Unit 2 Flashcards
What is ambivalence?
Contradictory, mixed feelings
What is alogia?
Poverty of speech
Poverty of content
Thought blocking
Define anhedonia?
Inability to experience pleasure.
Decreased activity, hypersomnia
What is apathy(avolition)?
With schizophrenia client shows an indifference or disinterest in the environment.
Poor hygiene
Lack of motivation
Work/school problems
Define autistic thinking.
Preoccupation with thoughts, daydreaming, fantasies. Self absorbed thinking.
Describe blocking
Sudden loss of thought content indicated by the stopping of spontaneous flow conversation. Usually due to preoccupation or auditory hallucinations.
What is catatonia?
State of motor immobility, does not move. Unresponsive to external stimuli in a person who is fully awake.
What is circumstantiality?
Individual delays in reaching the point of a communication because of unnecessary details. Point is usually met eventually with help focusing.
What is concrete thinking?
Literal interpretations of the environment, represents a regression to an earlier level of cognitive development. Abstract thinking is difficult. People in glass houses shouldn’t throw stones.
Define echolalia.
Repeats words that he/she hears. An attempt to identify with the person speaking.
Echopraxia
Purposefully initiate movements made by others.
What are ego boundaries?
-The ability to separate self from others and the environment.
-Ability to maintain realistic self identity and strong sense of self, personality
-egos sense of psychological and physical well being.
Ego mediates btn ID and superego
What is inappropriate affect?
Emotional tone is incongruent with the circumstance.
Define loose associations.
Unrelated complete thoughts expressed in rapid succession.
What do you say when someone is talking with loose associations?
Tell them you don’t understand what they mean.
What is it called when patients make up new words?
Neologisms
What is the term for when people have extreme suspiciousness of others and their actions or perceived intentions?
Paranoia…“I won’t eat this food. I know it’s been poisoned”.
What is tangential thinking?
Going off on tangents, never getting to the point.
Someone who believes ideas and emotions are being transmitted by thought?
Thought broadcasting
Thinks someone is putting thoughts into their mind is experiencing?
Thought insertion
A person who thinks someone is stealing their thoughts is experiencing?
Thought withdrawal
What condition describes when a client with schizophrenia allows body parts to be placed in bizarre or uncomfortable positions for long periods of time?
Waxy flexability
What is a group of words that are put together randomly, without any logical connection….”Most forward action grows life double plays circle uniform”.
Word salad
What are the risk factors for someone developing a psychotic disorder/suspicious behavior?
- Have a genetic predisposition
- Brain changes and biochemistry
- Environmental stressors in womb
- Life experiences and developmental tasks
What is meant by brain changes and biochemistry?
Pt. Having enlarged ventricles
- Neurotransmitters( dopamine and serotonin)
- Physiological developmental factors
Describe poor ego boundries and what effect it has on reality testing?
If you don’t have strong ego boundries, you will have difficulty with reality and get into trouble in life
What is it when someone thinks someone famous cares about them…almost stalker like?
Erotomanic delusions
A false idea about the functioning of their body is called….?
ie, “I’m 70 yrs old and am having a baby”
Somatic delusion
Patient feels that someone is after them is called…
Persecutory delusions
Thoughts that the pt. Is better than anybody else. Exaggerated feelings of importance, power and knowledge is called
Delusion of grandeur
The individual has the idea that they, or apart of them, others, or the world in nonexistance.
Nihilistic delusion
The individual believes certain objects or persons have control over their behavior.
Delusion of control or influence
All events in the environment are referred by the psychotic person to the pt. ( someone is trying to get a message to me through the articles in this magazine)
Delusions of reference
When in the presence of others, they assume they are the object of there discussion or ridicule.
Ideas of reference
A persistent and inappropriate mistrust in others. Extremely over sensitive and misinterpret minute cues. They don’t accept responsibility for there own behaviors. What type of pt does this describe?
Paranoid schizophrenia
Pt is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful way. Social withdrawal and uncomfortable with human interaction. Typically unable to experience pleasure and there affect is bland and constricted.
