Nursing Management of Schizophrenia – Flashcards
Unlock all answers in this set
Unlock answersquestion
Schizophrenia
answer
* A group of psychotic disorders * Split mindedness * Loses contact with what is real * Impairment in reality * Psychiatric disorder in brain functioning * D/O of normal thought processing * Bio-cellular dysfunction * There is no cure, only treatment
question
Schizophrenia: characteristics
answer
* Symptoms occur on a continuum * Distortions of reality * Withdrawal from social interactions * Disorganization in perception, thoughts, & emotions
question
Pervasive D/O
answer
* In brain but affects whole bod
question
Predisposition for schizophrenia (Etiologies)
answer
* Biologic Influences * Neurostructural influences * Positive and Negative Symptoms * Prodromal Signs
question
Biologic Influences
answer
* Genetics * Excessive dopamine * Physical conditions
question
Biologic Influences: Genetics
answer
* Occurs in family * Inherited genetic transmission * Occurs frequently in males
question
Biologic Influences: Excessive Dopamine
answer
* Amount of dopamine is excessive (excitatory) * Found in the limbic & mesolimbic pathways * Neurologic pathways of the brain that process response
question
Biologic Influences: Physical Conditions
answer
* Abnormal fetal brain development * Birth trauma * Head injury * Mental retardation * Epilepsy, Metabolic disturbances/Substance abuse
question
Neurostructural Influences
answer
* Ventricle: brain ratio is disproportionate * Atrophy of the frontal lobe * Cerebral blood flow increased
question
Schizophrenia: Positive Symptoms
answer
* Type 1 hyper-dopaminergic caused by hyper dopaminergic processes * Hallucinations, delusions, abnormal thought forms, bizarre behavior
question
Schizophrenia: Negative Symptoms
answer
* Type 2 structural changes (enlarge ventricles, atrophy, etc.) * Take away what should be there (emotions) * Flat affect, anhedonia, alogia, avolition, anergia
question
Anhedonia
answer
* Without pleasure
question
Alogia
answer
* Not speaking
question
Avolition
answer
* Without motivation
question
Anergia
answer
* Without energy
question
Schizophrenia: Prodromal Signs
answer
* Progression over a period of time * Diagnosed in late adolescence though mid 30's * Marginal functioning * Isolation * Withdrawal: not wanting to participate in family functions * Loss of interest in things they enjoy * Poor hygiene/grooming * Odd expressions * Unprovoked anger: easily upset/agitated * Onset precipitated by a major stressor: disease is already there, but this triggers it
question
Effects of Schizophrenia on Though Process and Content
answer
* Loose Associations * Autism * Mutism * Slow though processing * Rapid thinking * Concrete thinking * Thought blocking * Thought insertion * Perservation * Circumstantial * Tangential
question
Loose Associations
answer
* Poorly related thoughts * Illogical, unrelated to the conversation * Nurses find this by listening
question
Autism
answer
* Retreat into a private inner world * Fantasy * Chronic day dreaming * Delusional
question
Mutism
answer
* Inability to speak
question
Slow Thought Processing
answer
* Difficulty expressing full thoughts * Use silence to encourage them to finish
question
Rapid Thinking
answer
* Poor concentration * Meet with patient in quiet place
question
Concrete thinking
answer
* Inability to separate, differentiate or compare
question
Thought Blocking
answer
* The inability to complete thoughts
question
Thought Insertion
answer
* Belief that others are controlling or inserting their thoughts
question
Perservation
answer
* Repetitive behavior or sounds (all day long) * Process of brain gets held up
question
Circumstantial
answer
* Excessive & irrelevant detail
question
Tangential
answer
* Digression in conversation
question
Schizophrenia Sensory and Perceptual Disturbances
answer
* Delusions * Hallucinations * Paranoia
question
Delusions
answer
* Verbal expressions of fixed false beliefs * Not valid in reality * Exaggerated defense mechanism as compensation for anxiety, fear & low self-esteem
question
Types of Delusions
answer
* Reference * Grandeur * Somatic * Religious * Persecution
question
Reference Delusion
answer
* Belief that external events are r/t oneself
question
Grandeur Delusion
answer
* An exaggerated sense of self importance value
question
Somatic Delusion
answer
* Belief that their body is changing in an unequal way
question
Religious Delusion
answer
