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NSG212 > Psychotic and Neuro disorders > Flashcards

Psychotic and Neuro disorders Flashcards

1
Q

Schizophrenia is potentially a devastating brain disorder that affects:

A 
Thinking
Language
Emotions
Social behavior
Ability to perceive reality accurately
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2
Q

when does schizophrenia usually start

A

devastating brain disease that targets young people in their teens and early twenties

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3
Q

what is psychosis

A

refers to a total inability to recognize reality (e.g., delusions and hallucinations)

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4
Q

what kind of disease is schizophrenia

A

neurological

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5
Q

what are the co-occuring illness of schizophrenia

A
  • Substance abuse disorders
  • Anxiety disorders
  • Depression
  • OCD
  • Panic disorders
  • Obesity (probably due to antipsychotic medications); leads to comorbid diabetes and risk of cardiovascular disease
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6
Q

what are the theories of causes of schizophrenia

A
  • Prenatal infections, environmental toxins, stress, LSD, meth
  • Brain structure abnormalities (neuroanatomical)
  • Autoimmune?? Brain on Fire
  • Neurochemical (brain chemistry)
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7
Q

what are the theories of neurochemical causes for schizophrenia

A

dopamine, serotonin, glutamate

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8
Q

what kind of prenatal stressors causes risks for schizophrenia

A

Pregnancy and birth complications

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9
Q

what kind of psychologic stressors causes risks for schizophrenia

A

Developmental, psychologic, physical, and family stress

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10
Q

what kind of environmental stressors creates a risk for schizophrenia

A
  • Social adversity, chronic poverty, and growing up in high crime areas or in a foreign culture
  • Street drugs in those under 21
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11
Q

what are some positive symptoms of schizophrenia

A 
Hallucinations
Delusions 
Bizarre behavior 
Catatonia
Formal thought disorder
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12
Q

what are some mood symptoms of schizophrenia

A 
Depression
Anxiety
Demoralization
Dysphoria
Suicidality
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13
Q

what are some cognitive symptoms of schizophrenia

A
  • Impairment in memory; disruption in social learning
  • Inability to reason,
  • Solve problems,
  • Focus attention
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14
Q

what are some negative symptoms of schizophrenia

A 
Apathy
Lack of motivation 
Anhedonia
Blunted or flat affect
Poverty and speech
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15
Q

what is the alteration in thinking for impaired reality testing for schizophrenia

A

Absence of ability to correct errors in thinking

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16
Q

what is the alteration in thinking of delsuions for schizophrenia

A

False fixed beliefs not corrected by reasoning

  • Thought broadcasting
  • Thought insertion
  • Thought withdrawal
  • Delusion of being controlled
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17
Q

what is the alteration in thinking of concrete thinking for schizophrenia

A

Impaired ability to think abstractly

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18
Q

what are some alterations in speech you will notice in schizophrenia

A 
Associative looseness 
Neologisms 
Clang association 
Word salad 
Echolalia
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19
Q

what is Echolalia

A

Pathologic repeating of another’s words

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20
Q

what are some alterations in perception you will notice in schizophrenia

A 
Depersonalization
Hallucinations 
Illusions
Command hallucinations 
Derealization
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21
Q

what are some alterations in behavior you may notice with schizophrenia

A 
Bizarre behavior 
Extreme motor agitation 
Waxy flexibility 
Stupor
Negativism
Automatic obedience 
Stereotyped behaviors
Catatonia 
Echopraxia
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22
Q

Loss of impulse control may result in

A

agitated behaviors

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23
Q

Malignant catatonia is an ________ crisis

A

emergency

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24
Q

what is caratonia

A

the freezing movement it is moveable but they are stuck for a moment

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25
Q

what is Echopraxia

A

Mimicking the movements of another

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26
Q

what are some negative symptoms of schizophrenia

A

Apathy
Anhedonia
Poor social functioning
Poverty of thought
Flat, blunted, inappropriate, or bizarre affect
Develop insidiously over long period of time

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27
Q

after you have rules out medical or substance induced psychosis then assess for…

A 
Drug and alcohol use
Command hallucinations
Belief system
Comorbidity
Medication regimen
Family dynamics/support system
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28
Q

what is the outcomes/treatment for Phase 1 (acute)

