week 4 ati hw & ch 14, 15, 23, & 24 & pg 67-80 Flashcards
schizophrenia
hallucination
vs
delusion
hallucination = seeing/hearing things not there
delusion = fixed false beliefs (distorted reality)
4 types of delusions
- persecution
- grandiose
- thought insertion
- control
positive manifestations
ADDED to distort normal function – false feelings, beliefs, or behaviors, that are not typically present
*hallucinations / delusions
*disorganized speech & motor
*CATATONIC behavior
* clanging speech
*depresonalization
*derealization
negative manifestation
TAKE AWAY– missing feelings and behavior that are usually present resulting in a decrease/loss of function
*alogia = loss of words
*lack of motivation/interest/energy
*withdrawing from a situation
only managed by 2nd gen antipsychotics
3 phases of psychosis
- Prodromal Phase = early period between onset of initial manifestations & full development
- withdrawn
- loss of sleep & concentration
- increased anxiety - Active Phase = mania, depression, hallucination/delusion,
* incoherently mumbling to oneself w/o awareness they’re doing it - Residual Phase = negative manifestations
anosognosia
unaware of one’s own mental health
diagnosis for schizophrenia relies on
clinical assessment
* observations
discharge instructions for a client taking clozapine
WEEKLY BLOOD DRAWS = can cause agranulocytosis (WBC’s)
treats (-) & (+) symptoms
6wks for effect
a client w schizo shares that they are feeling lonely and isolated. which action is nurses priority?
- share info about support groups for people who have SMI
- Teach the client stress reduction techniques so that they can feel more in control of their social situation
- Help the client focus on recovery so that their relationships can improve down the road
- Suggest adding another type of treatment
- share info about support groups for people who have SMI
what factor is involved if schizo was due to complications in utero
physiologic
Bipolar 1 & 2 average onset & prevalence (female to male ratio)
1 = equally
2 = females
* avg onset is 18
symptoms of Mania
*mood swings
*euphoria
*irritability & aggression
*increased energy (worry of collapse)
* inapporpriately demanding of attention
*intrusive nature
*grandeur delusions “superior”
*rapid speech & thoughts
*DECREASED NEED FOR SLEEP (2 weeks)
DOES NOT THINK TO EAT
nursing considerations for a patient experiencing mania
don’t compete or burnout excess energy
to be diagnosed w Bipolar 1 disorder
already diagnosed w MDD
mania + MDD & maybe psychosis (grandeur, paranoia & hallucinations)
to be diagnosed w Bipolar 2 disorder
HYPOMANIA = no impairment in functioning & mania not as severe
MDD w/ severe depression (suicidal?)
NO psychosis
hypomania vs mania
hypo = annoying, poor boundaries, remembers to eat
mania = inappropriately demanding, mood swings, intrusive nature repels others,
does not think to eat
delirious mania symptoms
*is treated with?
most serious mania - progresses quickly
disorientation
psychosis
catatonia (slow motion & frozen)
*benzodiazepines
in a patient experiencing mania what is priority assessment?
- physiological status DEHYDRATION- I&O, water & skin
*cardiac status - safety = impulsivity & suicide
**monitor vitals every hour if manic & AVOID GROUP activities
implementing the nursing process for a patient w mania consists of :
solitary activities
1:1 sitter
no roommate
no nurses station
use firm & neutral statements
daily routines
- physiological need
- safety
Lithium
*range 0.5 to 1.2 mEq/L
- inverse relationship w sodium
- first line of treatment for acute mania & depression
-prevents manic & depressive episodes - mood stabilizer that prevents mood cycling (3-6 weeks)
*interacts w NSAIDS & diuretics
expected side effects of Lithium
*range 0.5 to 1.2 mEq/L
sedation
acne
nausea
excessive thirst
hand tremors
weight gain
early lithium toxicity
1.2 - 1.5
* hold med & call dr
n/v/d
muscle weakness
slurred speech
advanced lithium toxicity
> 1.5
-EEG changes
-hand tremor
- muscle hyper-irritability
- GI upset
- confusion
-incoordination
*stupor
*blurrred vision
*affects KIDNEYS
**treated w normal saline bolus
long term effects of Lithium
hypothyroidism - goiter
kidney dysfuction
*assess levels every 6 months
Anticonvulsants
1st line of treatment mood stabilizer – bipolar mania, hypomania, mixed states, cycling
*ValPROic Acid
*DivalPROex
*ValPROate
Expected side effects of valPROic Acid
*anticonvulsant
tremor
sedation
GI pain
hair loss
weight gain
blood dyscarias – anemia & thrombocytosis
hepatotoxicity
pancreatitis
*taken in patients w kidney dysfunction
lithium affects ____ buut anticonvulsants affect _____
lithium = kidneys
anticonvulsants = liver
