases may contribute to suicidality
usually subsudes when med is discontinued
tardive dyskinesia s/s
tongue
movements
movements
movements
protruding tongue and licking
irregular movemtns
slow movements
neck/shoulder movements
tardive dyskenisa
discontinuing
adminster
screen how often
side effects of antipsychotic medications
discontinuing rarely relieves symptoms
administer nazines as order
screen every 3 months
orthostatic hypotension
monitor
hold
rise
ensure
subsides when
side effects of antipsychotic medications
monitor lying/standing bp
hold dose when bp under 80
rise slowly
ensure hydration
subsided 1-2 weeks
severe neutropenia
s/s
check labs -first 6months/next 6 months
drug
observe for
side effects of antipsychotic medications
s/s are increased infections
check labs weekly for 6 months
check labs monthly for 6
hold drug and potential new med
observe for s/s of an infection
cholesatic jaundice s.s
first week
then what
fever malaise nausea ab pain fist week
jaundice 1 week later
cholestatic jaundice
consult
tests
diet
side effects of antipsychotic medications
consult about med change
liver function tests every 6 months
high protein high carb diet
NMS s/s
severe
hyper
d
tension/cardia
dys
severe muscle rigidity
hyperreprexia- fever over 103- always assess them first
delirium
hypertension, tachycardia
dysphagia
NMS
is it life threatening
reversal agents
what to temp
maintain
what to antipshyotics
side effects of antipsychotic medications
life threatening medical emergency
bromoctripine and dantrolene are reversal agents
cool body to reduce fever
maintain hydration
hold all antisphyotics
metabolic syndrome s/s
wt
dys
increased
wt gain
dyslipedemia
increased insulin resistance
metabolic syndrome
minimize
what’s used for diabetes
teach about.
side effects of antisphyoctocs
minimize wt gain through nutrition and activity
metformin is used to reduce diabetes
teach the pt and family about importance of regular medical evaluation to correct anything necessary
When to change regimen
no improvement
dangerous/intolerable side effects
Complementary and alternative medicine
Family Therapy
* Psycho-educational Approach
* Community Programs
* Exercise
* Nutrition
* Animal Therapy
* Transcranial Magnetic Stimulation
* Music Therapy