A
  • Patient safety
  • Medical stabilization
  • Refrain from acting on delusions/hallucinations
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29
Q

what is the outcome/treatment for Phase 2 (stabilization) and Phase 3 (maintenance)

A
  • Medical adherence, understanding, and compliance
  • Continual recovery and functional improvement
  • Control and relapse prevention
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30
Q

what is the planning for Phase 1 (acute)

A
  • Likely hospitalization (safety, workup, testing)

- Strategize safely and symptom stabilization

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31
Q

what is the planning for Phase 2 (stabilization) and Phase 3 (maintenance)

A 
Patient and family education
Skills training (psychosocial)
Relapse prevention skills
Social/vocational/coping skills
Geared toward strengths as well as deficiencies
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32
Q

what are some therapeutic strategies for schizophrenia

A
  • Lowering the patient’s anxiety
  • Decreasing defensive patterns
  • Encouraging participation in therapeutic and social events
  • Raising feelings of self-worth
  • Increasing medication compliance
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33
Q

what are the interventions for phase 1 (acute)

A
  • Psychopharmacologic treatment
  • Supportive/directive communications
  • Limit setting (milieu management and counseling)
  • Psychiatric, medical, neurologic evaluation
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34
Q

what is the health teaching for phase 2 and phase 3

A

Disease, medication management
Cognitive and social skills enhancement
Stress and anxiety controls

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35
Q

what is the health promotion and maintenance for phase 2 and phase 3

A
  • Improve functional deficits
  • Encourage nonthreatening activities
  • Encourage family and social interaction
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36
Q

Antipsychotic drugs are effective in:

A

Acute exacerbations of schizophrenia

Preventing or mitigating a relapse

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37
Q

what is the simple purpose of Conventional (first-generation) antipsychotics

A

Target positive symptoms, BLOCK DOPAMINE

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38
Q

what is the simple purpose of Atypical (second-generation) antipsychotics

A
  • Target positive and negative symptoms
  • Dopamine, AcH, NE Serotonin
  • Atypical agents have fewer side effects.
  • Atypical agents treat anxiety, depression, and decrease suicidal behavior.
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39
Q

what is chlorpromazine(thorazine)

med

A

1st gen antipsychotic

low potency

40
Q

what are some medium potency 1st gen antipsychotics

A

loxapine (Loxitane)
molidone (Moban)
perphenazine (Trilafon)

41
Q

what are some high potency 1st gen antipsychotics

A 
trifluoperazine(generic only)
thiothixene (Navane)	
fluphenazine (Prolixin)	
haloperidol (Haldol)	
pimozide (Orap)
42
Q

what are some conventional adverse reactions of 1st gen

A
  • Extrapyramidalsymptoms (EPSs) – (Akathisia, Acute dystonia, Pseudoparkinsonism)
  • Tardive dyskinesia (TD)
  • Neuroleptic malignantsyndrome (NMS)
  • Agranulocytosis (rare)
  • Anticholinergic effects
  • Orthostasis
  • Lowered seizure threshold
43
Q

what is the teaching of Neuroleptic malignantsyndrome (NMS)

A

it is an EMERGENCY
fatal 10%
occurs at start of treatment

44
Q

what are the ss of Neuroleptic malignantsyndrome (NMS)

A
  • Decreased LOC
  • Muscle- increased tone, rigidity
  • Fever, Labile HTN, rapid HR, sweating, drooling, rapid respirations
  • Treatment with Dantrium, Parlodel, ECT
45
Q

what is akathisia

A

lower leg shaking their leg is “alive”

46
Q

what is dystonia

A

a state of abnormal muscle tone resulting in muscular spasm and abnormal posture

47
Q

what is Tardive dyskinesia

A

movement disorder that causes a range of repetitive muscle movements in the face, neck, arms and legs

48
Q

what is the treatment of Extrapyramidal symptoms

A

Lowering the dose

Prescribing antiparkinsonian drugs:

