Schizophrenia Flashcards
How does age affect the prognosis of schizophrenia?
Adolescence or early adulthood (about 23 years) earlier the onset, the worse the outcome
What are the manifestations of Schizotypal Personality Disorder?
bizarre speech and behavior, eccentric, magical thinking, visual disturbances
How long does Delusional Disorder Last?
Delusional thinking lasts for 1 month
What scenarios could Delusional Disorder entail?
Situations that could occur in real life, such as being followed, loved by another, or having a disease.
A patient believes that their nurse is trying to poison them. What kind of delusion is this patient experiencing?
Persecution: he/she is being spied on, tricked, tormented. Singled out for harm (paranoia
A patient claims that their nurse is “cheating” on them with another patient. What kind of delusion is this patient experiencing?
Jealous: believing SO is sexually involved with another. Can be directed towards their nurse or others on the unit
A patient is continually preaching very specific passages from the Holy Bible with complete accuracy. What kind of delusion is this patient experiencing?
Religiosity: obsessed with religious beliefs
A patient is walking around the floor poking people wearing what they claim to be an “invisible cloak.” What kind of delusion is this patient experiencing?
Magical Thinking: believes that thoughts/actions can control others/situations… wearing a hat makes them invisible.
A patient is claiming that they are receiving someone else’s thoughts somehow. What delusion is this patient experiencing?
Thought Insertion: others’ thoughts are being inserted into their minds
A patient is wearing a tinfoil hat so that the government does not steal his thoughts. The patient is expressing what kind of delusion?
Thought withdrawal: thoughts removed by an outside energy
A patient is becoming paranoid that people around him can hear what he’s thinking about. What delusion is this patient exhibiting?
thought broadcasting: thoughts are heard by others
A patient states that “when I get out of here, Bradd Pitt and I are finally going to get married!” What delusion is this patient exhibiting?
Erotomania: belief that another person romantically desires him/her
A patient claims that they did not mean to harm another patient. They state that the government took control of their body. What kind of delusion is the patient experiencing?
Being Controlled: force outside their body is controlling them
What kind of therapy do nurses practice when treating those with delusions?
Milieu therapy - structured and safe environment to decrease anxiety and to distract the client from hallucinations
How should a nurse interact with a patient having hallucinations?
Be direct about hallucinations. DO NOT ARGUE or AGREE with the hallucination; ASK DIRECTLY WHAT THE VOICES ARE TELLING THEM
How should a nurse provide distractions for a patient experiencing hallucinations?
Focus on reality-based subjects, music, attend activities, walking, physical activities, talking to a trusted person, and telling hallucinations to “stop” or “go away”
A patient is asking about why their antipsychotic medication isn’t taking effect, How should the nurse respond?
All antipsychotics usually take effect 2 to 6 weeks after the regimen is started, and all may require significant dosage adjustment in order to obtain a balance between effectiveness and side effects
What low potency antipsychotics are typically used in the hospital?
Chlorpromazine, Thioridazine, and Mesoridazine
What SE indicate that a nurse needs to intervene in a patient taking low potency first generation antipsychotic medication?
Anticholinergic SE: dry mouth, constipation, blurry vision, urinary retention, confusion, and hypotension
What are some indications of anticholinergic toxicity?
nonreactive pupils, hot, dry red skin, agitation w, unstable vital signs
What is the nursing intervention for a patient experiencing the EPS SE of akathasia from a high-dosage antipsychotic?
Usually, it subsides when the antipsychotic is discontinued. Propanolol (Inderal), lorazepam (ativan), or diazepam (valium) may be used.
Where can involuntary movement be seen in a patient experiencing tardive dyskinesia?
abnormal involuntary movements, mainly of the face and trunk
What medications would a nurse plan to administer to a patient experiencing extrapyramidal symptoms?
IM Artane (trihexyphenidyl), Benadryl (diphenhydramine), or Cogentin (benztropine)
What is a potentially dangerous response to antipsychotics that nurses would be aware of?
