Card Set Information
lccc nursing psych schizophrenia
For Cummings Exam 3
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
What are some general treatments for schizophrenia?
Social Skills therapy
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
High risk of suicide
Polydipsia (risk of H2O poisoning and F/E imbalances. Fluid restriction necessary)
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
What disturbances occur in schizophrenia?
What are the four phases of schizophrenia?
: Pre-psychotic (schizoid personality)
-indifferent, cold, aloof, loners
-Do not enjoy personal relationships
: Prodromal phase
-often occurs before first psychotic break
-socially withdrawn, behavior is peculiar and eccentric
-Neglected personal hygiene
-Disturbances in communication, ideation and perception
: Active phase
-psychotic symptoms are prominent
-Hallucinations and delusions
: residual phase
-also called the maintenance phase
-similar to prodromal, near baseline
-flat affect, role impairment
What factors determine whether someone with schizophrenia will have a favorable prognosis?
-abrupt onset of goof pre-morbid functioning
-older age of onset
Less favorable if:
-slower onset of symptoms 2-3 yrs
-childhood history of withdrawal, seclusion, eccentric, tense behavior
What is the DSM-5 criteria for Schizophrenia?
Two or more of the following, each present during a one month period
-grossly disorganized or catatonic behavior
What is the general assessment for schizophrenia?
What are the 4 fundamental (Bleuler's 4As) signs of schizophrenia?
Autism (withdrawn into self)
Describe the positive (hard) symptoms of schizophrenia?
Hallucinations (auditory, visual, tactile, olfactory, gustatory)
Thoughts of insertion/withdrawal
Flight of ideas
What are the stages of hallucinations? What should be assessed?
: Controlling (Command) * emergency
: Conquering (does what they say)
Assess for duration, intensity, frequency
Pattern over time
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
Inability to follow conversation
decreased ability to follow verbal commands
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
Describe the positive symptoms of waxy flexibility, pressures speech, aggressive/agitated bizarre behavior and bizarre dress/grooming
: limbs remain where they are placed
: fast, loud speech
Aggressive, agitated bizarre behavior
: too many layers, inappropriate for weather
What are some common delusions?
Ideas of reference
: misconstruing trivial events/remarks and giving them personal significance
: believing one is being singled out for harm by others
: believing one is a powerful, important person
: false belief that the body is changing
: false belief that on's significant other is unfaithful
: thoughts have been removed from mind and taken away by another
: thought of another are being inserted into one's mind
: one's mind is being controlled by others
: preoccupation with religious beliefs
: thoughts/behaviors have control over specific situations or people
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
What are some different kinds of disorganized speech?
: inability to understand ideas, shifting from one unrelated topic to another
: choice of words r/t to rhyming sounds
: ideas shift from one unrelated topic to another
: never get to the point of the story
: point of story is reached through many unnecessary details
: literal interpretations (its raining cats and dogs)
: repeating another's words
: mixture of meaningless words
: words having meaning only for the client
: inability/refusal to speak
: repeating same word/idea in response to different questions
What is grossly disorganized or catatonic behavior?
Lack of any goal directed behavior
: clients doing the opposite of what is suggested or NOT doing what is suggested (such as getting out of bed)
: extreme psychomotor agitation or retardation
: extreme motor retardation, mutism
: waxy flexibility and passive bizarre posturing
What are some negative (soft) symptoms of schizophrenia?
Affect and cognition is effected
: lack of pleasure
: lack of energy
: poverty of speech (1 word answers)
: lack of motivation
: stop talk in middle of sentence
Flat affect, bizarre affect, inappropriate affect
Decreased spontaneity and gestures
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
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
What is schizoaffective disorder?
Positive symptoms of schizophrenia and meets the criteria for major affective (mood) disorder
Often schiz with depression
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
What is delusional disorder?
Prominent non-bizarre delusions
: believe someone of higher status is in love with them
: irrational ideas about your own worth, power
: irrational idea that one's partner is unfaithful
: most common
: irrational belief they have some physical defect, disorder, disease
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
What are some medical conditions that can cause psychosis and needs to be ruled out when considering schizophrenia?
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
Ineffective family coping
What interventions can be done for a client with a risk for violence?
Maintain Safe environment
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
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
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)
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
What are the first generation anti-psychotics for schizophrenia?
Dopamine Antagonists (D2 receptor antagonists)
Target the positive symptoms of schizophrenia
Less expensive than the second gen
EPS, TD, Weight gain, sexual dysfunction, endocrine disturbances, and anticholinergic side effects
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
What are the third generation anti-psychotics for schizophrenia?
Dopamine system stabilizer
Improves positive and negative symptoms and cognitive function
-little risk of EPS or tardive dyskinesia
What are EPS?
: tremors, shuffling gait, drooling, rigidity (often occur in women, elderly, dehydrated). Symptoms within 1-5 days of treatment
: muscular weakness
: continuous restlessness, fidgeting
Acute Dystonic Reactions
: involuntary muscular movements (spasms) of the face, arms, legs and neck (occurs suddenly, frightening, painful)
: IV/IM Cogentin, have resp support available
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
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
-rapid LOC deterioration
-Onset within hours of therapy and progression over 24-72hrs
-more common in dehydrated individuals
-D/C antipsychotic immeadiately
-monitor VS, LOC, I/O
-Physician may order Bromocriptine (parlodel) to reverse effects
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
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
What is syndrome X?
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
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
Keep in touch with supportive people
Stay physically healthy
Join a support group to deal with stigma