Psych Schizo

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julianne.elizabeth
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300995
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Psych Schizo
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2015-04-17 23:50:48
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lccc nursing psych schizophrenia
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For Cummings Exam 3
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  1. What does the word schizophrenia mean? What is it not?
    • Derived from the greek words Schizo (split) and phren (mind)
    • Psychosis is a break from reality

    Schizophrenia is not a split personality, caused by childhood trauma, bad parenting or poverty, and is not the result of any actions or personal failure
  2. What are some general treatments for schizophrenia?
    • Antipsychotic medications
    • Psychotherapy
    • Occupational therapy
    • Social Skills therapy
  3. What comorbidities are associated with schizophrenia?
    • Substance abuse in up to 50% of clients
    • Nicotine dependence up to 90%
    • Schizo associated with negative outcomes such as incarceration, violence, suicide, and HIV
    • Medications cause heart disease, DM
    • Anxiety, depression
    • High risk of suicide
    • Polydipsia (risk of H2O poisoning and F/E imbalances. Fluid restriction necessary)
  4. Describe the chemical and neurological complications associated with schizophrenia
    • Extra dopamine in the brain theory (dopamine blockers are effective)
    • Gradual deterioration of brain volume, especially frontal cortex (visual/auditory hall)
    • Genetic component linked
    • Combination of both genetic and non genetic factors
  5. What disturbances occur in schizophrenia?
    • Thought processes
    • Perception
    • Affect
  6. What are the four phases of schizophrenia?
    • Phase one: Pre-psychotic (schizoid personality)
    • -indifferent, cold, aloof, loners
    • -Do not enjoy personal relationships
    • Phase two: Prodromal phase
    • -often occurs before first psychotic break
    • -socially withdrawn, behavior is peculiar and eccentric
    • -Neglected personal hygiene
    • -Disturbances in communication, ideation and perception
    • -religiosity
    • Phase three: Active phase
    • -psychotic symptoms are prominent
    • -Hallucinations and delusions
    • Phase four: residual phase
    • -also called the maintenance phase
    • -similar to prodromal, near baseline
    • -flat affect, role impairment
  7. What factors determine whether someone with schizophrenia will have a favorable prognosis?
    • Favorable if:
    • -abrupt onset of goof pre-morbid functioning
    • -female
    • -older age of onset
    • Less favorable if:
    • -slower onset of symptoms 2-3 yrs
    • -childhood history of withdrawal, seclusion, eccentric, tense behavior
    • -younger onset
    • -male
  8. What is the DSM-5 criteria for Schizophrenia?
    • Two or more of the following, each present during a one month period
    • -delusions
    • -hallucinations
    • -disorganized speech
    • -grossly disorganized or catatonic behavior
    • -negative symptoms
  9. What is the general assessment for schizophrenia?
    • Positive symptoms
    • Negative symptoms
    • Cognitive symptoms
    • Affective symptoms
  10. What are the 4 fundamental (Bleuler's 4As) signs of schizophrenia?
    • Affect (flat)
    • Associative Looseness
    • Ambivalence
    • Autism (withdrawn into self)
  11. Describe the positive (hard) symptoms of schizophrenia?
    • Delusions
    • Hallucinations (auditory, visual, tactile, olfactory, gustatory)
    • Thoughts of insertion/withdrawal
    • Disorganized thoughts
    • Perseveration
    • Flight of ideas
  12. What are the stages of hallucinations? What should be assessed?
    • Stage 1: Comforting
    • Stage 2: Condemning
    • Stage 3: Controlling (Command) * emergency
    • Stage 4: Conquering (does what they say)

    • Assess for duration, intensity, frequency
    • Pattern over time
  13. What client behaviors display that the client is experiencing hallucinations?
    • Laughing, speaking to self
    • Moving lips without making sounds
    • Rapid eye movements
    • delayed verbal responses, as if preoccupied
    • Anxiety
    • Inability to follow conversation
    • decreased ability to follow verbal commands
  14. How can the nurse communicate with the hallucinating client?
    • Ask directly about the hallucinations
    • Watch for cues that client is hallucination
    • Avoid reacting to hallucinations as if they are real
    • Do not negate the client's experience
    • Offer your own perceptions
    • Focus on reality based diversions
    • Be alert to client anxiety
  15. Describe the positive symptoms of waxy flexibility, pressures speech, aggressive/agitated bizarre behavior and bizarre dress/grooming
