T2 - Schizophrenia (Josh) Flashcards
Bleuler’s Four ‘A’s’ of Schizophrenia.
- Affect
- Associative Looseness
- Autism
- Ambivalence
Negative Symptoms include –
Affect (ex: inappropriate)
Volition (ex: deteriorated appearance)
Interpersonal Functioning (ex: social isolation)
Psychomotor Behavior (ex: anergia)
Assoc. Features (ex: andedonia)
— reinforce hallucinations.
DO NOT
- let the client know you do not share the perceptions
- call them ‘voices’ not ‘they’ or ‘them’
Types of Hallucinations:
- Auditory
- Visual
- Tactile
- Gustatory
- Olfactory
A nurse is completing an admission assessment for a client who has schizo. Which of the following findings should the nurse document as positive symptoms? (SATA)
a) Auditory hallucination
b) Lack of motivation
c) Use of clang associations
d) Delusion of persecution
e) Constantly waving arms
f) Flat affect
a) Auditory hallucination
c) Use of clang associations
d) Delusion of persecution
e) Constantly waving arms
Interventions for a client who IS hallucinating.
- observe for OBJECTIVE S/S
- AVOID TOUCHING client
- ASSESS CONTENT ONCE A DAY
- DO NOT REINFORCE hallucination
- help client make CONNECTION BETWEEN HALLUCINATION and ANXIETY
- DISTRACTION METHODS – discuss ways of helping people cope
— are fixed, false beliefs.
Delusions
In — —, the the HCP can use praise and other positive reinforcements to help the client w/ schizo reduce the frequency of maladaptive behaviors.
Behavior Therapy
— has been shown to be effective when combined w/ drug treatment for schizophrenics.
Group Therapy
What is echolalia?
repeating words they hear
- it is an attempt to identify w/ the person speaking
Negative S/S of Schizophrenia:
- AFFECTIVE FLATTENING,
- ALOGIA (POVERTY OF SPEECH),
- AVOLITION/APATHY,
- ANHEDONIA,
- SOCIAL ISOLATION
Can schizophrenia be inherited?
Yes
Positive Symptoms are those that are —
exaggerated
- you can observe them
A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization?
a) I am a superhero, I am immortal
b) I am no one and everyone is me
c) I feel monsters pinching me all over
d) I know that you are stealing my thoughts
b) I am no one and everyone is me
Hallucinations have to do with —–
your 5 senses
— — stresses a client’s rights to goals and to have freedom of movement and informal relationship w/ staff.
Milieu Therapy
To be classified as Schizo, the signs of disturbance must persist at least –
6 mths
Which of the following would the nurse want to use benztropine?
a) client’s level of agitation has increased
b) client complains of a sore throat
c) client’s skin has yellowish cast
d) client develops tremors and a shuffling gait
d) client develops tremors and a shuffling gait
Examples of Conventional Antipsychotics (for positive symptoms)
ATI
Haloperidol
Loxapine
Chlorpromazine
Fluphenazine
Positive S/S of Schizophrenia:
- HALLUCINATIONS,
- DELUSIONS,
- DISORGANIZED THINKING/SPEECH,
- DISORGANIZED BEHAVIOR
(Must have 3 of these)
A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, ‘The voices want leave me alone!’
Which of the following is an appropriate statement? (SATA)
a) When did you start hearing the voices?
b) The voices are not real, or else we would both be hearing them.
c) It must be scary to hear voices
d) Are they voices telling you to hurt yourself?
e) Why are the voices talking only to you?
a) When did you start hearing the voices?
c) It must be scary to hear voices
d) Are they voices telling you to hurt yourself?
Schizophrenia is — multiple personalities.
NOT
Interventions for a patient w/ delusions.
- convey ACCEPTANCE
- do NOT ARGUE
- focus on REALITY - BASED activities
- DISCOURAGE DISCUSSIONS about delusions
- use SAME STAFF if suspicious
- DON’T TOUCH, LAUGH, WHISPER if suspicious
- give food in SEALED CONTAINERS
- discuss way of HELPING COPE with disturbing thoughts
Positive Symptoms include —
Content of thought (ex: delusion)
Form of thought (ex: neologism)
Perception (ex: illusion)
Sense of self (ex: echolalia)
Example of Antidepressant (ATI)
Paroxetine
Diagnostic criteria for Schizo..
2 or more of:
- Delusions
- Hallucinations
- Disorganized Speech
- Grossly disorganized/catatonic behavior
- Negative symptoms
When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first?
a) Provide large motor activities to relieve the client’s pent-up tension
b) Administer a dose of prn chlorpromazine to keep the client calm
c) Call for sufficient help to control the situation safely
d) Convey to the client that his behavior is not acceptable and will not be tolerated
c) Call for sufficient help to control the situation safely
Phases of Schizophrenia.
1) Premorbid Phase
2) Prodromal Phase
3) Schizophrenia
4) Residual
The nurse is caring for a client w/ schizo. Order include 100 mg chlorpromazine IM STAT and then 50 mg PO bid. Why is chlorpromazine used?
a) reduce EPS symptoms
b) prevent NMS
c) decrease psychotic symptoms
d) induce sleep
c) decrease psychotic symptoms
Examples of Atypical Antidepressants (ATI)
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Apriprazole
Clozapine
Purposefully imitating the movements of others
Echopraxia
How is social-skill therapy typically taught to schizo clients?
role-play using scenarios that they would face in every-day life
A nurse is caring for a client who reports hearing voices that are telling him to ‘kill your doctor.’ Which of the following is the priority action?
a) Use therapeutic communication to discuss the hallucination w/ the client
b) Initiate one-to-one observation of the client
c) Focus the client on reality
d) Notify the provider of the client’s statement
b) Initiate one-to-one observation of the client
When talking to a schizophrenic, use —, not —
‘the voices’
‘they’
— came up w/ the term ‘schizophrenia’
Dr. Eugene Bleuler
A nurse is speaking w/ a client who has schizo 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?
a) Stop the interview at this point, and resume later when the client is better able to concentrate
b) Ask the client “Are you seeing something on the ceiling?’
c) Tell the client, ‘You seem to be looking at something on the ceiling. I see something there too.’
d) Continue the interview without comment on the client’s behavior
b) Ask the client “Are you seeing something on the ceiling?’
When the emotional tone is weak, the affect is –
bland
Does schizophrenia mean ‘split personality’?
No