Schizoid personality disorder
A less severe form of schizoid disorder. Aloof, isolated, behave in a bland apathetic manner. Have magical thinking, ideas if reference, illusions, and depersonalization everyday. Believe in superstitions, telepathy, “sixth sense” and believes others can feel their feelings. Bizarre speech pattern, live in their own world. Talk and gesture to themselves.
Schizotypical
A disorder identical to those of schizophrenia but lasts less than 6months
Schizophreniform
This disorder is manifested by schizophrenic behaviors with a strong element of symptomatology associated with mood disorders ( depression or mania)
Schizoaffective disorder
What disorder is characterized by the main feature is having delusions with minimal occurrence of hallucinations and bizarre behaviors
Delusional disorders
What are the positive symptoms of schizophrenia?
- Hallucinations
- Delusions
- Disorganization ( of speech and thinking)
What are the negative symptoms of schizophrenia?
- Affective-flat/blunted affect, inappropriate affect, poor eye contact
- Alogia
- Anhedonia
- Avolition(apathy)-poor hygiene,lack of motivation, work/school problems
- Attention-inattention, distractibility
- Social withdrawal
5.
What is meant by positive and negative symptoms of schizophrenia?
Positive-what the client has, experience, perceives or thinks
(Respond better to meds than people with negative symptoms)
Negative symptoms-what the client lacks, loss of or decrease in function.
What defense mechanisms are overused by clients with psychotic disorders?
- Repression
- Projection
- Regression
- Denial
What impact does a psychotic disorder have on the clients ability to meet basic needs?
- Physiological, self care deficits, eat/sleep problems
- Safety and security-suicide/homicide risk, poor judgement
- Higher level needs-relationship problems, self-esteem issues
What is disturbed sensory perception?
A change in the amount or patterns of incoming stimuli followed by a diminished, exaggerated, distorted or impaired response to it…usually has hallucinations.
What are some outcomes for disturbed sensory perception?
- Pt will discuss content of hallucinations with nurse or therapist within one week
- Long term- pt will be able to define and test reality, reducing or eliminating the occurrence of hallucinations.
- Pt will verbalize understanding that the voices are a result of his or her illness and demonstrate ways to interrupt the hallucination.
What does impaired social interaction mean?
Insufficient or excessive quality of social exchange
What are the outcomes for impaired social interaction?
- Pt will willingly attend therapy activities accompanied by trusted staff member within 1 week.
- Long term-pt will voluntarily spend time with other pts and staff members in group therapy sessions.
What is “aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state.”
Nursing diagnosis-social isolation
What are the outcomes for social isolation?
- Identify feelings of isolation
- Practice social and communication skills needed to interact with others
- Initiate interactions with others; set and meet goals.
- Participate in activities and programs.
Name some TNI’s for social isolation
- Establish a therapeutic relationship by being emotionally pep resent and authentic.
- Observe for barriers to social interaction( illness, incontinence,lack of transportation,money, support)
- Discuss/assess causes of perceived or actual isolation.
- Promote social interactions.
What are the outcomes for a person with impaired verbal communication?…usually seen with delusions
- Pt will be able to remain on one topic,using appropriate intermittent eye contact for 5 minutes with the nurse or therapist.
- Long term- pt will demonstrate the ability carry on a verbal communication in a socially accepted manner with health care providers and peers.
What are some TNI’s for impaired verbal communication?
Attempt to decode incomprehensible communication patterns, seek clarification and validation…“I don’t understand what you mean by that”
- Verbalize the implied “that must have been a very difficult time for you when your mother left. You must have felt very alone”.
- Orient pt to reality as required
Describe primary prevention In the care of clients with or at risk for developing a psychotic disorder.
Identify at risk individuals
2. Teach coping and stress management skills prior to occurrence of psychosis.
What is secondary prevention for a pt with developing a psychotic disorder?
- Early identification and initial treatment for psychosis
2. Medications-antipsychotics also known as neuroleptics, and tranquilizers
What is an example of tertiary prevention in pts with psychosis disorders?
NAMI-working with clients and families
- Recovery model of outpatient treatment such as Personalized Recovery Oriented services (PROS) and psychosocial clubs
- Intensive care management including telephone contacts which decrease negative effects of community stressors.
