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Nursing 172 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Risk Factors

A
  • age (early)
  • gender (the same for male or female)
  • family history (10% of developing)
  • environmental stressors (problems with interpersonal relationships, work, school, and substance abuse)
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2
Q

Definition

A

a severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact or distortion of reality
-can not be defined as a single illness; syndrome or a disease process with many different varieties and symptoms

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3
Q

Initial Assessment

A
  • current physical status and physical history
  • current mental status
  • drug history; prescribed and OTC
  • safety needs
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4
Q

What does Schizophrenia Cause?

A

distorted and bizarre thoughts, perceptions, emotions, movements, and behavior
-may be evidence of hallucinations and delusional thinking

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5
Q

Categories of Symptoms

A
  • Positive or hard symptoms (delusions, hallucinations, disorganized thinking, speech, and behavior)
  • Negative or soft symptoms (flat affect, lack of volition, social withdrawal or discomfort)
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6
Q

Positive/ Hard Symptoms of Schizophrenia

A

(In temporal lobe)

  • ambivalence
  • associative looseness
  • delusions
  • echopraxia
  • flight of ideas
  • hallucination
  • ideas of reference
  • perseveration
  • bizarre behavior
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7
Q

Positive/Hard symptom: Ambivalence

A

holding seemingly contradictory beliefs or feelings about the same person, event, or situation

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8
Q

Positive/ Hard symptoms: Associative Looseness

A

fragmented or poorly related thoughts and ideas

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9
Q

Positive/ Hard symptoms: Delusions

A

fixed false beliefs that have no basis in reality

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10
Q

Positive/ Hard symptoms: Echopraxia

A

imitation of the movements and gestures of another person whom the client is observing

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11
Q

Positive/ Hard symptoms: Flight of Ideas

A

continuous flow of verbalization in which the person jumps rapidly from one topic to another

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12
Q

Positive/ Hard symptoms: Hallucinations

A

false sensory perceptions or perceptual experiences that do not exist in reality

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13
Q

Positive/ Hard symptoms: Ideas of reference

A

false impressions that external events have special meaning for the person

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14
Q

Positive/ Hard symptoms: Perseveration

A

persistent adherence to a single topic or idea; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic

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15
Q

Positive/ Hard symptoms: Bizarre Behavior

A

outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unusual social or sexual behavior

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16
Q

Negative/ Soft symptoms of Schizophrenia

A

(in frontal lobe)

  • alogia
  • apathy
  • asociality
  • blunted affect
  • catatonia
  • flat affect
  • avolition or lack of volition
  • inattention
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17
Q

Negative/ Soft symptoms: Alogia

A

tendency to speak little or to convey little substance of meaning (poverty of content)

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18
Q

Negative/ Soft symptoms: Anhedonia

A

feeling no joy or pleasure from life or any activities or relationships

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19
Q

Negative/ Soft symptoms: Apathy

A

feelings of indifference toward people, acitivites, and events

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20
Q

Negative/ Soft symptoms: Asociality

A

social withdrawal, few or no relationships, lack of cloeness

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21
Q

Negative/ Soft symptoms: Blunted Affect

A

restricted range of emotional feeling, tone, or mood

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22
Q

Negative/ Soft symptoms: Catatonia

A

psychologically induced immobility occasionally marked by periods of agitation or excitement; client seems motionless, as if in a trance

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23
Q

Negative/ Soft symptoms: Flat affect

A

absence of any facial expression that would indicate emotions or moods

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24
Q

Negative/ Soft symptoms: Avolition or lack of volition

A

absence of will, ambition, or drive to take action or accomplish tasks

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25
Q

Negative/ Soft symptoms: Inattention

A

inability to concentrate or focus on a topic or activity, regardless of its importance

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26
Q

Etiology

A

genetic theories focus on immediate family members (parents, siblings, children)

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27
Q

People with schizophrenia have decreased brain volume and abnormal brain function in what areas of the brain?

