What is Schizophrenia?
Which of the following is NOT a “high offender” neurotransmitter associated with Schizophrenia.
a. glutamate
b. norepinephrine
c. dopamine
d. serotonin
Answer: B. Norepinephrine
Dopamine, serotonin and glutamate are the high offenders
This type of therapy includes providing a structured, safe environment for patients in order to decrease anxiety and to distract patients from constant thinking about hallucinations.
Milieu therapy
Which antipsychotic medication class has the least impact on negative symptoms of schizophrenia and high levels of side effects?
First-generation antipsychotic medications primarily effect positive symptoms with little effect on negative symptoms. Second generations can treat both negative and positive symptoms with less side effects.
What are the four types of EPS symptoms from 1st or 2nd generation antipsychotic medications?
1. Acute Dystonia
2. Akathisia
3. Pseudoparkinsonism
4. Akinesia
Which of the following is a community-based support group for patients with schizophrenia
A. Alcoholics Anonymous
B. National Alliance on Mental Illness
C. SAFE-T
D. Mothers Against Drunk Driving
Answer: B. National Alliance on Mental Illness (NAMI)
What type of therapy can address cognitive deficits in patients and help to increase their ability to function?
Cognitive therapy
Name and describe 3 types of hallucinations.
Visual: seeing persons or things
Olfactory: smelling odors
Gustatory: experiencing tastes
Tactile: feeling bodily sensations
Give one example of using appropriate communication to address hallucinations and delusions in the patient experiencing psychosis.
Ask the client directly about hallucinations. Do not argue or disagree.
Do not argue or with a client's delusions but focus on patients' feelings and reorient to reality.
Ask the client direct questions about paranoia.
A patient with a history of schizophrenia taking Clozapine, starts complaining of a fever, chills, a sore throat and weakness. What side effect is he likely experiencing?
Agranulocytosis, a serious and life-threatening condition, is most associated with Clozapine. Symptoms of Agranulocytosis include signs of infection such as fever, chills, malaise and body aches. Those individuals taking this medication should have neutrophil monitoring.
This is an acute life-threatening medical emergency. The client with schizophrenia presents with: Severe Muscle Rigidity, decreased responsiveness, and is excessively sweating. With the following Vital Signs: Temperature is 104 F, Heart Rate is 120, BP is 140/100
A. Agranulocytosis
B. Metabolic Syndrome
C. Neuroleptic Malignant Syndrome (NMS)
D. Fatal blood Dyscracia
Neuroleptic Malignant Syndrome (NMS)
Describe services provided by the ACT team.
Case management, medication management, intensive wrap around services to assist clients with community living needs.
Which support group would a person with schizophrenia benefit most from?
a. NAMI Peer to Peer Group
b. NAMI Family Support Group
c. AA meeting
d. Unity Recovery Meeting
a. NAMI Peer to Peer Group
NAMI is the National Alliance on Mental Illness. A Peer to Peer group is beneficial for individuals living with schizophrenia, whereas a Family Support Group is for family members or loved ones of someone with schizophrenia. AA is for alcoholics and Unity Recovery focuses on all types of recovery, may not be specific enough
Individuals with this type of delusion believe that their thoughts are heard by others.
Thought broadcasting
Name and give examples of least restrictive to most restrictive methods of addressing a patient with psychosis who is displaying high levels of agitation and aggression.
Verbal de-escalation, offering prn medication, remove from stimulating environment, close obs, one to tone, seclusion and restraints.
A patient is taking Haloperidol for schizophrenia. Which screening tool would the nurse use to assess for tardive dyskinesia?
Abnormal Involuntary Movements Scale (AIMS)
This side effect can present with the following 4 symptoms below.
-Acute painful contractions of tongue, face, neck and back.
-Spasms of the muscles causing backward arching of the head and neck-TORTICOLLIS.
-Oculogyric crisis
-This side effect can threaten the airway
ACUTE DYSTONIC REACTION
Name 4 things to teach a patient with schizophrenia regarding early warning signs of relapse
1. sleep disturbance
2. troubling thoughts,
3. difficulty thinking or remembering,
4. hearing voices,
5. becoming more uncomfortable around others,
6. being unsure of what is real
This is an evidence-based therapeutic intervention for patients and their loved ones that provides information and cope with illness.
Psychoeducation
A patient diagnosed with schizophrenia says, “I think the CIA is following my every move. Put away your cell phone, they’re listening to everything we say.” This patient is having a disturbance in which assessment?
Thought Content
A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should the nurse use first?
Ask the client about any previous problems with psychotropic medications.
This class of antipsychotic medications has the greatest risk for metabolic syndrome.
Second-generation/atypical antipsychotics
NAME ONE SIGN AND SYMPTOMS OF AKATHISIA, ONE PHARMACOLOGICAL INTERVENTION, AND ONE NONPHARMACOLOGICAL INTERVENTION
B. ROCKING WHILE SITTING, GIVE PROPANOLOL, DO RELAXATION TECHNIQUES,
(CAN ALSO GIVE LORAZAPAM OR DIAZEPAM)
Name 3 important topics to teach a family and patient regarding relapse prevention?
1. Medication Adherence
2. managing stress through stress avoidance
3. relaxation techniques
4. Sleep hygiene
Name three health teaching areas for individuals experiencing psychosis.
Understanding of the disorder
need for self-care to prevent relapse
medication effects, adverse effects, and importance of adherence
Abstinence from drug or alcohol use
Which individual is among the highest prevalence for the onset schizophrenia?
late teens to early twenties
Name two interventions for a patient with schizophrenia who presents avolition.
Prompt client to complete ADLS
Assist client with ADLs when needed.
A patient taking Fluphenazine starts complaining of restlessness and is unable to remain still. He seems agitated, anxious and unable to sleep. The nurse also witnessed him pacing around the room. What medication can be given to treat this side effect?
Propranolol or Lorazepam, Cogentin
Give antiparkinsonian agent as ordered lorazepam. Propranolol (Inderal), Lorazepam (Ativan), or diazepam (Valium) may be used.
A patient has been on prolong treatment of first generation antipsychotic medication. The patient has involuntary rhythmic movements that are slow & snake like movements. Her hips jerk and twist occasionally. She has a protruding or writhing tongue with smacking lips alternating with grimaces.
What problem is most likely occurring?
Tardive Dyskinesia
Name four ways to teach stress management for a patient with schizophrenia.
1. Avoid loud or stressful places or activities
2. going for a walk
3. meditation
4. reading or listening to music
5. taking a hot bath
Described the use of long-acting injectable antipsychotics for the person with psychosis who is non-adherent to oral medication.
Patients with poor oral med adherence should be counseled on LAIs
Before administering an LAI, make sure that the patient has tolerated the oral form without significant side effects.