What is the classification of Clozapine? ( clozaril)
Atypical Antipsychotic
What is the action of clozapine?
Interferes with dopamine receptor ..stops action of dopamine…excitatory hormone.
What is the use of clozapine( clozaril)?
Management of psychotic symptoms , positive and negative, in schizophrenia when other antipsychotics have failed. LAST RESORT
What are the major side effects of clozapine(clozaril)?
Low potential for EPS, sexual dysfunction,GI disturbances
Anticholinergic effects-slurred speech,constipation, dry mouth
Postural hypotension …Agranulocytosis!! Decrease in WBC
What are the nursing implications for Clozapine(clozaril)?
Lab work q 2 weeks
If WBC are to low check labs, temp, cold,flu ..don’t give
Monitor for EPS
What is the classification of Risperidone (Risperdal)?
Atypical Antipsychotic
What is the action of atypical antipsychotics?
Blocks dopamine receptor…unknown
What is the use of Risperidone (Risperdal)?
Irritability associated with bipolar, mania, and schizophrenia
What are the nursing implications for Risperidone ( Risperdal)?
CBC, hepatic studies q month
Monitor for orthostatic hypotension,
Take BP, pulse, and respirAtions q 4 hrs during initial treatment. Establish baseline before starting tx.
What Is the classification of haloperidol ( haldol)?
Antipsychotic, neuroleptic
What is the action of conventional antipsychotics ( neuroleptics)?
Blocks neurotransmission produced by dopamine at synapsis
Strong adrenergic and anticholinergic blocking action
What is use of haloperidol (haldol)?
Psychotic disorders, control tics, vocal utterances, emergency sedation of severely agitated or delirious patients, ADHD
What are the side effects of Haloperidol (haldol)/ conventional antipsychotics?
EPS, neuroleptic malignant syndrome, hyperprolactemia, orthostatic hypotension, anticholinergic effects-blurred vision, glaucoma, dry eyes, dry mouth. jaundice, ileus, hepatitis,constipation
What are the nursing implications for Haloperidol (Haldol)?
Do ophthalmic exam, UA, prolactin and CBC.
Monitor for neuroleptic malignant syndrome/serotonin syndrome
IM use- inject into lg muscle use 21 gauge and 2 inch needle ..pt should remain recumbent for 1/2 hr.
What is the classification of Aripiprazol
Atypical Antipsychotic
What is the action of aripiprazole (abilify)/atypical antipsychotics?
Exact mechanism unknown; blocks dopamine at receptors
What is Aripiprazol used for?
Schizophrenia and bipolar, mania, major depressive disorders.
What are the side effects with Aripiprazol?
EPS, postural hypotension, hypoglycemia, constipation, blurred vision.
What are the nursing implications when using Aripiprazol?
May be given without regard to food
-hypotension may occur
-no abrupt withdrawal from meds
Quick acting meds
What classification is olanzapine(zyprexa)?
Atypical Antipsychotic, neuroleptic
What is the action of olanzapine ( zyprexa)?
Unknown, may be dopamine and serotonin antagonist.
What is the use for olanzapine (zyprexa)?
- Schizophrenia
2. Acute manic episodes in bipolar disorder
What are the side effects of olanzapine(zyprexa)?
Pseudoparkinsonism, akathisia, dystonia,agitation, nervousness,hostility nervousness, dry mouth, N,V, anorexia constipation, abdominal pain, hepatitis,joint pain, hypotension
What are the nursing implications for olanzapine?
BP-sitting, standing, pulse and respirations q 4hrs
Take with full glass of water, milk or with food for GI upset…constipation.
Can use IM..no SQ or IV..observe for 3 hrs after injection to make sure pt is alert, oriented, and free from post injection delirium/sedation syndrome.
Increase oral fluids..constipation, good oral hygiene
What is akathisia?
This syndrome consists of subjective (feeling of inner restlessness and the urge to move) as well as objective components (rocking while standing or sitting, lifting feet as if marching on the spot and crossing and uncrossing the legs while sitting).