* Pre-occupied w/religious themes/ideas
question
Persecution Delusion
answer
* Belief that one is in danger * Most dangerous
question
Hallucinations
answer
* False Sensory impressions * Dysfunction in normal sensory activity * Generated as an internal response to anxiety * Content can cause further anxiety
question
Types of Hallucinations
answer
* Auditory (command): most common * Visual * Gustatory * Tactile * Olfactory
question
Paranoia
answer
* Suspiciousness & belief that one is being harassed, persecuted or unfairly treated
question
Effects of Schizophrenia on Speech
answer
* Echolalia * Neologisms * Clang association * Word Salad
question
Echolalia
answer
* Purposeless repetition of sounds/words they just heard
question
Neologisms
answer
* Coinage of new words * Make up new words
question
Clang Association
answer
* Association by sound * Rhyming almost
question
Word Salad
answer
* Illogical linking of ordinary words
question
Effects of Schizophrenia on Emotions
answer
* An effect of negative symptoms that takes away from healthy adaptive emotional functioning * Flat or blunted effect * Emotional ambivalence * Depression * Depersonalization * Projection * De-realization
question
Flat/Blunted Effect
answer
* Limited range of emotional expression
question
Emotional Ambivalence
answer
* Produces confusion in relating to others * Two different feelings about it
question
Depression
answer
* Absence of emotional energy * Risk for suicide
question
Depersonalization
answer
* Detachment from self * Loss of ego boundaries * Risk for injury
question
Projection
answer
* Displacement of unacceptable ideas/feelings on to others
question
De-Realization
answer
* Impaired sense of what is concretely real * Difficulty reading the environment
question
Effects of Schizophrenia on Behavior
answer
* Withdrawal * Stupor * Bizarre or strikingly odd behavior * Waxy flexibility * Exhopraxia * Hyperactivity in physical energy * Stereotyped behavior * Automatic obedience * Negativism * Deterioration in appearance * Coping Skills are ineffective
question
Withdrawal
answer
* Defense against anxiety * many forms: Social, behavioral, emotional * Can become a conditioned behavior over time
question
Waxy Flexibilty
answer
* Posturing in a fixed position * Can move them like a wax figure
question
Exhopraxia
answer
* Mimic the movement of others
question
Hyperactivity in Physical Energy
answer
* Pacing
question
Stereotyped Behavior
answer
* Ritualistic behaviors that are repeated w/out variation * If they stop, they are improving
question
Automatic Obedience
answer
* Follows simple commands as if they are a robot
question
Negativism
answer
* Acting w/in opposite of what is asked
question
Deterioration in Appearance
answer
* Disheveled * No awareness of this
question
Schizophrenia: Nursing Interventions
answer
* Orem's Nursing Systems
question
Orem's Nursing System
answer
* Helps to define & implement appropriate nursing care * Wholly Compensatory * Partly Compensatory * Educative/Supportive
question
Wholly Compensatory
answer
* High acuity * limited or impaired ability to provide self-care
question
Partly Compensatory
answer
* Moderate to some limitation in providing self care
question
Educative/Supportive
answer
* Adequate ability to provide self-care
question
Traditional Neuroleptic Drugs
answer
* Originally developed as a surgical anesthetic d/t powerful calming effect * 'To take hold of one's nerves'
question
Traditional Neuroleptic Drugs: Mechanism of Action
answer
* Crosses over blood-brain barrier to affect chemical activity on the brain * Provide antagonistic effect on post-synaptic dopamine receptors in limbic, cerebral, cortex, basal ganglia, hypothalamus, bran stem and medulla * Effect on positive symptoms * Effect observed in the central and peripheral nervous systems * Protein bound: bind to the protein to be transported * lipophilic: combines with lipids * Metabolized in the liver; eliminated via kidneys: enterohepatic circulation * Peak in 2-3 hours; full therapeutic effect in 2-4 weeks depending on the acuity of the patient * Monitor routine laboratories: renal panel, liver panel, cell counts, electrolytes, metabolic panel, lipid profile
question
Traditional Neuroleptic Drugs: Therapeutic Effects
answer
* Slows down CNS activity: decrease violent, agitated emotions & behaviors * Decrease psychotic features: decrease hallucination & delusions * Improve thought processes: organizes thinking ability, speech, and behaviors * Improve sleep and nutrition activity