    • Waxy flexibility: limbs remain where they are placed
    • Pressured speech: fast, loud speech
    • Aggressive, agitated bizarre behavior: labile
    • Bizarre dress/grooming: too many layers, inappropriate for weather
  16. What are some common delusions?
    • Ideas of reference: misconstruing trivial events/remarks and giving them personal significance
    • Persecution: believing one is being singled out for harm by others
    • Grandeur: believing one is a powerful, important person
    • Somatic: false belief that the body is changing
    • Jealousy: false belief that on's significant other is unfaithful
    • Thought withdrawal: thoughts have been removed from mind and taken away by another
    • Thought insertion: thought of another  are being inserted into one's mind
    • Thought control: one's mind is being controlled by others
    • Religiosity: preoccupation with religious beliefs
    • Magical thinking: thoughts/behaviors have control over specific situations or people
  17. How can the nurse communicate with the delusional client?
    • Be open, honest, reliable
    • Be matter-of-fact and calm
    • Ask client to describe delusion
    • Avoid arguing, but interject doubt
    • Focus on feelings the delusions generate
    • Once delusion is described, do not dwell on it
    • Observe events that trigger delusions
    • validate any true part of the delusion
  18. What are some different kinds of disorganized speech?
    • Incoherence: inability to understand ideas, shifting from one unrelated topic to another
    • Clang Association: choice of words r/t to rhyming sounds
    • Loose Association: ideas shift from one unrelated topic to another
    • Tangential: never get to the point of the story
    • Circumstantial: point of story is reached through many unnecessary details
    • Concrete thinking: literal interpretations (its raining cats and dogs)
    • Echolalia: repeating another's words
    • Word Salad: mixture of meaningless words
    • Neologisms: words having meaning only for the client
    • Mutism: inability/refusal to speak
    • Perseveration: repeating same word/idea in response to different questions
  19. What is grossly disorganized or catatonic behavior?
    • Lack of any goal directed behavior
    • Negative behavior: clients doing the opposite of what is suggested or NOT doing what is suggested (such as getting out of bed)
    • Catatonia: extreme psychomotor agitation or retardation
    • Catatonic stupor: extreme motor retardation, mutism
    • Catatonic posturing: waxy flexibility and passive bizarre posturing
  20. What are some negative (soft) symptoms of schizophrenia?
    • Affect and cognition is effected
    • Anhedonia: lack of pleasure
    • Anergia: lack of energy
    • Apathy: indifference
    • Alogia: poverty of speech (1 word answers)
    • Avolition: lack of motivation
    • Thought blocking: stop talk in middle of sentence
    • Flat affect, bizarre affect, inappropriate affect
    • Social isolation
    • Poor grooming/hygiene
    • Decreased spontaneity and gestures
  21. What are the affective symptoms of schizophrenia (mood disorders)?
    • Assessment for DEPRESSION is crucial
    • May herald impending relapse
    • Increase in substance abuse
    • Increase in suicide risk
    • Further impairs functioning
  22. What are the crucial assessments for a client with schizophrenia?
    • Any medical problems
    • Abuse of or dependence on alcohol or substances
    • Risk to self or others
    • Command hallucinations
  23. What is schizoaffective disorder?
    • Positive symptoms of schizophrenia and meets the criteria for major affective (mood) disorder
    • Often schiz with depression
  24. What is brief psychotic disorder?
    • Sudden onset of psychotic symptoms following a severe psychosocial stressor
    • Symptoms last <1mo
    • Individual returns to full premorbid functioning
    • More common in borderline and BPD clients
  25. What is delusional disorder?
    • Prominent non-bizarre delusions
    • Erotomanic: believe someone of higher status is in love with them
    • Grandeur: irrational ideas about your own worth, power
    • Jealousy: irrational idea that one's partner is unfaithful
    • Persecution: most common
    • Somatic: irrational belief they have some physical defect, disorder, disease
  26. What is shared psychotic disorder?
    • A delusional system develops in a second person as a result of close relationships with a psychotic, delusional person
    • Also called "folie a deux" and is considered a cult phenomenon
  27. What are some medical conditions that can cause psychosis and needs to be ruled out when considering schizophrenia?
    • TBI
    • CVA
    • Epilepsy
    • Thyroid imbalance
    • Hypoglycemia
    • Lupus (LSE)