What is akinesia?
This is loss of standard motor functions or slowness that causes impaired movement of muscle; plainly “without movement” or “without much movement”. It can be caused by paralysis or paralysis that is temporary and also from being in a coma.
What is dystonia?
involuntary muscle contractions that cause slow repetitive movements or abnormal postures.
The movements may be painful, and some individuals with dystonia may have a tremor or other neurologic features. There are several different forms of dystonia that may affect only one muscle, groups of muscles, or muscles throughout the body.
What is tardive dyskinesia?
involuntary movements of the tongue, lips, face, trunk, and extremities
occur in patients treated with long-term dopaminergic antagonist medications.
What is pseudoparkinsonianism
includes slow pill-rolling finger tremors, masklike facial expression, weakened voice, absence of arm swing when walking, stiff stooped posture, and an impaired shuffling gait. Cogwheeling rigidity, assessed frequently in the arms, is a ratchet-like motion of the extremities during extension. Mentally, the client can display bradyphrenia, or a slowed ability to think through familiar situations. One unique manifestation after prolonged use of the APM is the rabbit syndrome which is tremors of the lips and a constant chewing motion.
What is neuroleptic malignant syndrome?
-high fever, stiffness of the muscles, altered mental status (paranoid behavior), autonomic dysfunction. wide swings of blood pressure, excessive sweating excessive secretion of saliva.
What is the purpose for the use of benztropine ( Cogentin) po and IM with client taking antipsychotics?
It is used to control tremors and stiffness of the muscles due to certain antipsychotic medicines (eg, phenothiazines).
What is psychomotor retardation?
Extreme slowdown of physical movements. Posture slumped, speech is slowed digestion becomes sluggish.
What is anhedonia?
Decreased activity, hypersonic, inability to experience any pleasure.
What is the classification of amitriptyline (elavil)?
Antidepressant, tricyclic
What is the action of amitriptyline (Elavil)?
Blocks reuptake of norepinephrine, serotonin in nerve endings, increasing action of norepinephrine, serotonin in nerve cells
What is the use of amitriptyline (Elavil)?
Major depression
What are the side effects of amitriptyline (Elavil)?
Dizzy, drowsy, confusion,anxiety, tremors,orthostatic hypotension, palpitations, dysrhythmias tinnitus,mydriasis, dry mouth, constipation, paralytic ileus, hepatitis, urinary retention
What are the nursing implications for amitriptyline (Elavil)?
Take with milk or food May crush in unable to swallow Dosage at bedtime if over sedation occurs,may take entire dose at bed time unless geriatric Therapeutic effects take 2-3 wks Use contraception when taking Photosensitive
What is the classification of paroxetine(Paxil)?
Antidepressant, SSRI
What is the action of paroxetine (Paxil)/SSRI’s?
Inhibits the uptake of serotonin
What is the use of paroxetine (Paxil)?
Major depressive disorder,OCD,panic,anxiety,PTSD,social anxiety disorder, premenstral disorders
What are the side effects of paroxetine (Paxil)/SSRI’s?
Dry mouth Sedation Insomnia Headache Sexual dysfunction Weight loss
What are the nursing implications for paroxetine (Paxil)?
Avoid use with St. John’s wart and Kava
Check mental status mood, suicidal tendencies,increase in psychiatric symptoms, check BP and vitals if pts have cardiac disease.
-give with milk or food
-crush if can’t swallow
- may take 1-4 wks to start to notice an effect
What is the classification of citalopram (Celexa)?
Antidepressant, SSRI
What is the action of citalopram (Celexa)
Inhibits CNS neuron uptake of serotonin but not norepinepherine.
What is the use of citalopram(Celexa)?
Major depressive disorder
What are the side effects of citalopram (Celexa)/SSRI’s?
Dry mouth Sedation Insomnia Headache Sexual dysfunction Weight loss
What are the nursing implications for citalopram( Celexa)?
Administer with food or milk
Can crush
Bedtime dose if over sedation
May have increased anxiety for the first 5-7 days, therapeutic effect 4-6 wks
Effects of serotonin syndrome -N/V, tremors
What is the classification of fluoxetine (Prozac )?
