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Mental Health > Schizophrenia: Exam 2 > Flashcards

Schizophrenia: Exam 2 Flashcards

1
Q

What are the major behaviors regarding Schizophrenia?

A

perceptions
thought (cognitive): process and content
affect (emotions)
motivation

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2
Q

What a person feels is not in keeping with what one would normally expect.
What major behavior is this?

A

Affect (emotions)

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3
Q

What does the major behavior: affect (emotions) consist of?

A

Blunted
Flattened
Inappropriate
Over-responsive
Labile

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4
Q

What does the major behavior: motivation consist of?

A

Withdrawal
Regression
Ambivalence
Changes in motor behavior: catatonic, motor excitement, and impulsive behavior.

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5
Q

What are the positive symptoms of schizophrenia?

A
  1. Delusions
  2. Bizarre Behavior
  3. Paranoia
  4. Hallucinations
  5. Disorganized
    Speech
  6. Mutism
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6
Q

What are the negative symptoms of schizophrenia?

A
  1. Flat Affect
  2. Inappropriate Affect
  3. Poverty of Thought
  4. Lack of Energy
  5. Emotional
    Ambivalence
  6. Inability to
    Experience Pleasure
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7
Q

The onset of schizophrenia may be ______ or ________. Most clients slowley and gradually develop signs and symptoms.

A

Abrupt
Gradual

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8
Q

________ usually with more actively positive symptoms of psychosis. Regardless of when and how the illness begins and the type of ___________, consequences for most clients and their families are substantial and enduring.

A

Diagnosis
Schizophrenia

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9
Q

______ and how the illness develops seems to affect the _______. Age at onset appears to be an important factor in how _____ the client fares.

A

When
Outcome
Well

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10
Q

What do younger clients display?

A

Poorer premorbid adjustment
More prominent negative signs
Greater cognitive impairment

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11
Q

Those who experience ______ onset (about 50%) tend to have a _______ immediate and long-term course than those who experience an _____ and sudden onset.

A

Gradual
Poorer
Acute

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12
Q

Approximately 1/3 to ½ of clients with schizophrenia relapse within 1 year of an acute episode.

Higher relapse rates are associated with:

A

Medication noncompliance
Substance use
Caregiver criticism (stigma)
Negative attitude toward treatment

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13
Q

What are the 2 patterns of immediate-term course?

A

Ongoing psychosis (the person never fully recovers)

Episodes of psychotic symptoms alternating with episodes of relatively complete recovery

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14
Q

What is included in the long-term course?

A

Intensity of psychosis diminishes with age
Disease becomes less disruptive
Clients may live independently later in life
Many have difficulty functioning in the community

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15
Q

What are the related disorders to schizophrenia?

A

Schizophreniform
Catatonia
Delusional
Brief psychotic
Shared psychotic
Schizotypal personality

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16
Q

Neurological-anatomical:
Brain structure and functioning
-Changes in basal ganglia activity
-Structural brain abnormalities: what does the abnormalities include?

A

Cerebral atrophy
Decreased cerebral blood flow
Decreased brain volume

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17
Q

Findings have demonstrated that people with schizophrenia have relatively less brain tissue and cerebrospinal fluid than those who do not have schizophrenia

A

Brain structure and functioning

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18
Q

Reduced _______ metabolism in the frontal and temporal lobes as seen on imaging studies (CT, MRI, and PET scan).

Imbalance between _________ systems (dopamine, serotonin, PCP glutamate, norepinephrine, gamma-aminobutyric acid, and acetylcholine [GABA]).

A

Glucose
Neurotransmitter

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19
Q

What do the genetic factors include in regards to neurological-anatomical?

A

Increased risk for schizophrenia associated with a positive family history of schizophrenia

Increased risk for schizophrenia with first-degree relatives diagnosed with schizophrenia

No specific genetic defect identified that causes schizophrenia

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20
Q

Recent studies indicate that the genetic risk of schizophrenia is polygenic, meaning several genes contribute to the development (Kendler, 2015).