A

frontal and temporal lobes of the brain

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28
Q

Temporal Lobe

A

involved in memory, sensory input, language, emotion and comprehension

  • damage can cause disturbance of auditory, visual sensation, and perception. Also impaired organization, disturbance of language comprehension
  • positive signs of schizophrenia
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29
Q

Frontal Lobe

A

controls important cognitive skills such as emotional expression, problem solving, memory, language, judgment, and sexual behavior
-negative signs of schizophrenia

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30
Q

Neurochemical Theories for Schizophrenia

A

imbalance of neurotransmitters dopamine and glutamate are found to play a role

  • dopamine and serotonin
  • excess dopamine as a cause
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31
Q

The most prominent neurochemical theories involve….

A

dopamine and serotonin

-excess dopamine as a cause or excess serotonin

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32
Q

Clozapine

A
  • dopamine and serotonin antagonists
  • dramatically reduce psychotic symptoms and ameliorate the negative signs of schizophrenia
  • atypical antipsychotic
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33
Q

Cultural Considerations

A

ideas that are considered delusional in one culture, may be commonly acceptable by other cultures

  • auditory or visual hallucinations, such as seeing the virgin Mary or hearing gods voice may be a normal part of religious experience in some cultures
  • assessment of affect requires sensitivity to differences in eye contact, body language, and acceptable emotional expression
  • ethnicity; genetic makeup; metabolized meds more slowly
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34
Q

Psychopharmacology

A
  • anti-psychotic medications also known as neuroleptics, are prescribed for their efficacy to decrease psychotic symptoms
  • do not cure, rather they manage symptoms of the disease
  • Convention/ First Generation–> Dopamine antagonists
  • Atypical/ Second Generation–> Dopamine and Serotonin Antagonists
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35
Q

Conventional/ First Generation Anti-psychotics

A
  • dopamine antagonists
  • targets the positive signs of schizophrenia such as delusions, hallucinations, disturbed thinking, and other psychotic symptoms
  • have no observable effect on the negative signs
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36
Q

Atypical/ Second Generation Anti-psychotics

A
  • both dopamine and serotonin antagonists
  • diminish positive symptoms and lessen the negative sings of lack of volition and motivation, social withdrawal, and anhedonia
  • used as a first-line treatment because of fewer side effect than with conventional anti-psychotic meds
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37
Q

Examples of Atypical/ Second Generation Anti-psychotics

A

Dopamine and Serotonin Antagonists

  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Aripiprazole
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)
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38
Q

Examples of Conventional/ First Generation Anti-psychotics

A

Dopamine Antagonist

  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
  • Thiothixene (Navane)
  • Chlorpromazine (Thorazine)
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39
Q

Side Effects of Anti-Psychotic Medications

A
  • dystonic reactions
  • tardive dyskinesia
  • neuroleptic malignant syndrome
  • akathisia
  • EPSs or neuroleptic-induced parkinsonism
  • seizures
  • sedation
  • photosensitivity
  • weight gain
  • dry mouth
  • blurred vision
  • constipation
  • urinary retention
  • orthostatic hypotension
40
Q

Drugs to treat extrapyramidal side effects

A
  • Benztropine
  • Diphenhydramine
  • Amantadine
  • Biperiden
41
Q

Side effect of Anti-Psychotics: Dystonic Reactions

A

spasms in discrete muscle groups such as neck (torticollis) or eye muscle (oculogyric crisis)
-accompanied by protrusion of the tongue, dysphagia and laryngeal and pharyngeal spasms that compromise the clients airway, causing a medical emergency
Treatment: diphenhydramine (Benadryl) given IM or IV, or Benztropine given IM
-it is a extrapyramidal side effect

42
Q

Nursing Interventions for Dystonic Reactions

A
  • administer medications as ordered (diphenhydramine)
  • assess for effectiveness
  • reassure client if he/she is frightened
43
Q