    • Hypoxia
    • Toxic Fumes
    • Sleeplessness
    • Carbon Monoxide
  28. What are the priority nursing diagnosis for someone with schizophrenia?
    • Risk for violence to self or others
    • Alteration in sensory perception
    • Altered thought process
    • Impaired verbal communication
    • Self-care deficit
    • Social isolation
    • Ineffective family coping
    • Noncompliance
  29. What interventions can be done for a client with a risk for violence?
    • Maintain Safe environment
    • Decrease stimuli
    • Increase monitoring of client
    • ASSESS FOR PRESENCE OF COMMAND HALLUCINATIONS
    • Provide distraction activities
    • Ask, don't ignore behaviors
    • Never go alone but have one leader
    • Directly ask about agitation
    • Remain calm, non threatening, but firm
    • Use clear, simple statements
    • Cite specific behaviors
  30. What kind of nurse relationship is beneficial for a client with schizophrenia?
    • Primary nursing, trust v mistrust
    • Unconditional positive regard, provide praise
    • Mutually agreed upon contract
    • Brief, frequent contacts (5-10 min, several times a shift)
    • Gradually increase length of sessions
    • Consistency
    • Reliability
  31. What nursing considerations should be taken if a client is experiencing hallucinations?
    • Observe for s/s of hallucinating
    • Avoid touching the client without asking
    • Encourage client to share content of hallucinations with you
    • Actively listen for theme or tone and respond to it
    • Do not reinforce or discredit the hallucinations (present reality)
  32. What nursing interventions can be done for a client experiencing paranoid delusions?
    • Promote trust- use primary nursing
    • Slowly and gradually increase involvement in group activities as client can tolerate
    • Avoid being obvious in monitoring client
    • Avoid laughing, whispering, joking within earshot of client
    • Provide pre-packaged, unopened food if necessary
  33. What are the first generation anti-psychotics for schizophrenia?
    • Dopamine Antagonists (D2 receptor antagonists)
    • Chlorpromazine (Thorazine)
    • Fluphenazine (Prolixin)
    • Thiothixene (narvane)
    • Haloperidol (Haldol)
    • Target the positive symptoms of schizophrenia
    • Less expensive than the second gen
    • EPS, TD, Weight gain, sexual dysfunction, endocrine disturbances, and anticholinergic side effects
  34. What are the second generation anti-psychotics for schizophrenia?
    • Treat both positive and negative symptoms with minimal to no EPS and TD
    • Disadvantage is that they tend to cause significant weight gain
    • Risperidone (risperidol)
    • Quetiapine (seroquel)
    • Olanzapine (Zyprexa)
    • Clozapine (clozaril)
    • Ziprasidone (Geodon)
    • Paliperidone (Invega)
  35. What are the third generation anti-psychotics for schizophrenia?
    • Aripiprazole (Abilify)
    • Dopamine system stabilizer
    • Improves positive and negative symptoms and cognitive function
    • -little risk of EPS or tardive dyskinesia
  36. What are EPS?
    • Extrapyramidal Symptoms
    • Pseudoparkinsonism: tremors, shuffling gait, drooling, rigidity (often occur in women, elderly, dehydrated).  Symptoms within 1-5 days of treatment
    • Akinesia: muscular weakness
    • Akathisia: continuous restlessness, fidgeting
    • Acute Dystonic Reactions: involuntary muscular movements (spasms) of the face, arms, legs and neck (occurs suddenly, frightening, painful)
    • Treatment: IV/IM Cogentin, have resp support available
  37. Describe tardive dyskinesia
    • Irreversible involuntary movements due to long use of anti-psychotic medications, decreasing or stopping abruptly after long term use
    • Irreversible, must be detected early (no treatment at present)
    • Tongue protrusion, lip smacking, chewing, blinking, grimacing, foot tapping
  38. What is NMS? What are the appropriate interventions?
    • Rare, potentially fatal dysregulation of the thermoregulation system
    • -Parkinsonian muscle rigidity (severe)
    • -Hyperpyrexia up to 107
    • -Tachycardia and tachypnea
    • -labile BP
    • -diaphoresis
    • -rapid LOC deterioration
    • -elevated CPK
    • -Onset within hours of therapy and progression over 24-72hrs
    • -more common in dehydrated individuals
    • Interventions:
    • -D/C antipsychotic immeadiately
    • -monitor VS, LOC, I/O
    • -Physician may order Bromocriptine (parlodel) to reverse effects
    • -Supportive care
  39. Describe anti-psychotics and agranulocytosis
    • WBC levels can drop fatally low (<3,000mm3 or <1500mm3 granulocyte count)
    • High incidence associated with Clozaril, occurring within the first 3 months
    • Abrupt onset of fever (always take temp), malaise, ulcerative sore throat (always report a sore throat), leukopenia
    • Interventions include antibiotics and reverse isolation
  40. How is cigarette smoking related to schizophrenia?
    • Schizophrenia clients smoke at the double the rate of the general population (up to 88% of clients)
    • Offer a nicotine patch
    • All drug trials are done on smoking clients
  41. What is syndrome X?
    • Dyslipidemia
    • DM II
    • HTN
    • Abd obesity
    • Insulin resistance
  42. How is diabetes related to schizophrenia?
    • Higher risk of developing DM II r/t high risk of obesity
    • Clozapine and Olanzapine are agents most commonly associated with DM
    • Risperidone not associated with signif risk of DM
  43. What are some teaching guidelines for clients and families facing schizophrenia?
    • Learn all you can about the illness
    • Develop a relapse prevention plan- recognize symptoms that signal relapse
    • Take advantage of psycho-educational tools
    • Comply with treatment
    • Avoid alcohol/drugs
    • Keep in touch with supportive people
    • Stay physically healthy
    • Join a support group to deal with stigma

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