Psychiatric Nursing Test 3.txt

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kernizm
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28764
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Psychiatric Nursing Test 3.txt
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2010-08-02 20:44:09
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Psychiatric Nursing Test txt Steve\'s Lecture
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Psychiatric Nursing Test 3.txt (Steve's Lecture)
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  1. How long do you have to have the symptoms to classify as schizophrenia?
    Symptoms X30 days for >6Months
  2. How long for schizophrenoform DO?
    Symptoms < 6 months
  3. What is SAFD?
    • Schizoaffetive Disorder….
    • Symptoms with & without mood episode
  4. What is a delusional disorder?
    Non-bizarre delusion x 1month
  5. How long is a brief psychotic disorder?
    > 1 day <1 month
  6. What is a shared psychotic disorder?
    It takes on other delusions
  7. Some other psychotic disorders can be caused by what?
    Medicine/drugs

    NOS?
  8. What is the diagnosis criterion for schizophrenia?
    • 1. Positive or negative symptoms for 30 days for greater than 6 months
    • 2. Marked social/vocational dysfunction
    • 3. NOT due to:
    • …….. medical
    • …….. drugs
    • …….. SAFD
    • …….. Manic Depressive Disorder (MDD) with psychotic features
  9. What are the 4 types of POSITIVE symptoms?
    • 1. Delusions
    • 2. Hallucinations
    • 3. Disorganized Speech
    • 4. Catatonia
  10. Grandiosity, persecution, somatic, reference, thought insertion/withdrawal/broadcasting, ect?
    Delusions
  11. auditory, visual, tactile, olfactory, gustatory?
    Hallucinations
  12. clang, neologisms, thought block, loose assoc, perseveration?
    Disorganized Speech
  13. stupor, posture, excitation?
    Catatonia
  14. What are the NEGATIVE symptoms of schizophrenia? *Hint-Crazy 8's*
    - Affective blunting

    • -
    • Anhedonia

    • -
    • Anergia

    • -
    • Alogia

    • -
    • Apathy

    - Avolition

    - Asociality

    • -
    • Attention problems


  15. What are the subtypes of schizophrenia?
    • •Paranoid
    • •Disorganized
    • •Catatonic
    • •Undifferentiated
    • •Residual
  16. Negative symptoms persist in
    spite of resolution of positive symptoms
    Residual
  17. What is the scope of schizophrenia?
    • •40 % attempt suicide within 10 yrs.
    • •10 % actually complete suicide
    • •9th
    • leading cause of disability
    • •60-70% never marry/have children
    • •Occupy 25% of all hospital beds
    • •70%–80% are unemployed or underemployed
    • •10% of permanently disabled Americans
    • • 20%–30% of the homeless population
  18. Schizophrenia vs. Violence
    • •Evidence mixed
    • •Media sensationalized?
    • •Schizophrenics 14% more likely to be victim
    • rather than comit violent crime
  19. What are the demographics of Schizophrenia?
    • •0.5 - 1.5 % of population
    • •Urban > Rural
    • •Uniform rates across racial and ethnic groups
    • in US, except for higher rates with racial minorities in large cities
    • •Higher rates with maternal malnutrition
  20. What are the gender differences of Schizophrenia?
    • •Male > Female (up to 20%)
    • •Onset: male (18-25 yr); female (25-35 yr)
    • •Second peak in onset women after 45 yrs.
    • •Pre-morbid function females > males
    • •Males – More positive symptoms
    • •Females – More negative symptoms
    • •Women have more
    • emotional/affective

    • symptoms – misdiagnosed MDD or SAFD
  21. What are the etiological theories concerning Schizophrenia?
    • •Genetic – familial ; 10% greater chance
    • •Hormonal – onset S/P puberty, thyroid, DM
    • •Apoptosis/Excessive pruning
    • •Virus – selectivity; dormancy; triggered by
    • stress/hormonal; alter cellular process without destroying cells
    • •Neurotransmitter – drugs can either mimic or eleviate
    • symptoms
  22. What is the pathology behind Schizophrenia?
    • •Up To 25% loss of gray
    • matter
    • •Enlarged ventricles
    • •Enlarged amygdala
    • •Neurological abnormalities
    • •Impaired cognitive function
    • •Decreased prefrontal brain
    • function
    • •Impaired awareness of
    • illness
  23. What are the 4 stages of progression when dealing with Schizophrenia?
    • 1. Premorbid
    • 2. Prodromal
    • 3. Psychotic
    • 4. Recovery
  24. Asymptomatic with
    genetic/environmental vulnerability.
    Premorbid (0-35 yrs.)
  25. Insidious decline in
    work/school/social/adaptive functioning
    Prodromal (2-5 yrs.)
  26. Abrupt onset of (+) &
    significant worsening of (-) symptoms.
    Often hospitalized due to unable to care for self.
    Psychotic (wks.-yrs.)
  27. Exacerbations & remissions
    with 80% relapse rate. Degree of illness/level of functioning plateau after 10
    yrs.
    Recovery (yrs.)
  28. What are some ways to treat Schizophrenia without medications?
    • •Supportive psychotherapy
    • •Family therapy
    • •Socialization/social skills training
    • •Cognitive Behavioral Therapy
    • •Hospitalization
  29. What are the two types of pharmacotherapeutics that treat Schizophrenia?
    • 1. Typicals
    • 2. Atypicals
  30. These Alleviate positive symptoms, have More side effects, but are Less
    expensive
    typicals
  31. These will alleviate positive symptoms, offer some help with negative symptoms, have fewer side effects, and MIGHT have neuroprotective effects????
    Atypicals
  32. What are the medication forms that treat Schizophrenia?
    • •Pill/capsule
    • •Elixir
    • •Orally disintegrating tabs (ODT)
    • •IV/IM
    • •Deaconate
  33. What are the drug side effects for drugs that treat Schizophrenia?
    • •Histaminic effects – Sedation
    • •Adrenergic effects – Orthostasis

    • •Anticholenergic effects – Dry mouth
    • •Hyperprolactinemia – Sexual
    • •Metabolic effects:
    • - Weight gain
    • - Hyperglycemia/diabetes
    • - Hyperlipidemia
  34. What are the other med risks?
    • •Seizures
    • •Stroke
    • •Sudden death (dementia)
    • •QTc
    • Prolongation (Geodon & Melaril)
    • •Extrapyramidal symptoms (EPS)
    • •Tardive dyskinesia
    • (TD)
    • •Neuroleptic malignant disorder (NMS)
    • •Agranulocytosis (Clozaril)
  35. What does the nurse need to monitor the patient for that is receiving treatment for Schizophrenia?
    • •Vital signs – include orthostatic BP (falls)
    • •Weight & BMI
    • •EKG
    • •AIMS – Abnormal Involuntary Movement

    • Scale (TD)
    • •Labs – CBC, renal function,lipids, glucose, Hgb
    • A1C, LFTs, TFTs, prolactin

    •Suicidality

  36. ASEs Typicals?
  37. ASEs Atypicals?
  38. Dopamine pathways

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