A

Genetic Factors

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21
Q

Intrauterine influences such as poor nutrition, tobacco, alcohol, and other drugs, and stress also are being studied as possible causes of the brain pathology found in people with schizophrenia (Sadock et al., 2015)

A

Environmental Factors

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22
Q

Viral exposure or the body’s immune response to a virus could alter the brain pathology of people with schizophrenia
Cytokines
Infections in pregnant women

A

Immunovirological factors

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23
Q

chemical messengers between immune cells that mediate inflammatory and immune responses

A

Cytokines
Specific cytokines play a role in signaling the brain to produce behavioral and neurochemical changes needed.

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24
Q

Describe the infections in pregnant women.

A

Higher rates of schizophrenia among children born in crowded areas in cold weather or conditions that are hospitable to respiratory ailments

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25
Q

1st discovered—Thorazine — have more effect on positive symptoms

A

Anti-psychotics (Neuroleptics) Typical

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26
Q

newer — effective in treating both positive and negative symptoms — fewer extrapyramidal side effects

A

Anti-psychotics (Neuroleptics) Atypical

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27
Q

Overview for Anti-psychotics (Neuroleptics):

A

Do not cure—control symptoms
Reduce anxiety
Decrease hallucinations and delusions
Increase ability to respond to other forms of treatment.
Atypical—decrease negative symptoms

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28
Q

What are the pharmacokinetics regarding anti-psychotics (Neuroleptics)?

A

Well absorbed by GI tract
Metabolized by liver
Food & antacids can ↓ absorbtion
½ life 18-20 hrs except deconates
Passed onto fetus & in breast milk
Rapid sedative effect—takes longer to get antipsychotic effect

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29
Q

Neuroleptics Typical (1st Gen.)

A

Thorazine
Chlorpromazine
Haldol
Haloperidol
Prolixin
Fluphenazine
Loxitane
Loxapine
Trilafon
Perphenazine
Mellaril
Thioridazine

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30
Q

Neuroleptics Atypical (2nd Gen.)

A

Clozaril
Clozapine
Risperdal
Respiridone
Zyprexa
Olanzapine
Geodon
Ziprasidone
Abilify
Aripiprazole
Invega
Paliperidone

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31
Q

What are the side effects of neuroleptics?

A

Sedation
Postural hypotension
Sexual dysfunctions
Photosensitivity
Allergic skin reactions
Weight gain

32
Q

What are the anti-cholinergic side effects?

A

Lowers BP
Dry Mouth
Blurred vision
Constipation
Urinary Retention
Lowers Seizure Threshold

33
Q

What are the severe side effects of Neuroleptics?

A

Agranulocytosis
Jaundice
Extrapyramidal Reactions
-Pseudoparkinsonism
-Akathesia
-Akinesia or Bradykinesia
-Dystonias
Tardive Dyskinesia
Neuroleptic Malignant Syndrome (NMS)

34
Q

How do you control Extra-pyramidal symptoms?

A

Lower dose
Change meds
Meds and Nursing Interventions
-Cogentin
-Akineton
-Artane
Use of Antihistamines–Benadryl

35
Q

What does Neuroleptic malignant syndrome consist of?

A

FEVER !!! Hyperthermia
Parkinsonian rigidity
Changes in BP
Tachycardia
Death

36
Q

What is the nrusing diagnosis for Neuroleptic Malignant Syndrome?

A

hyperpyrexia

37
Q

RX regarding neuroleptic malignant syndrome:

A

Stop antipsychotic
Reduce temp
Meds: Dantrium and Parlodel

38
Q

What are the nursing measures in regards to neuroleptic medication?

A

Teach Client
Acute observation for:
-Effectiveness
-Onset of side effects
-Serious adverse effects
Gain cooperation
AIMS

39
Q

What is the assessment for schizophrenia?

