Schizophrenic Manifestations
True or False
When a patient as delusions, the nurse should confront the delusions.
Example: A patients states they have to speak to a ghost in the corner. Should the nurse state "There is no ghost"?
False
Rationale: Confronting delusions can be viewed as argumentative by the client and is nontherapeutic for communicating with a client who is experiencing a delusion.
A patient who is experiencing this type of delusion believes that others are trying to control them and often thinks that others are forcing thoughts into their brain
What are control delusions?
True or false: Chronic stress makes a patient more susceptible to viral infections
True:
The nurse should expect to find the client with a decreased immune response, which leads to viral or bacterial infections in response to chronic stress.
A patient with schizophrenia taking olanzapine should be aware of this adverse effect
What is weight gain?
True or False
Patients who are involuntarily admitted to the hospital forfeit their right to informed consent
False
Rationale: Clients who are admitted involuntarily retain the right to informed consent.
You are a new nurse and you are assigned to a patient in the ER who is experiencing crisis. Name three essential steps when caring for patients in crisis
1. Establish Rapport
2. Identify the cause of the crisis
3. Validate the patient's feelings
A patient stating that they borrowed their hair from a friend is an example of this manifestation of schizophrenia
What is depersonalization?
Rationale: The client who experiences depersonalization might feel that parts of her body belong to someone else or are different in some way. Depersonalization is experienced as a loss of personal identity
True or false: for a patient who is experiencing difficulty sleeping and is showing signs of anxiety, remaining with the patient can be more effective than providing PRN sleeping aids
True: Remaining nearby the client can help to alleviate feelings of abandonment and reassures the client of his safety. A client who is given a PRN sleeping medication will not be alleviated of severe anxiety. This action will only temporarily suppress the feelings.
Recurring dreams or nightmares are a hallmark of this mental health disorder
What is PTSD?
What is support of a close friend?
True or false: A nurse should assess alcohol use for a patient that is a victim of abuse
True
Alcohol and drug use should be included in an abuse assessment, as the person may self-medicate to escape the situation.
Coping patterns should be included in an abuse assessment to assess family strengths and stressors
Support systems should be included in an abuse assessment, as the person may be in a dependent and isolated situation and unaware of available support
This type of thinking means the patient is unable to think in abstract terms and will often have literal interpretation of proverbs or metahpors
What is concrete thinking?
When looking at photos of a wheelbarrow, a rake, and a hoe, a concrete thinker might point to a shared characteristic instead of describing the general function, “They all have wooden handles,” rather than, “You can use them all in the garden."
This is how a nurse should sit in regards to the patient when doing an intake interview or assessment
What is sitting next to the patient?
Rationale: The nurse should sit beside the client or at a 90? angle from him so that direct eye contact is unnecessary. Sitting facing the client directly can cause him to feel uncomfortable and can make the interview more intense.
True or false: A patient is screaming about their delusions. The nurse stating "You seem to be having frightening thoughts" is considered therapeutic communication
True:
When responding to a client who is delusional, the nurse should avoid making statements that directly confront or affirm the client's delusional beliefs. Instead of responding literally to the client's words, the nurse should respond to the feelings that the client is attempting to communicate. By doing this, the nurse is shifting the focus from the delusional beliefs, which are not real, to the client's fear, which is real.
When a patient is taking antipsychotics, such as haldol, the nurse should monitor for these symptoms which cause involuntary movements
What are extrapyramidal symptoms?
Name three somatic responses to general anxiety disorder
Urinary frequency, headache, backache, hypertension, insomnia, constipation or digestive issues
"That's where I saw the leprechaun. He tells me to burn things" is an example of this manifestation of schizophrenia
What are command hallucinations?
Name three early signs of relapse
What are lack of sleep, inability to concentrate, poor nutrition, lack of exercise, fatigue, social isolation, loneliness, mood swings, low self-concept, anxiety, worry, forgetfulness, neglecting appearance etc. See table 16.5
True or false: When a patient is experiencing severe anxiety the nurse should be concerned for possible threatening behavior
True:
The client experiencing severe anxiety can have feelings of confusion and impending doom. The client may feel the need to be aggressive and defensive, speaking with loud, rapid speech and possibly making threats and demands of others.
Name three signs and symptoms of serotonin syndrome and medications that can cause it.
Diaphoresis, agitation, restlessness, anxiety, hyperthermia, tachycardia, nausea, tremor, muscle rigidity, hyperreflexia, flushed skin.
SSRI, SNRI, Buspirone, Tricyclic antidepressants, MAOIs, Anti-migraine, Pain medications, Lithium, Illicit drugs, herbal supplements, Reglan
https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
Tongue thrusting, lip smacking, facial grimacing, eye blinking, involuntary pelvic rocking and hip thrusting movements are all examples of this
What is Tardive dyskinesia?
"My cake is a lake we went swimming in the pool hall" is an example of this manifestation
Associative looseness
Rationale: The client who is manifesting associative looseness has ideas that do not connect to each other and are expressed in garbled and illogical speech. This is a typical disturbance for the client who has schizophrenia.
Following crisis it is important for the nurse to assess if the patient has psychotic thinking for this reason
Clients experiencing a situational crisis are at greatest risk for injury to themselves or others; therefore, determining if psychotic thinking is present is the highest priority.
A patient with this disease will often participate in ritualistic behavior in order to decrease their anxiety to a tolerable level
What is OCD?
With OCD, obsessions give rise to anxiety, and the anxiety is then reduced by compulsive behaviors. Compulsive rituals are strengthened and maintained because they decrease the anxiety by terminating the event that gives rise to it.
This antipsychotic drug can cause agranulocytosis, which makes reporting signs of infection to the provider extremely important
What is thioridazine (Mellaril)?
A patient is taking antipsychotics and presents with muscle stiffness, this should be the nurses next step
What is notify the provider and stop all antipsychotic medications.
Rationale: Muscle rigidity is a manifestation of neuroleptic malignant syndrome, which is a potentially serious adverse effect of antipsychotics especially aripiprazole, and should be reported to the provider immediately.