Side Effect of Anti-psychotics: Tardive Dyskinesia

A

characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of limbs and feet

  • irreversible once appears but decreasing or discontinuing the medication can arrest the progression
  • Clozapine recommended for clients who have experienced this while taking conventional anti-psychotics
44
Q

Nursing Intervention for Tardive Dyskinesia

A

assess with tool such as AIMS

-report occurrence of score increase to physician

45
Q

Abnormal Involuntary Movement Scale (AIMS)

A

to screen symptoms of movement disorders

ex: tardive dyskinesia

46
Q

Fatal Side Effect of Clozapine (Atypical Anti-psychotic)

A

agranulocytosis

47
Q

6 anti-psychotics are available for long-acting injections (depot injections) for Maintenance Therapy

A
  • Fluphenazine (conventional)
  • Haloperidol (conventional)
  • Risperidone (atypical)
  • Olanzapine (atypical)
  • Aripiprazole (atypical)
  • Paliperidone
48
Q

Anti-psychotic side effect: Neuroleptic Malignant Syndrome

A

muscle rigidity, high fever, increased muscle enzymes and leukocytes

49
Q

Nursing Interventions for Neuroleptic Malignant Syndrome

A
  • treated by stopping medication
  • ability to tolerate other anti-psychotic meds after NMS varies, but seems possible
  • stop all anti-psychotic meds
  • notify physician immediately
50
Q

Clinical Presentation Symptoms

A
  • delusions
  • form of thought
  • perception (hallucinations)
51
Q

Application of the Nursing Process: Assessment

A

schizophrenia affects thought processes and content, perception, emotion, behavior, and social functioning
-affects each individual differently

52
Q

General Appearance

A

may vary

  • appear normal exhibiting no strange or unusual postures or gestures
  • others exhibit odd or bizarre behavior; appear disheveled and unkempt with no obvious concern for their hygiene, or may wear strange or inappropriate clothing
    ex: heavy wool coat in hot weather
53
Q

Motor Behavior

A

may be odd

  • restless, unable to sit still, exhibiting agitation and pacing or appear unmoving (catatonia)
  • demonstrate purposeless gestures and odd facial expression such as grimacing
  • echopraxia
  • rambling speech
  • psychomotor retardation (sowing of all movements)
54
Q

Catatonic/ Catatonia Subtype

A
  • waxy flexibility
  • stupor
  • motor immobility
  • peculiarities of voluntary movement
  • maintain any position in which they are placed, even if the position is awkward or uncomfortable
55
Q

Mood and Affect

A
  • flat affect (no facial expression)
  • blunted affect (few observable facial expressions)
  • “mask-like”
  • described as silly, characterized by giddy laughter for no reason
  • exhibit inappropriate expressions or emotions incongruent with context of situation
  • anhedonia
  • conversely, feeling all-knowing, all-powerful, not concerned with circumstance of situation
56
Q

Unusual Speech Patterns

A
  • Clang associations
  • Neologisms
  • Verbigeration
  • Echolalia
  • Stilted language
  • Perseveration
  • Word Salad
57
Q

Unusual Speech Patterns: Clang Associations

A

ideas that are related to one another based on sound or rhyming rather than meaning
-ex: “I will take a pill if I go up the hill but not if my name is Jill, I don’t want to kill”

58
Q

Unusual Speech Pattern: Neologisms

A

words invented by the client

-ex: “I’m afraid of grittiz. If there are any grittiz here, I will have to leave.”

59
Q

Unusual Speech Pattern: Verbigeration

A

is the stereotyped repetition of words of phrases that may not have meaning to the listener
ex: “I want to go home, go home, go home, go home”

60
Q

Unusual Speech Pattern: Echolalia

A

clients imitation or repetition of what the nurse says
-ex: NURSE: “can you tell me how you’re feeling?”
CLIENT: “can you tell me how you’re feeling, how you’re feeling?”

