Nursing Care of the Patient with Schizophrenia – Flashcards
Unlock all answers in this set
Unlock answersquestion
Psychosis
answer
Loss of touch with reality
question
Schizophrenia
answer
One way psychosis manifests Diagnosis associated with psychosis (>6 months)
question
Schizo
answer
Not always meaning schizophrenia but loss of touch with reality
question
Schizophreniform Disorder
answer
Exact same s/s as schizophrenia but doesn't meet the time requirement (>1 month < 6 months)
question
Schizoaffective Disorder
answer
Same s/s of schizophrenia plus depression or bipolar disorder
question
Other Psychotic Disorders
answer
Don't meet the criteria for schizophrenia, schizophreniform, or schizoaffective disorder Not sure what it is Used to be called not otherwise specified
question
Delusional Disorder
answer
Refers to a condition associated with one or more nonbizarre delusions of thinking
question
Personality Disorder
answer
Schizotypal personality disorder Schizoid personality disorder Paranoid personality disorder *Not related to schizophrenia but have something to do with loss of touch with reality or odd eccentric behaviors*
question
Epidemiology/Statistics
answer
Effect 1% of people world wide (1:100) One of ten leading disabilities world wide 50% disabled for life 5-10% commit suicide Equal prevalence in men and women Earlier onset for men Late teens/early 20's when actual diagnosis is made but there may be prodromal symptoms before then Frequent lengthy hospitalizations Have for life, no remission 1/3 homeless 15% don't respond to medications 70% are only partial responders to medications 20% shorter life expectancy (with all mental health disorders) partly due to medications side effects
question
Side Effects of Medications
answer
Increase chronic illness rate in almost every body system 3 times likely to develop hypothyroidism 8 times more likely to have hepatitis C Twice as likely to have asthma, diabetes, COPD, peripheral vascular disease 3 times more likely to be a smoker
question
History & Myths
answer
Used to be believed it was caused by a certain type of mothering pattern (distant/didn't provide enough love/no connection)
question
Contributing Factors
answer
Physiological Environmental Psychological Sociocultural/spiritual
question
Physiological
answer
Genetics Dopamine hypothesis
question
Genetics
answer
1/3 people have strong genetic prevalence but up to 2/3 have no family history at all (biological) 9 times greater risk for developing if brother/sister have 10-15% risk for developing if one parent has 45% risk of developing if both parents have 50% risk of developing if twin has it *Stronger genetic link with bipolar than schizophrenia*
question
Dopamine Hypothesis
answer
Doesn't effect everyone Used to develop medications Hypothesis is there is too much dopamine in the brain which causes brain function to not work properly and the patient can't interpret reality properly Medications block dopamine from attaching to NT and decrease dopamine in the brain which can cause other issues
question
Environmental
answer
Exposure to psychoactive substances If the brain is predisposed to developing schizophrenia and exposed to a psychoactive substance, likely to develop schizophrenia
question
Psychological
answer
No link
question
Sociocultural/Spiritual
answer
No link
question
Signs & Symptoms of Schizophrenia
answer
Prodromal symptoms Positive symptoms Negative symptoms Cognitive symptoms
question
Prodromal Symptoms
answer
The early symptoms and signs of schizophrenia that precede the characteristic manifestations of acute, fully developed schizophrenia
question
Positive Symptoms
answer
*Symptoms that are excess in behavior (added on/not typically seen)* Delusions Hallucinations Disorganized thoughts/speech Disorganized behavior
question
Delusions
answer
*False personal beliefs that are inconsistent with the persons intelligence, cultural background. It is a fixed personal belief, do not challenge* Persecutory Grandiose Ideas of reference Thought insertion/deletion/broadcasting
question
Persecutory
answer
Most common Someone/something is out to get them
question
Grandiose
answer
Delusion of grandeur They are the best They are the mesiya They are Jesus
question
Ideas of Reference
answer
IOR Patient thinks that something happening is a message for them, it is a direct reference to them
question
Thought Insertion/Deletion/Broadcasting
answer
Patient thinks someone/thing is inserting thoughts that are not the patients own into their mind Patient thinks someone/thing is taking their thoughts from them Patient thinks that everyone can hear their thoughts
question
Hallucinations
answer
Sensory experiences which are not perceptible by others Auditory Visual Tactile Gustatory Olfactory
question
Auditory Hallucinations
answer
Most common Usually negative and threatening Command auditory hallucinations are potentially the most dangerous
question
Visual Hallucination
answer
Second most common Highly unlikely to experience auditory and visual together If the patient does, suspect psychoactive substance or medical process but unlikely to be associated with schizophrenia
question
Gustatory Hallucinations
answer
Taste something weird/bad R/O neurological problem first even if the patient has schizophrenia
question
Olfactory Hallucination
answer
Burning smell, not pleasant R/O neurological problem first even if the patient has schizophrenia
question
Tactile Hallucination
answer
Feel something on their body Most commonly associated with alcohol abuse or withdrawal
question
Disorganized Thoughts/Speech
answer
Loose associations Tangentiality Perseveration Neologism Magical thinking Clang associations Word salad Mutism Echolalia
question
Loose Associations
answer
Patient's responses do not relate to the interviewer's questions
question
Tangentiality
answer
