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NSG 211 > Test 2- Schizophrenia, Psychosis, Cognition > Flashcards

Test 2- Schizophrenia, Psychosis, Cognition Flashcards

1
Q

What are DSM criteria for Dx of schizophrenia?

A

2 or more symptoms for at least 1 month and at least one specific symptom (1,2 or 3)

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2
Q

What are the 3 specific symptoms for DSM Dx of schizophrenia?

A
  1. Impairment of a major area of functioning (self care, interpersonal relations, or work)
  2. Signs lasting for at least 6 months
  3. Schizoaffective + bipolar or depression; + psychotic features
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3
Q

What are the s/s of schizophrenia? Which are positive? Which are negative? name at least 2 of each

A

Positive: hallucinations, delusions, disorganized speech, bizarre behavior
Negative: blunted affect, poverty of thought (alogia), loss of motivation (avolition), inability to experience pleasure or joy (anhedonia)

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4
Q

What is a prodromal symptom? What are some related to schizophrenia? Name at least 3

A

An early s/s before dx of disorder
Social withdrawal, hyper religiosity, odd or schizotypal preoccupations, worsening hygiene/self care, deteriorating academics, deep sense of wrongness (dysphoria), bizarre behaviors, other conduct problems, substance abuse, aggressive behaviors

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5
Q

What are DSM criteria to Dx schizoaffective disorder?

A

Uninterrupted duration of illness during which there is a major mood episode (manic or depressive) in addition to the criteria for schizophrenia

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6
Q

What are s/s of schizoaffective disorder?

A

Delusions, racing thoughts, anxiety, hopelessness, hallucinations, psychosis, impulsivity, restlessness, rapid speech

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7
Q

What is catatonia?

A

Behavioral syndrome causing patients to be unable to move normally

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8
Q

What are some s/s of catatonia? Name at least 3

A

Sustained abnormal positions, stupor/unresponsiveness, waxy flexibility, weakness, staring, rigidity, echolalia, purposeless/repetitive overactivity, mutism, echopraxia, limited range of emotions, deep sadness

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9
Q

What does EPS stand for/mean? What causes it?

A

EPS= Extrapyramidal Symptoms. It is alterations in movement (akathisia, tardive dyskinesia, acute dystonia, pseudoparkinsonism) caused by a blockade of dopamine or a depletion in the basal ganglia

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10
Q

What does acute dystonia look like? How is it treated?

A

Muscle cramps in the head/neck/abdomen/pelvis; can lead to abnormal posture/paralysis. Treat immediately with cogentin and can be treated with Benadryl

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11
Q

What does pseudoparkinsonism look like? How is it treated?

A

Stiffened extremities/fine motor tremors; antipsychotic + anticholinergic or mantadine

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12
Q

What does akathisia look like? How is it treated?

A

Internal and external restlessness, can include rocking/pacing/grunting or moaning; treat with a beta blocker, benzos, and/or anticolinergic

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13
Q

What does tardive dyskinesia look like? How is it treated?

A

Facial grimaces, tongue movements, lip smacking, or tremors. There is currently no treatment-it is permanent

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14
Q

How is Lithium used with schizophrenia?

A

Atypical- it is normally used as a mood stabilizer-it reduces aggressive behaviors

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15
Q

How are SSRIs, SNRIs or MAOIs used with Schizophrenia?

A

Atypical- they are normally used as antidepressants. They treat depression r/t schizophrenia

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16
Q

How are anti-tremor meds used with schizophrenia?

A

It is used to treat abnormal muscle movements and can treat some EPS in schizophrenia patients. Benztropine

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17
Q

How do BP meds help with Schizophrenia?

A

Clonidine is an antihypertensive and it can act as a sedative
Propanalol is a beta blocker and it can be used for tremors

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18
Q

Is Fluphenazine (Prolixin) a typical or atypical antipsychotic?

A

Typical

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19
Q

is Haloperidol (Haldol) typical or atypical?

A

Typical

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20
Q

Is Chlorpromazine (thorazine) typical or atypical?

A

Typical

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21
Q

Is Loxaine (Loxitane) typical or atypical?

A

Typical

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22
Q

How do typical antipsychotics work? Side effects?

A

They are dopamine antagonists

They may cause EPS, neuroleptic malignant syndrome, tachycardia, agranulocytosis, seizures, arrhythmias, and hypotension

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23
Q

Is clozapine (clozaril) typical or atypical? Side effects?

A

Atypical; severe neutropenia leading to infection, agranulocytosis, and possibly death

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24
Q

Is aripiprazole (abilify) typical or atypical? Side effects?

A

Atypical; interact negatively with SSRIs/antidepressants, can cause sedation or drowsiness

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25
Q

Is Olanzipine (zyprexa) typical or atypical? Side effects?

A

Atypical; sedation or drowsiness, neuroleptic malignant syndrome

26
Q

Is Quetiapine (seroquel) typical or atypical? Side effects?

A

Atypical; arrhythmias, tachycardia

27
Q

Is paliperidone (invega) typical or atypical? Side effects?

A

Atypical; NMS if combined with CNS depressants, tongue paralysis, respiratory depression, and neutropenia

28
Q

What are treatments for schizophrenia?

A

Antipsychotics, therapy

29
Q

What is the RN concerned about for a schizophrenic patient?

A

Decreasing anxiety, establishing trust, client self care, ensuring safety, and encouraging social interaction

30
Q

What are the advantages and disadvantages of atypical antipsychotics?