A

history
general appearance, motor behavior and speech
mood and affect
thought process and content
delusions
censorious and intellectual processes
judgement and insight
self-concept
roles and relationships
physiological and self-care considerations

40
Q

History assessment:

A

Age at onset, previous suicide attempts, current support systems, perception of situation

41
Q

May appear odd, may exhibit psychomotor retardation, word salad, echolalia, latency of response

A

General appearance, Motor behavior and speech

42
Q

Flat and blunted; anhedonia

A

Mood and Affect

43
Q

Thought blocking, broadcasting, withdrawal, insertion

A

Thought process and content

44
Q

Hallucinations (affect the senses)
Depersonalization

A

Sensorium and intellectual processes

45
Q

Impaired =

A

Judgment and insight

46
Q

Loss of ego boundaries

A

self-concept

47
Q

Social isolation,
Frustration occurs in fulfilling family and community roles

A

roles and relationships

48
Q

Poor hygiene and grooming
Failure to recognize sensations
polydipsia

A

Physiological and self-care considerations

49
Q

Nursing Diagnoses for Schizophrenia

A

Social isolation
Self-care deficit
Disturbed Thought processes
Communication, impaired verbal
Disturbed Sensory Perception
Violence, risk for
Ineffective coping
Coping, disabled family
Identity, disturbed personal
Health maintenance, ineffective

50
Q

Outcome identification for schizophrenia

A

Focus on safety of client and others
Contact with reality
Interact with others in the environment
Express thoughts and feelings in a safe, socially acceptable manner
Adhere to interventions

51
Q

What does social isolation consist of?

A

Build a trust relationship
Don’t overwhelm
Increase self-esteem
Deal with regression
Deal with ambivalence
Deal with altered affect

52
Q

Steps on how to build a trusting relationship:

A

Introduce yourself
Explain your role (I’m your nurse, I’ll be passing your medications)
Clarify client’s expectation’s & your expectations.
Be honest! – don’t make promises you can’t keep.
Be consistent.

53
Q

Step on how to NOT overwhelm the client:

A

Assign the same staff members (if possible).
Be persistent in seeking client out, but don’t demand an immediate response.
Attend to nonverbal communication (be aware for patients who are responding to internal stimuli).
Observe client’s anxiety level.
Allow client to sit at a distance.
As the client can tolerate, introduce to small group situations

54
Q

Steps on how to increase self-esteem:

A

Respect the client as a person.
Provide opportunities for success (Identify any special talents).
Acknowledge successes.

55
Q

How do you deal with ambivalence?

A

Help client recognize the presence of ambivalent feelings.
Help client connect behavior with feelings.
Help weigh decisions (find factors that will weigh the decision to one side or other).
Find a third course of action which will resolve the conflict.

56
Q

How do you deal with anosognosia (lack of insight)?

A

Medicate without consent (in cases where the patient is court ordered involuntary treatment)
Understand that anosognosia is neurological and beyond a patient’s control.
LEAP:
Listening to the patient
Empathizing with the patient
Agreeing with the patient
Partnering with the patient

57
Q

How do you deal with regression?

A

Assist client with learning social skills.
Be aware of own feelings (In some cases, nurses will react to regressed behavior with anger of disgust).
Don’t misinterpret regressed behavior as a sexual advance

58
Q

How do you deal with altered affect?

A

Attempt to find out what the person is experiencing.
Explore your own feelings (you don’t want to reject the person).
Accept expressions of anger (this may be a sign that the client feels comfortable enough with you to express their feelings).

59
Q

How will you evaluate improve in the client’s social isolation?

A

The client:
demonstrates an ability to relate satisfactorily with others.
has not harmed self or others.
maintains anxiety at a manageable level.
demonstrates the ability to trust others.
uses appropriate verbal communication in interaction with others.

60
Q

Assist with ADLs
Direct activities
Maintain adequate nutrition
Teach ADLs
What is this considering?

A

Self-care deficit

61
Q

What is the outcome for schizophrenia clients?

A

The client performs self-care activities independently

62
Q

How do you describe altered thought processes?

A

Autistic thinking
Clarify communication
-Automatic knowing
-Unclear connections
-Global pronouns
-Overgeneralizations

Use simple concrete language
Clarify any magical thinking
Watch for ideas of reference
Deal with delusions

63
Q

Disturbed Sensory Perceptions and Disturbed Thought Processes are handled similarly. HOW WILL YOU HANDLE THESE?

