Schizophrenia
What are positive symptoms associated with schizophrenia? (think of examples of how a patient may present)
What are negative symptoms associated with schizophrenia? (think of examples of how a patient may present)
Positive symptoms are "adding" to the situation
Negative symptoms are "taking away" from the situation
Anxiety is classified into what categories?
How might a patient present in each level?
Mild: special attention; increased sensory stimulation; motivational--Anxiety is not bad, but rather a warning sign.
Moderate: something
definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected
Severe: trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry
Panic: fight, flight, or freeze response; increased vital signs; dilated pupils; cognitive processes focusing on defense
Patient's experiencing a mood disorder are at a high risk for ____________?
What nursing intervention would be the highest priority?
Suicide
Safety Assessment
When caring for a patient experiencing alcohol withdrawal, what areas (types of questions) might the nurse ask to obtain assessment information for the CIWA?
CIWA is assessing the following areas:
signs of EPS include?
Treatment of EPS would include what immediate medication administration?
Tardive dyskinesia (TD) - involuntary muscular spasms of the face and jaw, lip smacking, or unusual tongue movements,
Acute Dystonia: severe spasms of the muscles of the tongue, head and neck, fixed upward deviation of the eyes, severe back spams
Akathisia: internal restlessness, inability to site still ( pacing, fidgeting)
Pseudoparkinsonism: stiffening of muscular activity, shuffling gait, tremors,
Prevention is essential- patients should begin with benztropine when starting antipsychotics
Treatment may include: benztropine IV/IM or diphenhydramine IM/IV
When caring for a patient with severe or panic level anxiety, what is the main priority for the nurse?
What type of medication would the nurse anticipate being ordered?
Safety- stay with the patient. remind them they are safe and use short, direct sentences
Benzo's are used for short-term, immediate relief
Lithium level ranges are?
What signs or symptoms would lead the nurse to suspect lithium toxicity?
Ranges 0.8-1.2 (ideally around 1)
Mild Toxicity
<1.5 mEq/L
(Exaggeration of expected side effects)
Metallic taste in mouth, nausea, polyuria, polydipsia, diarrhea, muscle weakness, weight gain, edema
Moderate Toxicity
1.5-2.5 mEq/L
Severe diarrhea, dry mouth, nausea and vomiting, ataxia, incoordination, tinnitus, slurred speech, vertigo, muscle twitching, asymmetric deep tendon reflexes
Severe Toxicity
> 2.5 mEq/L
Fasciculations, nystagmus, coarse tremors, cardiac arrhythmias, hallucinations, oliguria, peripheral vascular collapse, confusion, seizures, coma
Stimulant (meth, cocaine, etc) abuse can lead to patients experiencing what types of complications?
Elevated BP
Insomnia
Hallucinations
Violence/Aggression (potential for violence)
Impaired judgment
Severe to panic levels of anxiety
Neuroleptic Malignant Syndrome (NMS)
What are clinical manifestations?
Treatment includes?
F: Fever
E: Elevated CPK/WBC
V: Vital signs instability
E: Encephalopathy
R: muscle Rigidity
Treatment includes aggressive treatment of symptoms: antipyretics to treat hyperprexia; dantrolene to reduce muscle spams; IV fluids for dehydration
Obsessions are classified as?
Compulsions are classified as?
A short term goal for a patient being treated for OCD is?
Obsessions = thoughts
Compulsions = behaviors
Short term goal = reduction in compulsions
How might a patient present with HYPOmania?
•Cheerful, enthusiastic, abnormally elevated or especially irritable mood
•Does not impair ability to function (no psychotic functions)
•Excessive and pressured speech
•Decreased need for sleep and increased activity and/or psychomotor agitation
Opioid abuse is treated with what medications? how is it managed?
Substitution therapy is a main form of treatment/management:
Methadone (tapered slowly is the end goal)
Buprenorphine (also the idea is to taper the patient off of it)
Clonidine can be used to manage autonomic symptoms (n&v, diarrhea)
Clients also benefit from peer support and outpatient therapy to determine the underlying cause of their substance abuse
First-Generation Antipsychotics:
Side Effects?
Nursing interventions for potential side effects
•Can cause extrapyramidal side effects (EPS) due to the blockage of D2 receptors
•Acute dystonia, Akathisia, Pseudoparkinsonism, Tardive dyskinesia
•May adjust dose, change drug, or add oral anticholinergic (benztropine)
- monitor for weight gain (may start metformin to help control weight gain and potential diabetes)
- monitor for seizures
- monitor NMS (FEVER)
- monitor for prolactin elevation (gynecomastia, galactorrhea)
Other disorders related to OCD include?
•Self-soothing behaviors:
–Excoriation (skin picking)
–Onychophagia (nail biting)
–Trichotillomania (hair pulling)
•Reward-seeking behaviors:
–Kleptomania (compulsive stealing)
–Oniomania (compulsive buying)
–Hoarding (excessive acquisition)
–Pyromania (fire setting)
•Disorders of body appearance and function:
–Body dysmorphic disorder (preoccupation with slight or even imagined physical imperfection)
–Body identity integrity disorder (feeling alienated from a part of the body to the extent of seeking amputation of the identified body part)
•Excoriation AKA dermatillomania
–Skin picking
–Leads to medical complications
–May require medicine, surgery, plastic surgery to treat
•Onychophagia
–Nail biting
–Onset is in childhood- behavior decreases by age 18
–SSRI antidepressants for treatment
•Trichotillomania
–Repetitive, chronic hair-pulling
–Distress and functional impairment
–Common onset in childhood, comorbidities with anxiety and depression
The nurse is caring for a patient with suspected mood disorder. They appear withdrawn, have been absent from work for the last 2 weeks, does not appear they have showered recently and are crying.
What is the priority nursing intervention ?
SAFETY assessment
Medications used to help patients maintain sobriety from alcohol include?
•Disulfiram (Antabuse)- helps with impulse drinking d/t long lasting effects, when mixed with alcohol the patient will have violent physical reactions
•Naltrexone (Vivitrol)- reduces desired pleasant feelings by blocking release of endorphins, also blocks cravings
•Acamprosate (Campral)- reduces unpleasant symptoms of abstinence and decreases cravings