Antidepressant , SSRI
What is the action of fluoxetine (Prozac)?
Inhibits CNS uptake of serotonin but not norepinephrine
What is the use of fluoxetine?
Major depression, OCD,bulimia nervosa,panic,sarafem,PMDD-premenstral dysphoric disorder
What are the side effects of fluoxetine/SSRI’s?
Dry mouth Sedation Insomnia Headache Sexual dysfunction Weight loss
What are the nursing implications for fluoxetine?
Mental status:
Allergic reactions-itching,rash urticaria
-administer with food or milk
-may take 1-4wks
What classification is bupropion (Wellbutrin)?
Antidepressant, smoking deterant
What is the action of bupropion (Wellbutrin)?
Increase concentration of norepinephrine and serotonin.
What is the use of bupropion (Wellbutrin)?
Depression, smoking cessation,seasonal affective disorder
What are the side effects of bupropion (Wellbutrin)?
Akinesia, headache, bradykinesia, delusions, insomnia,tremors,dysrhythmias,auditory disturbance,impotence, urinary retention
What are the nursing implications for bupropion (Wellbutrin)?
Assess hepatic and renal fxn
-DC product after 7-12 wks if smoking cessation progress has not been made.
Avoid giving at night to help prevent insomnia
May take 2-4 wks
Do not use with nicotine patches
What is the classification of venlafaxine (Effexor)?
Antidepressant, SNRI
What is the action of venlafaxine (Effexor)?
Potent serotonin and norepinephrine uptake inhibitor, weak inhibitor of dopamine.
What is the use of venlafaxine(Effexor)?
Prevent/tx major depression, tx depression at end of life, general anxiety panic disorder,social anxiety disorder…Effexor XR only
What are the side effects of venlafaxine ( Effexor)/SNRI’s?
Insomnia; agitation Headache Weight loss Sexual dysfunction Serotonin syndrome
What are the nursing implications of venlafaxine (Effexor)?
Mental status;mood, sensorium, affect, increase in psychiatric symptoms,depression, panic. Bleeding, GI, ecchymosis, epistaxis, hematoma, petechia, -wt check q wk Administer with food and milk Take with a full glass of water Start with small amounts Wear sunscreen, Monitor BP for hypertension
What side effect of antipsychotics is a medical emergency?
NMSNeuroleptic malignant syndrome, or NMS, is a rare, but potentially fatal side effect of antipsychotic treatment. NMS is characterized by fever, muscle rigidity, autonomic dysfunction, and altered mental status.
What vital sign needs close monitoring when using antipsychotics?
BP
SSRI’s are known for what type of dysfunction?
Sexual, GI disturbances and increased agitation
Name anti manic medications?
Lithium carbonate
Name some anticonvulsants?
Clonazepam(Klonopin)
Divalproex sodium (depakote)
Lamotrigine (Lamictal)
Name some conventional antipsychotics
Haloperidol.
Phenothiazine
What are the side effects of atypical antipsychotics?
EPS, anticholinergic effects, weight gain
Name some SSRI’s
Paxil (paroxetine)
Citalopram (Celexa)
Fluoxetine (Prozac)
Name a tricyclics antidepressant
Amitriptyline (Elavil)
Name a SNRI
Effexor (venlafaxine)
What are the side effects of SSRI ‘s and SNRI’s?
Dry mouth Sedation Insomnia Headache Sexual dysfunction Weight loss
Name some atypical antipsychotics
Aripiprazol (abilify)
Olanzapine ( Zyprexa)
Risperidone ( Risperdal)
What is the classification of lithium?
Anti manic
What is the classification of divolproex sodium (valproic acid, depakote)?
Anticonvulsants
What is the classification of lamotrigine?
Anticonvulsant
What are the side effects of anti manic medications?
Drowsiness Dry mouth,thirst GI upset N/V Hypotension/arrythmias Polyurea Weight gain
What are the side effects of anticonvulsants?
N/V Drowsiness Blood dyscrasias Prolonged bleeding time with valproic acid Decreased efficacy with contraceptives
What are the nursing implications for anticonvulsants?