A

Recognize that they may not know the boundaries of their body.
Orient the client to their surroundings.
Ask the client for his perceptions and then give feedback.

64
Q

Nurse: dealing with hallucinations/delusions.

A

Act as bridge to reality - Trust
Clarify reality
Do not belittle / challenge
State your perception and Focus on their feelings
Maintain contact
Decrease Anxiety!
Set limits
Distract
Encourage reality based events
Concrete tasks
Hallucinations increased with Isolation

65
Q

Outcomes regarding hallucinations:

A

The client:
will discuss the content of hallucinations.
will be able to define and test reality, reducing or eliminating the occurrence of hallucinations (may not be realistic with severe and persistent illness).
will verbalize understanding that the voices are a result of his or her illness and demonstrate ways to interrupt hallucination.

66
Q

Describe paranoia:

A

Not confined to schizophrenia
Sees world has hostile
Often have a façade of self-sufficiency
Often acts superior
Very suspicious
Develop trust
Offer Choices
Avoid competition
Release hostility
Diversional activities
Decreased stimulation & anxiety
Verbalize hostility
Set limits
Self esteem
Look for themes
Plant seed of doubt

67
Q

Describe disturbed personal identity.

A

Recognize—may not know body boundaries
Orient to surroundings
Give feedback
May want to touch

68
Q

What is the goal in regards to decreasing violence?

A

Goal: Decrease the hostile behavior with the least amount
of external control.

69
Q

What are the principles in regards to decreasing violence?

A

Motor behavior is predictor
Is a defensive stance against helplessness.
Reason & logic intensifies anger.
Often terrified of losing control.

70
Q

Describe hostile behavior interventions/prevention’s:

A

DO NOT act authoritarian
DO NOT use reason & logic
Allow distance
Offer food or fluid
Call by name
Allow to vent
Short precise sentences
Try not to leave alone.

71
Q

Describe how to handle physical violence:

A

Get more staff
Surround Client
Physical restraint is last resort, & if used must explain why.

72
Q

Describe the evaluation for a hostile behavior, violent behavior, or physical violent behavior environment.

A

The nurse must consider evaluation of the care plan in the context of each client and family
Ongoing assessment provides data to determine whether the client’s individual outcomes were achieved
The client’s perception of the success of treatment also plays a part in evaluation
-Even if all outcomes are achieved, the nurse must ask if the client is comfortable or satisfied with the quality of life

73
Q

Describe Patient, Family, & Community Education:

A

Teaching the client and family
-Coping with schizophrenia is a major adjustment for both clients and their families
-Key issues include
(The need for medication continuation and follow up)
(The uncertainty of prognosis or recovery)
-Clients and families need help coping with the emotional upheaval caused by schizophrenia (see Videbeck CLIENT AND FAMILY EDUCATION FOR SCHIZOPHRENIA, p. 276)
-Self-care, proper nutrition, social skills, and medication management
(This is associated with fewer and shorter hospital stays and reduces the likelihood of relapse)

74
Q

Describe community-based care:

A

Clients with schizophrenia are no longer hospitalized for long periods and return to the community with
-Housing (family or independently)
-Assertive community treatment programs
-Behavioral home health care
-Community support programs
-Case management services

75
Q

Describe the goal of psychiatric rehabilitation:

A

Work with clients to
-Manage their own lives
-Make effective treatment decisions
-Have an improved quality of life

Early intervention – an emerging goal of research investigating the earliest signs of the illness
-Initiatives of early detection, intervention, and prevention of psychosis have been established to
-Recognize prodromal signs predictive of later psychotic episodes
-Provide individualized interventions and treatment to enhance self-mastery

76
Q

Describe self-awareness issues:

A

Recognize client’s suspicious or paranoid behavior
-Is part of the illness
-Do not become offended

Nurse may be frightened
-Acknowledge these feelings
-Take measures to ensure safety

Don’t take client’s success or failure personally
Focus on the amount of time client is out of hospital
Visualize the client as he or she gets better

Mental Health (23 decks)

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