61
Q

Unusual Speech Pattern: Stilted Language

A

use of words or phrases that are flowery, excessive, and pompous
ex: “would you be so kind, as representative of Florence Nightingale, as to do me the honor of providing just a wee bit of refreshment, perhaps in the form of some clear spring water?”

62
Q

Unusual Speech Pattern: Perseveration

A

persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase, or word, even when another person attempts to change the topic
ex: NURSE: “how have you been sleeping lately?”
CLIENT: “I think people have been following me”
NURSE: “where do you live?”
CLIENT: “at my place people have been following me.”
NURSE: “what do you like to do in your free time?”
CLIENT: “nothing because people are following me”

63
Q

Unusual Speech Pattern: Word Salad

A

combination of jumbled words and phrases that are disconnected and incoherent and make no sense to the listener
ex: “corn, potatoes, jumps up, play games, grass, cupboard”

64
Q

Thought Processes and Content

A
  • thought disorder; primary feature of disease
  • thought process disordered, and continuity of thought and information processing is disrupted
  • thought broadcasting
  • thought blocking
  • thought withdrawal
  • thought insertion
  • tangential thinking
  • poverty of content (alogia)
65
Q

Thought Blocking

A

client may suddenly stop talking in the middle of a sentence and remain silent for several seconds to 1 minute

66
Q

Thought broadcasting

A

may state that they believe others can hear their thoughts

67
Q

Thought withdrawal

A

believe others are taking their thoughts

68
Q

Thought insertion

A

believe that others are placing thoughts in their mind against their will

69
Q

Tangential Thinking

A

veering onto unrelated topics and never answering the original question
-gives unnecessary details or strays from the topic but eventually provides the requested information

70
Q

Poverty of Content (Alogia)

A

lack of any real meaning or substance in what the client says
-speak little
-ex: NURSE: “how have you been sleeping lately?”
CLIENT: “well, I guess, I don’t know, hard to tell”

71
Q

Delusions

A

fixed, false beliefs with o basis in reality

  • part of psychotic phase of illness
  • common characteristic is the direct, immediate, and total certainty with which the client holds these beliefs
  • he/she acts according to delusions
72
Q

Types of Delusions

A
  • Persecutory/ Paranoid

- Referential

73
Q

Persecutory/ Paranoid Delusions

A

involve the clients beliefs that “others” are planning to harm him or her or are spying, following, ridiculing, or belittling the client in some way

  • sometimes client cannot define who the “others” are
  • Ex: Clients may think that food has been poisoned or that rooms are bugged with listening devices
  • “persecutor” is government, FBI, or another powerful organization
  • specific individuals or family members can be the “prosecutor”
74
Q

Referential Delusions

A

or ideas of reference, involve the clients belief that television, broadcasts, music, or newspaper articles have special meaning to him/ her

75
Q

Sensorium and Intellectual Processes

A
  • hallmark symptom of schizophrenic psychosis is hallucinations
  • disoriented to time, sometimes to place
  • depersonalization
  • poor intellectual functioning
  • difficulty with abstract thinking (legitimate)
76
Q

Hallucinations

A

false sensory perceptions, or perceptual experiences that do not exist in reality

  • can involve 5 sense and bodily sensations
  • distinguished from illusions
  • perceives these as real but later in illness recognizes them as hallucinations
77
Q

Example of hallucinations

A

Auditory Hallucinations

>command

78
Q

Auditory Hallucinations

A

most common

  • involve hearing sounds, most often voices, talking to or about the client
  • may be one or multiple voices; a familiar or unfamiliar persons voice may be speaking
79
Q

Command Hallucinations

A

type of auditory hallucination

-voices demanding the client to take action often to harm the self or others and are considered dangerous

80
Q

Depersonalization

A

client feels detached from his or her behavior
-although the client can state his/ her name correctly, he/she feels as if their body belongs to someone else or that their spirit is detached from the body