49
Q

what are some Lowering the dose antiparkinsonian meds

A 
* trihexyphenidyl (Artane) 
•	benztropine mesylate (Cogentin) 
•	diphenhydramine hydrochloride (Benadryl) 
•	biperiden (Akineton) 
•	amantadine hydrochloride (Symmetrel)
50
Q

what are some atypical 2nd gen meds that target positive or negative symptoms

A
  • aripiprazole (Abilify)
  • clozapine (Clozaril) ** last resort, agranulocytosis
  • olanzapine (Zyprexa)
  • paliperidone (Invega)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)
51
Q

what are the ss metabolic syndrome

A

Weight gain, dyslipidemia, altered glucose

Risk of diabetes, hypertension, atherosclerosis, and increase in heart disease

52
Q

what are the disadvantages of atypical 2nd gen

A
  • metabolic syndrome
  • More expensive than conventional antipsychotics
  • Agranulocytosis (Low WBC) with Clozapine
53
Q

what are the 6 cognitive domains

A
  • Complex attention
  • Executive functioning
  • Learning and memory
  • Language
  • Social cognition
  • Perceptual and motor ability
54
Q

Neurocognitive Disorders: Three (3) Main Categories

A

Delirium
Mild neurocognitive disorder
Major neurocognitive disorder

55
Q

does delirium have co-morbities

A

Always exists secondary to another medical condition or substance use.

56
Q

what are the common co-morbidities of delirum

A 
Surgery
Drugs
Infection, hypoglycemia, fever, other homeostatic disruptions
Pain, emotional stress
Pneumonia, cerebrovascular disease
Congestive heart failure (CHF)
57
Q

what are the cognitive disturbances seen in delirum

A

Thinking, memory, disorientation, impairment, and perception

58
Q

what are the attention disturbances seen in delirum

A

Loss of focus and attention; confusion over situation and environment

59
Q

what is sundown syndrome

A

Increased confusion in the evening hours

60
Q

what is the clinical pic of delirum

A
  • Disturbances in consciousness occur.
  • Change in cognition occurs.
  • Develops over a short period.
  • Is common in hospitalized patients, especially older adults.
  • Is always secondary to another physiologic condition.
  • Is a transient disorder.
  • If the underlying condition is corrected, then complete recovery should occur.
61
Q

what is the initial presentation of delirum

A
  • Acute onset
  • Sudden reduced clarity of environmental awareness
  • Impaired ability to focus, sustain, or shift attention and fluctuating course
  • Inattention; questions need to be repeated
  • Distracted by irrelevant stimuli
  • Fluctuating, unpredictable levels of consciousness
  • Sundowning: Disorientation worse at night and early morning
62
Q

what are the physical and mood beahviors will you notice in delirum

A
  • Wandering, falling; requires simple environment
  • Dramatic fluctuations
  • Labile (quick, changing) moods
63
Q

what are the common symptoms noticed in delirum

A
  • Autonomic hyperactivity (increased vital signs)
  • Hypervigilance (constantly alert or scanning room)
  • Labile mood swings
  • Agitation and/or anger
64
Q

what is the outcome goal of delirum

A

Patient will return to premorbid level of functioning.

65
Q

what is the medical management of delirum

A

directed toward identifying and treating any underlying cause.

66
Q

what is the nursing implementations of delirum

A

directed toward patient safety.

67
Q

what is mild cognitive impairment

A
  • Memory impairment = Main symptom
  • Does not interfere with general cognitive functioning
  • Does not interfere with ADLs and socialization
68
Q

what is demientia

A

Evidence of “. . . significant decline in previous cognitive abilities (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition).”

irreversable related to primary encephalopathy

69
Q

what are the major risk factors for Alzhiemer or dementia

A

Age and female gender

70
Q

what is the genetic theory for late onset Alzheimer

A 
does not seem to have an obvious inheritance pattern.
Apolipoprotein E (apoE) on chromosome 19 a risk factor in 20%-25% of cases.
71
Q

what is the genetic theory for early onset Alzheimer

A

age 30–60) is rare and is probably inherited.