question
Traditional Neuroleptic Drugs: Potency
answer
* High potency * Low potency
question
High Potency
answer
* Smaller does, rapid effects (esp. sedation) * Extrapyramidal side effects * Fewer anticholinergic effects * Ex.: Fluphenazile, Prolixin, Haloperidol
question
Low Potency
answer
* Higher doses * Less intense extrapyramidal side effects * More sedating throughout day * Ex.: Thorazile, Thoridazile
question
Traditional Neuroleptic Drugs: Administration
answer
* Orally: tablets or liquids or quick dissolve * IM: parenteral * Depot Preparation: esterification process-long acting * Elimination/administration times: can take less # times/day = same effect * Dosing based upon receptors occupation: longer time to eliminate; Reduction in frequency of administration
question
Traditional Neuroleptic Drugs: Patient Education
answer
* Take regularly at the same time to keep it constantly in your blood * Caution against abruptly stopping * No alcohol or drugs that are CNS depressants because they occupy the same receptors & increase the sedative properties * Avoid caffeine for the same reason
question
Extrapyramidal Side-Effects
answer
* Acetylcholine and dopamine balance * Reduction in dopamine * Effect on pyramidal tracts which controls involuntary movements * Dystonic Reactions * Akathisia * Pseudo-parkinsonism * Tardive Dyskinesia
question
Dystonic Reactions
answer
* Reaction involving facial and neck muscles * Higher in men and younger individuals ( 25 years and younger) * Torticollis *Laryngeal/pharyngeal dystonia
question
Torticollis
answer
* Abrupt, painful muscle spasms of neck/jaw
question
Laryngeal/Pharyngeal Dystonia
answer
* Facial grimacing/abnormal eye movement
question
Akathisia
answer
* An effect of motor restlessness * Uncontrolled motor restlessness, difficulty sitting still, pacing about
question
Pseudo-Parkinsonism
answer
* An effect on muscular rigidity * Motor retardation, shuffled gait, rigidity, tremors, pill rolling, salivation * More often in women & elderly
question
Tardive Dyskinesia (TD)
answer
* Long-term of psychotropic drug use * Involuntary uncontrollable movements of face, tongue, trunk, extremities, * Irreversible effect * R/T hypersensitive dopamine receptors * Protrusion of tongue * Puffing cheeks * Chewing movements
question
Management of Extrapyramidal Side-Effects
answer
* Administrations of anticholinergic drugs -Often prescribed to decrease EPS: balancing the neurotransmitter - Benzotropine (Cogentin) -Diphenhydramine (Benadryl): taken daily & orally with traditional neuroleptic med
question
Cogentin & Benadryl
answer
* Employs Acetylcholine * Can be given IM in emergency
question
Management of Tardive Dyskinesia
answer
* Early recognition by vermiform movement of the tongue * Abnormal Involuntary Movement Scale (AIMS)
question
Abnormal Involuntary Movement Scale (AIMS)
answer
* Hold out arms to see if they move, etc. * D/C or titrate the dose down -Can affect swallowing too * May need to administer a dopamine anta-agonist like bromocriptidel (parlodel)
question
Management of Other Common Side Effects
answer
* Anticholinergic * Vascular * Endocrine
question
Management of Other Common Side Effects: Anticholinergic
answer
* Muscarinic Receptors: Acetylcholine * Significant weight gain bc its a key factor in insulin production * Drowsiness, sedation * Dry mouth, urinary retention, constipation, blurred vision, photosensitivity
question
Management of Other Common Side Effects: Anticholinergic Management/Patient Education
answer
* Monitor Caloric intake * High fiber diet * Regular exercise * Increase fluid intake * Void prior to taking med * Avoid excessive sun exposure * Visual aids
question
Management of Other Common Side Effects: Vascular
answer
* Alpha 1 receptors: Norepinephrine * Arrhythmias * Tachycardia * Postural Hypotension * impotence
question
Management of Other Common Side Effects: Vascular Management/Patient Education
answer
* Monitor VS * Baseline EKG * Rise slowly * Elastic support hose * Promote open communication
question
Management of Other Common Side Effects: Endocrine
answer
* H1 Receptors: Histamine * Substantial weight gain * Hypothyroidism * Sedation * Gynecomastia
question
Management of Other Common Side Effects: Endocrine Management/Patient Education
answer
* Monitor caloric intake * Regular exercise * Routine serum thyroid panel; prolactin levels * Short naps (to manage sedation) * Adjust dose if necessary