81
Q

Self-Concept

A
  • deterioration of the concept of self
  • “loss of ego boundaries”
  • may believe they are fused with another person or object, may not recognize body parts as their own, or may fail to know whether they are male or female
82
Q

Loss of Ego Boundaries

A

describes lack of clear sense of their own body, mind, and influence end and where those aspects of other animate and inanimate objects begin

83
Q

Roles and Relationships

A
  • social isolation
  • low self-esteem
  • lack confidence
  • feel strange or different from others
  • experience great frustration with fulfillment of roles
  • success in school or work can be compromised because of difficulty thinking clearly, remembering, paying attention, and concentrating
  • frightens and embarrasses family
84
Q

Physiological and Self-care Considerations

A
  • self-care deficits
  • inattention to hygiene and grooming
  • occupied in delusions or hallucinations; fail to perform basic activities of daily living
  • fail to recognize sensations of hunger or thirst; malnourishment, constipation
  • unable to sit down long enough to eat, needs finger foods high in protein and nutrients
  • develop polydipsia
  • sleep problems; insomnia
85
Q

Polydipsia

A

excessive water intake

  • leads to water intoxication
  • serum sodium levels to become too low, leading to seizures
86
Q

Nursing Diagnoses for Positive Signs

A
  • risk for other-directed violence
  • risk for suicide
  • disturbed thought process
  • disturbed sensory perception
  • disturbed personal identity
  • impaired verbal communication
87
Q

Nursing Diagnosis for Negative Symptoms

A
  • self-care deficit
  • social isolation
  • deficient diversional activity
  • ineffective health management
  • ineffective therapeutic regimen management
88
Q

Atypical Anti-psychotic Drugs

A

used as a first line treatment because of fewer side effects than with conventional or typical anti-psychotics

  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
89
Q

Nursing Interventions

A
  • promoting safety of patient and others
  • establishing a therapeutic relationship via trust
  • using therapeutic communication (clarifying feelings and statements when speech and thoughts are disorganized or confused)
  • implementing interventions for delusional thoughts
90
Q

Nursing Interventions for Delusions

A
  • do not openly confront the delusion or argue with client
  • establish and maintain reality for the client– listen to what the patient is saying
  • use distracting techniques; work with staff one to one, then small group
  • teach positive self talk, positive thinking, and to ignore delusions
91
Q

Interventions for Hallucinations

A
  • help present and maintain reality by frequent contact and communication
  • elicit description of hallucination to protect client and others. Understanding hallucination helps know how to calm or reassure patient– listen to what the patient is saying
  • engage in reality based activities; card playing, occupational therapy, or listening to music
92
Q

Coping with Socially Inappropriate Behavior

A
  • redirect patient away from problem situations–taking the patient to a quiet area away from public
  • in a nonjudgmental and matter- of- fact manner, give factual statements
  • attempt to re-integrate patient into treatment milieu as soon as possible; 1:1, 1:2, small group
  • don’t make patient feel punished or shunned for their behavior
  • teach social skills through education, role-playing and practice
93
Q

Auditory Hallucination Intervention: Dismissal Intervention

A

telling the voices to go away

  • teaching to talk back to the voices forcefully may help manage auditory hallucinations
  • done in private
94
Q

Medication Management

A
  • drink sugar-free liquids
  • sugar free hard candy to ease anti-cholinergic effect of dry mouth
  • avoid calorie-laden beverages and candy; promote dental caries, weight gain, do little to reduce dry mouth
  • constipation; increase water and bulk-forming foods in diet; avoid laxatives
  • photosensitivity; sunscreen, avoid long hours in the sun
  • orthostatic hypotension; rise slowly
  • monitor sleepiness and drowsiness; sedation
95
Q

Medication Adherence Rating Scale

A

provides a clear picture bout the clients difficulties with medication adherence

  • questionnaire with 10 yes-or no questions clients can answer easily
  • guide staff in identifying strategies to improve compliance if used on a regular basis

Nursing 172 (120 decks)

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