Amyloid precursor protein (APP) on chromosome 21; PS-1 on chromosome 14; and gene PS-2 on chromosome 1

72
Q

what is the difference for primary vs secondary dementia

A 
primary 
Irreversible
Progressive
Not secondary to any other disease
Example: AD

secondary
Result of some other pathologic process
Example: Acquired immunodeficiency syndrome (AIDS)–related dementia

73
Q

what are the cultural risk factors for Alzheimer

A

African American older adults: twice as likely to develop AD as white counterparts.
Hispanic American older adults: 1.5 times as likely to develop AD as white counterparts.
Other correlations: higher incidence with hypertension, CV disease, and diabetes.

74
Q

what is the pathology of Alzheimer

A 
Tau protein changes
Neurofibrillary tangles
Cortex shrinking
Hippocampic degeneration
Enlarged ventricles
Beta-amyloid plaques
Granulovascular degeneration
Brain atrophy
75
Q

what are the four defense behaviors for Alzheimer

A

Denial (cover up)
Confabulation (making up answers in unconscious attempt to maintain self-esteem)
Perseveration (repetition of phrases or behavior)
Avoidance of questions

76
Q

what are the 4 A’s of Alzheimers

A

Amnesia
Aphasia
Apraxia
Agnosia

77
Q

what are the cardinal symptoms of alzheimers

A

Disturbances in executive functioning and the 4 A’s

78
Q

what is amnesia

A

memory impairment

79
Q

what is aphasia

A

loss of language ability

80
Q

what is apraxia

A

loss of purposeful movement in the absence of motor or sensory impairment

81
Q

what is agnosia

A

loss of sensory ability to recognize objects

82
Q

what is stage 1 of Alzheimer

A

forgetfulness; possible depression

83
Q

what is stage 2 of Alzheimer

A

confusion; memory gaps; self-care gaps; apraxia. Labile mood.

84
Q

what is stage 3 of Alzheimer

A

unable to identify familiar objects or people; advanced agnosia and apraxia

85
Q

what is stage 4 of Alzheimer

A

agraphia, hyperorality, hypermetamorphosis

86
Q

what is agraphia

A

reading and writing impaired

87
Q

what is hyperorality

A

compulsion to put things in mouth

88
Q

what is hypermetamorphosis

A

need to touch everything in sight

89
Q

People with dementia often show what in communication

A 
Have difficulty finding the right words.
Use familiar words repeatedly.
Invent new words to describe things (neologisms).
Lose their train of thought.
Rely on nonverbal gestures.
90
Q

what are the communication guidelines for alzheimers

A

Always identify yourself.
Call the person by his or her name at each meeting.
Speak slowly.
Use short, simple words and phrases.
Maintain face-to-face contact.
Be near the patient when talking, one or two arm lengths’ away.
Do not argue or refute delusions.

91
Q

what is the only drug used for Alzheimer

A

cholinesterase inhibitors

92
Q

what does the med cholinesterase inhibitors do

A

for alzheimers

  • Delay and prevent symptoms from becoming worse for a limited time.
  • Are useful in treating mild-to-moderate AD.
  • Prevent breakdown of acetylcholine, and stimulate nicotinic receptors to release more acetylcholine.
93
Q

what are some Ach E inhibitors (prevents destruction of Ach)

Used for mild to moderate AD med examples

A

donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Razadyne)

94
Q

what are some NMDA inhibitors (normalizes glutamate)

A

Used for moderate to severe AD

memantine (Namenda)

95
Q

what should be considered for alzheimers enviornement safety

A

Gradually restrict the use of a car.
Remove throw rugs and other objects.
Minimize sensory stimulation.
If verbally upset, give support and change the topic.
Label rooms, drawers, and often-used objects.
Install safety bars in the bathroom.
Supervise the patient when he or she smokes.
History of seizures exists; educate the family on seizure management.

96
Q

what are some interventions you can do for wandering

A

Place a mattress on the floor, or use a bed monitor.
Provide a MedicAlert bracelet with identification.
Notify the police department with photographs, or alert the neighbors.
If in the hospital, have the patient wear a brightly colored vest with the patient’s identification printed on the back.
Install complex locks on the door and locks at the top of the door.
Explore feasibility of sensor devices or global positioning system (GPS).

NSG212 (7 decks)

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