Neuroleptic malignant syndrome (NMS)
What are the symptoms to look out for that indicate Neuroleptic malignant syndrome?
FARM: Fever- tachycardia, diaphoresis, elevated BP and pulse, dilation of pupils/Autonomic- increased vitals, low LOC, diaphoreses, dilated pupils/Renal- failure, dark cola-colored urine (rhabdomyolysis)/Muscle Rigidity- dysphagia
What should a nurse do if they witness a patient undergoing NMS?
Stop the drugs and call MD
What would be administered to a patient if they are experiencing NMS
Dantrolene
What unique SE does clozapine have that makes it so dangerous to take?
Agranulocytosis
What second-generation antipsychotic meds are also available in sublingual form?
Zyprexa, Risperidone, and Clozapine
When should Clozapine not be administered?
HOLD TX IF WBC BELOW 3000 mm3 and ANC BELOW 1500
What is the normal reference range for WBC count?
Normal WBC 4500 to 11000
What is the normal reference range for ANC?
AND 2500 and 6000
A patient experiencing anticholinergic effects tends to go out into the sun frequently. What nursing intervention needs to be applied here?
The patient needs to wear long sleeves, sunscreen, and sunglasses because they may experience photosensitivity
A 21-year-old client, being treated for asthma with a steroid medication, has been experiencing delusions of persecution and disorganized thinking for the past 6 months. Which factor may rule out a diagnosis of schizophrenia?
The client is receiving a medication that could lead to thought disturbances
A client has been prescribed ziprasidone 40mg BID. Which of the following interventions are important related to this medication?
Obtain a baseline EKG initially and periodically throughout treatment., teach the client to take medication with meals, monitor the client’s pulse because of the possibility of palpitations
A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms?
Auditory hallucinations, use of clang associations, delusions of persecution, constantly waving
A patient with schizophrenia states, “the devil keeps telling me I am going to burn in hell.” what is the appropriate nursing response?
The voices must be scary for you. What you hear is part of your illness; it is not real.”
The nurse documents that a client diagnosed with schizophrenia is experiencing anticholinergic side effects from long-term use of thioridazine. Which symptoms has the nurse noted?
Dry mouth, constipation, and urinary retention
A nurse is caring for a client in an acute mental health unit. The client reports hearing voices that are telling her to “kill your doctor.” Which of the following actions should the nurse take first?
Initiate 1:1 observation of the client
For the past year, a client has received haloperidol. The nurse administering the client’s next dose notes a twitch on the right side of the client’s face and tongue movements. Which nursing intervention takes priority?
HOLD the haloperidol and call the physician - TD - hold the med to avoid permanent damage - call doc!!!!
A client has a history of schizophrenia, controlled by haloperidol. During an assessment, the nurse notes continuous restlessness. Which medication would the nurse expect the physician to prescribe for this client?
Benztropine
A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics?
Auditory hallucinations, delusions of grandeur, severe agitation
Which atypical antipsychotic medication has the highest potential for a client to experience serious side effects?
Clozapine
A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client’s safety?
Note escalating behaviors and intervene immediately
A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse’s questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take?
Ask the client, “Are you seeing something on the ceiling?”
When assessing a newly admitted patient with schizophrenia, which assessment data will the nurse document as negative symptoms?
Asociality, blunted affect, poor motivation
A patient with schizophrenia who began taking haloperidol 1 week ago reports signs of tardive dyskinesia. What assessment finding does the nurse anticipate?
Lip puckering
A client on an inpatient psychiatric unit refuses to take medications because “The pill has a special code written on it that will make it poisonous.” What kind of delusion is this client experiencing?
A persecutory delusion
A client recently prescribed fluphenazine (prolixin) complained to the nurse of severe muscle spasms. On one examination, HR is 100, BP 160/92 mm Hg, and temp is 102F. Which nursing intervention takes priority?
Hold the next dose of fluphenazine and call the MD