anticonvulsant therapeutic levels & toxicity symptoms
*ValPROic Acid
*DivalPROex
*ValPROate
85 - 125 ug/mL
toxic = intentional overdose
- ataxia (loss of body movement)
- confusion
- somnolence
-coma
Carbamazepine
anticonvulsant
treats bipolar disorder, rapid cycling, mixed states
treats & prevents acute mania
*MONITOR FOR RASHES
Adverse effects of Carbamazepine
*anticonvulsant = mood stabilizer
- hyponatremia & fluid overload
- decreases effectoveness of birth control
- blood dyscrasias
- hepatic disease
RASH
*fatigue & nausea
*diplopia (double vision)
*ataxia
Lamotrigine treats ___ & adverse effects
**anticonvulsant = bipolar depression–acute &maintenance
- monitor for FEVER = aseptic meningitis
- lower birth control effectiveness
- Steven Johnsons
Anxiolytics are
Benzodiazepenes = Clonazepam & Lorazepam
given when concerned about heart or delirium
adjunctive agents for acute mania & psychomotor agitation
second - generation antipsychotics are best for
non-compliance for acute mania, bipolar depression, & their prevention
when evaluating mood assess & ask about
stable vitals
hydration
sleep
self-control
4 phases of schizophrenia
- Prodromal Phase = identification, depression, withdrawn from society
- Acute Phase = psychotic break
- Stabilizaton Phase = no sleep, trouble focusing
- Maintenance Phase = able to ignore hallucinations
catatonia
slow & zombie-like
limbs stay in place
treated w benzodiazepines & anti-psychotics
schizoaffective disorder
major or manic episodes occur at the same time as the active phase of delusions/hallucinations
first-generations antipsychotics
Chlorpromazine
Loxapine
Fluphenazine
Haloperidol
- treat POSITIVE symptoms
- used less = adverse effects
extrapyramidal symptoms of first-generation antipsychotics
*PSEUDOPARKINSONISM - fall risk
*ACUTE DYSTONIA - (muscle & laryngeal symptoms - concern for airway)
*AKATHISIA- (restless feet & extreme stress- suicide risk)
*TARDIVE DYSKINESIA - (face droop- irreversible)
other side effects of 1st gen antipsychotics
lowered seizure threshold
orthostatic hypotension
sedation
increased prolactin = sex dysfunction, amenorrhea, galactorrhea
*high fall risk
adverse effects of first gen antipsychotics
*METABOLIC SYNDROME
*prolonged QT interval
*anticholinergic toxicity
*neuroleptic malignant syndrome
metabolic syndrome presents as..
weight gain, hypertension, diabetes, & dyslipidemia
anticholinergic toxicity presents with..
*dry mouth
*urinary retention
anxiety, hallucinations, hyperactivity, seizures, & delirium
symptoms disappear w stop of first gens
Neuroleptic Malignant Syndrome presents as
*high fever (103-105)
*muscle rigidity (monitor DVT & rhabdomyolysis)
*increased vitals
*altered mental status
Second & Third Generation Antipsychotics
*CLOZAPINE - last resort
*ARIPIPRAZOLE - sedating
*RISPERIDONE - stroke risk
*LURASIDONE
*OLANZIPINE - gain weight
*QUETIAPINE - high street value & homeless
treat NEGATIVE & POSITIVE
when using clozapine
*monitor for FEVER
*AGRANULOCYTOSIS - WBC’s
drooling
mycarditis
*last-resort
Injectable Antipsychotics
Haldol
Aripriprazole
Risperidone
Olanzipine
Ziprasidone
*must be stable on PO verison first
when evaluation antipsychotic medication effectiveness the nurse should ask about..
*have the symptoms LESSENED
*medication ADHERENT
*support system
a nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should expect a prescription for which of the following medications?
- Chlorpromazine
- Thiothixene
- Risperidone
- Haloperidol
- Risperidone ( the only 2nd gen)
lithium levels during a manic episode
0.8 to 1.4
okay to administer next dose if patient is within the range
a nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following meds? sap
- Olanzapine
- Quetiapine
- Aripiprazole
- Clozapine
- Asenapine
- Olanzapine
- Aripiprazole
- Clozapine
- Asenapine
a nurse is assessing a client who is currently taking perphenazine. which of the following findings should the nurse identify as an extrapyramidal symptom? sap
- decreased level of consciousness
- drooling
- involuntary arm movements
- urinary retention
- continual pacing
- drooling
- involuntary arm movements
- continual pacing
a nurse is providing discharge teaching for a client who has schizo & a new prescription for iloperidone. which client statement indicated understanding of the teaching?
- “I will be able to stop taking this medication as soon as I feel better.”
- “If i feel drowsy during the day, I will stop taking this medication and call my provider.”
- ” I will be careful not to gain too much weight while taking this medication.”
- “This medication is highly addictive and must be withdrawn slowly .”
- ” I will be careful not to gain too much weight while taking this medication.”