question
Agranulocytosis
answer
* A blood dyscrasia * Involves leukocyte production
question
Agranulocytosis: Adverse Side Effects
answer
* Potentially fatal * Affects healing potential/ability * Easy risk for infection * Early sign: fever
question
Agranulocytosis: Management
answer
* Monitor daily temperature & WBC count & absolute (ANC) neutrophil count weekly * WBC = at least 3500 mm/ANC = 700/mm
question
Neuroleptic Malignant Syndrome
answer
* Over-depletion of dopamine * Impacts muscle synthesis * Disrupts thermoregulation- protein in muscles to coagulate * Progressive in nature
question
Neuroleptic Malignant Syndrome: Management
answer
* Lab findings (elevated CK creatinine phosphokinase), leukocytosis, urine myoglobin
question
Atypical Antipsychotics
answer
* Antagonizes specific receptors sites * Controls both positive and negative symptoms * Reduction in extrapyramidal side-effects * Indication when limited effects with traditional meds * First-line treatment for psychotic d/o * Available in early 90's * Active on D1-3, 5 HT serotonin & alpha-adrenergic receptors in limbic system * Needs to take 4-6 weeks to kick in
question
Types of Antipsychotics
answer
* Zyprexa * Risperdal * Seroquel * Abilify * Latuda * All Brand names end in 'ine' and 'one'
question
Atypical Antipsychotics: Significant Adverse Affects
answer
* Hypersensitivity * AGRANULOCYTOSIS (FEVER, WBC COUNT, ANC) * Seizure potential * Neuroleptic malignant Syndrome cause by over depletion of dopamine * TARDIVE DYSKINESIA (TD) * Cardiovascular effects: orthostatic hypotension, tachycardia, depressed ST segment, prolonged QT intervals * Altered hepatic function: increased bilirubin * Hyperglycemia * Pancreatic enzymes: increased based on high sugar levels these meds can cause * Hyperlipidemia: increase cholesterol & triglycerides * Dysphagia: difficulty swallowing * Hyper salivation: drooling
question
Metabolic Syndrome
answer
* Increase weight gain * HTN * hyperglycemia * hypercholesterolemia
question
Psychopharmacology: Antipsychotic Medications
answer
* Decrease psychotic features * Promote safety * Organize normal brain function * Promote compliance
question
Psychopharmacology: Delusions
answer
* Recognize defense mechanism * Accept need for the delusion as a protector- promotes empathy & understanding * Respond to the underlying anxiety/emotion: Recognize this * Refrain from arguing/discussing/reasoning about the delusion * Do not convey acceptance of the delusion * Set limits on delusional content: re-focus on the here & now * Prevent reality/give facts/reasonable doubt * Redirect to concrete reality/activity: act as a distraction * Patient Education: promotes pts. insight into their self
question
Psychopharmacology: Hallucinations
answer
* Observe for behavior/validate observations * Inquire for command hallucinations * Suggest humming/whistle/opening mouth * Offer ear plugs/head phones * Encourage verbal elimination: "Go Away" "Stop" * Patient Education
question
Psychopharmacology: Milieu Management
answer
* Safe environment * Whereabouts : promote safety/early intervention * Environmental stimuli: sound, light, climate- balance this * Rest and nutrition: offer regular meals, promote sleep * Hygiene & Grooming * Daily Routine: Establish this- decreases anxiety & improves integration * Activities: concrete, tangible: distraction * Socialization: no discussion of hallucination -1:1 nurse/pt. interactions; simple activities
question
Evaluation of Outcome/Thoughts: cognition
answer
* Organized, spontaneous, reality based * Laughs or smiles at funny comments * Starts conversations with others
question
Evaluation of Outcome/Thoughts: Safety
answer
* Physical safety * Nutrition * Sleep * Activity
question
Evaluation of Outcome/Thoughts: Activity
answer
* Shows interest in activities around them
question
Evaluation of Outcome/Thoughts: Self-care
answer
* Keeps his clothes & self neat/clean
question
Evaluation of Outcome/Thoughts: Socialization
answer
* Tried to be friendly with others * Talks about his/hers interests
question
Factors Influencing Outcomes of Schizophrenia
answer
* Age: at onset of illness. The younger, the worse because their body takes on the pathology for longer * Satisfactory adjustments: in work, social & sexual functions * Emotional warmth * Family support: people with this do better * Compliance to drug & behavioral therapies * Infrequent relapse: better chance at wellness