When one tends to digress readily from one topic under discussion to other topics that arise in the course of associations
question
Perseveration
answer
Repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus
question
Neologism
answer
Person creates new words or expressions
question
Magical Thinking
answer
Believing that one event happens as a result of another without a plausible link of causation
question
Clang Associations
answer
Clanging is a manner of speaking in which words are chosen for their related sounds rather than logical meanings
question
Word Salad
answer
A confused or unintelligible mixture of seemingly random words and phrases
question
Mutism
answer
Not speaking at all
question
Echolalia
answer
Repeating what the speaker is saying
question
Disorganized Behavior
answer
Echopraxia Odd dress Bizarre posturing Waxy flexibility Catatonia
question
Echopraxia
answer
Meaningless repetition or imitation of the movements of others
question
Waxy Flexibility
answer
Decreased response to stimuli and a tendency to remain in an immobile posture *Symptom of catatonic schizophrenia*
question
Catatonia
answer
Immobile or unresponsive stupor
question
Negative Symptoms
answer
Affect Apathy Asociality Avolition Anhedonia *Up until the 80's, medications did not help with negative symptoms*
question
Affect
answer
Flat or inappropriate mood/behavior
question
Apathy
answer
Lack of interest, enthusiasm, or concern
question
Asociality
answer
Don't want to be around other people, prefer to be alone
question
Avolition
answer
No motivation to do anything
question
Anhedonia
answer
Loss of pleasure in things once enjoyed
question
Cognitive Symptoms
answer
*Disturbance in memory and frontal executive functioning so thought, planning and doing* Anosognosia Memory
question
Anosognosia
answer
Lack of insight/awareness of disease process which makes treatment a challenge
question
Assessment, Diagnostic Testing, and Laboratory Values
answer
Neuroanatomical changes Positive and negative syndrome scale (PANSS) Differential diagnosis
question
Neuroanatomical Changes
answer
Enlarged ventricles Frontal lobe atrophy Increased sulci
question
Enlarged Ventricles
answer
Decreased amount of white matter in the brain making it more difficult for NT to communicate with each other
question
Frontal Lobe Atrophy
answer
Wasting away of the frontal lobe Frontal lobe is where executive learning and thought process takes place
question
Increased Sulci
answer
Decreased amount of white matter in the brain making is more difficult for NT to communicate with each other
question
Positive and Negative Syndrome Scale (PANSS)
answer
Used a lot in research to see if there are changes in a patients symptoms
question
Differential Diagnosis
answer
Delirium Substance abuse/misuse Bipolar disorder Medical Issues
question
Delirium
answer
Post-Op looks like psychosis R/O first especially if its the patients first experience with loss of touch with reality
question
Bipolar Disorder
answer
Manic episode might have delusions of grandeur and they may hear voices
question
Medical Issues
answer
Neurochemical Hyperthyroidism Hypothyroidism Drug induced Metabolic syndrome Diabetes
question
Evidence Based Practice/Collaboration Care
answer
Health promotion Nursing process Pharmacological/parenteral therapies Therapeutic measures Communication and documentation Utilization of resources Patient/family education and referral
question
Health Promotion
answer
Early identification and treatment of disease Focus on what the patient can do Barriers to treatment Comorbidities
question
Early Identification and Treatment of Disease
answer
What helps manage the voices? Identify triggers Music Talking to the voices, telling them to stop Reading out loud Finding strengths Hobbies
question
Focus On What The Patient Can Do
answer
A patients perceived consequences Problem solve around what would help them achieve their goals Supportive employment Clubhouse Finding something important to them Checking in with someone daily
question
Barriers to Treatment
answer
Anosognosia Access to health care/services and transportation Side effects of medicatons What the patient thinks are barriers
question
Comorbidities
answer
*See side effects of medications* Nicotine/caffeine
question
Nicotine
answer
When the patient is in the hospital, they need to receive higher doses of their medications if they are a smoker. The patch is metabolized differently than smoking which suppress some symptoms
question
Nursing Process
answer
Nursing diagnosis: disturbed thought process
question
Nursing Diagnosis: Disturbed Thought Process
answer
Maintain safety Establish trust
question
Establish Trust
answer
Consistent caregivers Suggest collaboration
question
Pharmacological/Parenteral Therapies
answer
*See Psychopharmacology study set*
question
Therapeutic Measures
answer
Milieu therapy Level of care
question
Level of Care
answer
Inpatient, IOP/PHP, day program, VNA
question
IOP
answer
Intensive outpatient program
question
PHP
answer
Partial hospitalization
question
Communication and Documentation
answer
Therapeutic communication
question
Therapeutic Communication
answer
Acknowledge Empathize Distract Redirect
question
Utilization of Resources
answer
Information technology Quality indicators TJC national patient safety goal
question
TJC National Patient Safety Goal
answer
The joint commission *Find out which individuals severed are most likely to try to commit suicide*
question
Patient/Family Education and Referral
answer
Patient-specific signs and symptoms of relapse and plan Effective management of symptoms Managing side effects of medications Social skills training Supported employment program Supervised housing Psychiatry/social work Community mental health agency
question
Community Mental Health Agency
answer
Strafford county: community partners Rockingham county: seacoast mental health