Regular blood tests,
Initial platelet test- monitor for bruising
Make aware of decreased oral contraceptive action
What are the nursing implications for antimanics?
Ensure adequate intake of sodium Strict oral hygiene, frequent sips of water, sugarless candy No operating machines Administer meds with food Monitor hydration status Monitor vial signs 2-3x a day
What are the side effects of antipsychotics?
Drowsiness Dry mouth, constipation EKG changes EPS Hyperglycemia Increased appetite and weight
What is ECT?
Electro-convulsive therapy. Dose of a small electrical current in pts brain to induce a controlled seizure.
When is ECT indicated?
Clients who can’t tolerate the side effects of antidepressants and mood stabilizing medications.
Severe depression
Bipolar
Thinking is not clear and unrealistic
No longer function on a day to day basis
Serious thoughts of committing suicide
Physical condition is in danger from lack of food, fluids and sleep
What are the risks using ECT?
Acute heart attack Coronary insufficiency Permanent memory loss Brain damage Impairment of cognitive function
What is needed in prep for ECT?
Informed consent
Physical and EKG
Lab tests
NPO after midnight
What medications are given for ECT and why?
Robinul- drying agent..prevent aspiration
Succinylcholine- short acting muscle relaxant
Oxygen-to enhance oxygen saturation during paralysis and seizure
What is assessed during ECT procedure?
Vitals, O2
Skin color
Signs of seizure activity
Duration of seizure
How often are ECT procedures done?
3x/wk, for 4-5 weeks…tapered when clinical picture has improved.
What are the therapeutic nursing interventions for post ECT?
Assess LOC
- Vitals
- Gag reflex
- Orientation
- Provide fluids and snack when awake
- Increase activity slowly, reorient to surroundings
What are short term effects of ECT?
Increased BP Confusion Headache Nausea Myalgias( muscle aches and pains)
What needs to be discontinued before ECT tx?
Benzodiazepines and most mood stabilizers…limit effectiveness of tx
What do you do if pt is tangential?
Try to refocus back to the point
What do you do if a client is blocking?
Remind them they stopped talking
What do you do if a pt is using loose associations
Tell them you don’t understand what they mean.
What if pt is using neologisms?
“Sorry, I don’t know what that means”.
What do people usually use impaired communication?
With delusions
When do pts have disturbed sensory perception!
With hallucinations
What is benztropine (Cogentin) used for?
EPS-extrapyramidal side effects
What are nursing interventions for someone with low self esteem or poor ego boundries?
Use simple brief, concrete statements
Avoid discussion of intense feelings,except fear
Support strengths and reassure
Voice doubt as necessary.
What are mild cognitive symptoms of depression?
Pre-occupied
Self-blame
Ambivalence
Blaming others
What are moderate cognitive symptoms of depression?
Slowed thinking Difficulty concentrating Poor attention span Repetitive thoughts Suicidal ideation
What are severe cognitive symptoms of depression?
Delusional thinking Confusion Indecisive Hallucinations Illusions Thoughts of suicide
What are mild behavioral symptoms of depression?
Regression,
Restless
WithdrAwn
What are moderate behavioral symptoms of depression?
Slow movements Slumped posture Slow speech Isolation with focus on self Increase use of substances Decrease interest in hygiene
What are severe behavioral symptoms of depression?
Sitting curled up Motor slowness Little speech No hygiene Isolation with no interest in others
What are mild physiological symptoms of depression?
Anorexia or overheating Too much/too little sleep Headache Back ache Chest pain
What are moderate physiologic symptoms of depression?
Amenorrhea Decreased libido Abdominal pain Low energy Diurinal variation
What are severe physiological symptoms of depression?
Generalized slow down of entire body
Psychomotor retardation
Name some nursing interventions for the depressed client.
- Kind, warm firm attitude
- Assess for suicide
- Reassure that present state is only temporary-positive reinforcement
- Brief frequent contact
- Encourage expression of thoughts and feelings
- Assist in daily decision making
- Provide schedule and routine
- Set small goals
- Encourage participation in activities
- Teach meds, illness