A

Advantage: alleviate positive and negative s/s, minimal EPS s/s, improves cognition, decrease anxiety and depression and suicidal thoughts and behaviors
Disadvantage: metabolic syndrome, more expensive than typical antipsychotics

31
Q

How is catatonia treated? What does the nurse worry about?

A

Benzos, ECT, muscle relaxers, tricyclics, talk to/treat them as if they were awake
Maintain patient safety, hydration, and nutrition

32
Q

What are non-pharmacologic treatments for schizophrenia?

A

PAC team (treatment compliance assistance), therapy, and social skills training

33
Q

What are treatment options for schizoaffective disorder?

A

Antipsychotics, anticonvulsants, SSRIs, therapies, psychoeducation

34
Q

How does the RN help the schizoaffective patient?

A

Reinforce reality, establish trust, positive reinforcement, avoid stress, strive for regular routine

35
Q

What are criteria and s/s for a dx of developmental delay?

A

Onset prior to age 18, impaired intellectual performance and adaptive skills. Common delays: gross or fine motor, language, social skills, thinking skills

36
Q

What does the RN consider when treating a pt with a developmental delay?

A
  • Assessment of the child-caregiver relationship (is there abuse or neglect?)
  • Assessment for spurts or lags in development or loss of previous abilities
37
Q

What treatment is used for developmental delays?

A

PT, OT, adaptive skill therapy, target specific symptoms

38
Q

What are the DSM criteria for dx of autism spectrum disorder?

A
  • Defects in social communication/interaction, -Restricted repetitive patterns of behavior, interests, or activities
  • Symptoms present during early developmental period
  • S/s impair everyday functioning
  • S/s not caused by intellectual disability or developmental delay
39
Q

What are s/s of autism spectrum disorder?

A

Stereotypical repetitive speech, obsessive focus on objects, over adherence to routines, hyper/hypo activity to sensory output, hand flapping, not responding to name, lack of eye contact

40
Q

What does the RN consider when treating an ASD patient?

A

Assess pt for abuse/neglect, reduce sensory stimuli, explain thoroughly, stick to a schedule

41
Q

What medications can manage ASD?

A

Risperdol (risperidone)

Abilify (aripiprazole)

42
Q

What are the 4 cardinal features of delerium?

A
  1. Acute onset & fluctuating course
  2. Inattention
  3. Disorganized thinking
  4. Disturbance of consciousness
43
Q

What are other s/s of delerium?

A

Rambling/pressured/irrelevant speech, impaired reasoning, goal directed behaviors, disorientation, sleep disturbance, agitation, anger, illusions, hallucinations, labile mood swings

44
Q

What does the RN worry about with a pt experiencing delerium?

A

Pt safety, treatment of underlying cause, reorientation, minimize distractions/stimuli

45
Q

What causes delerium?

A

Underlying medical condition

  • Common in hospitalized pt or older adults
  • Common cause may be a UTI
46
Q

What are the DSM criteria for a dx of ADHD?

A

Inattention, hyperactivity, impulsivity

Difficult to dx before age 4

47
Q

What meds are used to treat ADHD?

A

Ritalin
Wellbutrin
Catapres
Strettera

48
Q

What are non-pharm treatments for ADHD?

A

Omega3 diet, cognitive-behavioral therapy, exercise, limit stimuli, neuro feedback

49
Q

What is the RN concerned about with an ADHD patient?

A

Limiting stimuli, weekly weights, anorexia, take meds at least 6 hrs before bed, eat before taking meds, monitor growth r/t malnutrition

50
Q

Explain Alzheimer’s (not what it means, what does it look like/some facts about it).

A

Slow onset, no cure, periods of stability, stages range from mild to severe

51
Q

What are the cardinal symptoms of Alzheimer’s?

A

apraxia, aphasia, amnesia, agnosia

52
Q

If there is no cure for Alzheimer’s, why do patients take meds?

A

To slow the progression- the earlier you intervene, the slower the disease progresses

53
Q

What medications might an Alzheimer’s patient be on?

A

Donepezil (Aricept)
Memantine (Nameda)
Galantamine (Razadyne)
Rivastigmine (Exelon)

54
Q

What is the RN worried about r/t Alzheimer’s patients?

A

Hygiene, nutrition, safety, social interaction, communication (speak slowly and in simple phrases)

55
Q

How might the nurse help an Alzheimer’s patient?

A

Memory boards, distraction during agitation, reminiscence therapy, familiar items in their environment, provide them with few and simple choices, puzzles

56
Q

What is the difference in lewy body dementia and vascular dementia?

A

Lewy body: protein clusters in nerve cells

Vascular: Series of mini strokes causing oxygen deprivation in the brain

57
Q

What are the s/s of Lewy body dementia?

A

Visual hallucinations, delusions, REM sleep behavior disorder, change in walking or movement, unpredictable levels of cognitive abilities

58
Q

What are the s/s of vascular dementia?

A

Confusion, disorientation, stroke symptoms, trouble speaking and understanding

59
Q

Treatments for lewy body dementia?

A

Cholinesterase inhibitors (donepezil)
Anti-parkinson meds (levodopa)
Anti-depressants (SSRIs)
Clonazepam

60
Q

Treatment for Vascular dementia?

A

Cognition enhancement meds (Memantine)
Pt safety
Comorbidity management (HTN, DM, etc)

NSG 211 (2 decks)

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