Patho/Etiology
There is a single treatment to cure schizophrenia...True or False?
What is false, there are multiple modalities used
Name a positive symptom seen in schizophrenia
hallucinations, delusions, Disorganized Thinking (Manifested in Speech), or Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)
Name a second generation (atypical) antipsychotic medication used in schizophrenia
Risperdone, clozapine, aripiprazole, olazapine, etc..
Nursing diagnoses for someone suffering from schizophrenia
What is Disturbed sensory perceptions, social isolation, risk for violence, impaired verbal communication, ineffective health maintenance, disturbed thought process, self-care deficit
Match this intervention to a nursing diagnosis: "Encourage independence in ADLs, but intervene as needed. Offer recognition and positive reinforcement of patient after accomplishing ADLs"
Nursing diagnosis: Self-care deficit- psychotic disorders often interfere with self care!
Symptoms of schizophrenia often present at what stage or period of life?
What is symptoms generally appears in late adolescence and early adulthood HOWEVER they may appear later in life. Some studies indicate schizophrenia presents earlier in men!
Name a negative symptom seen in schizophrenia
Lack of Emotional Expression (Blunted affect, Lack of movement in head and hands that add expression in communication, Lack of intonation in speech), Decreased or Lack of Motivation to Complete Purposeful Activities (Avolition-Neglect of activities of daily living), Decreased Verbal Communication (Alogia), Decreased Interest in Social Interaction and Relationship (Asociality-Withdrawal,Poor rapport), Diminished Ability for Abstract Thinking (Concrete Thinking)
These are harder symptoms to treat!
Haldol, a first generation antipsychotic can cause a life- threatening syndrome as a adverse effect. What is the name of this syndrome?
What is neuroleptic malignant syndrome? It is an idiosyncratic reaction causing hyperpyrexia (is the main feature: temperature over 103°F), tachycardia, tachypnea, muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood pressure..this is life threatening!
Is this True or False: While caring for a patient living with schizophrenia and auditory and visual hallucinations the nurse should go along with delusions and agree so they don't anger the patient.
False! The RN should ask directly about auditory and visual hallucinations and present reality (but not argue with the patient). Attempt to focus the conversations on reality-based subjects. "I understand you think that is true", "I do not see anyone standing in the corner"
Discharge planning commences as soon as the patient is admitted. What are some support services a schizophrenic patient may require on discharge?
What is financial assistance, housing, legal assistance, home healthcare, caregiver support groups, respite care
This is a MAJOR concern with schizophrenia
What is safety?
Alterations in thought (delusions) are common in schizophrenia. Define Grandiosity.
The individual has an exaggerated feeling of importance, power, knowledge, or identity. The individual may believe that he or she has a special relationship with a famous person or even assume the identity of a famous person (believing that the actual person is an imposter). Grandiose delusions of a religious nature may lead to assumption of the identity of a deity or religious leader (e.g., “I am Jesus Christ”).
Second generation antipsychotics are currently the drug of choice for psychotic disorders. Name a side effect of second generation antipsychotics.
What is weight gain, sedation, sexual dysfunction, GI disturbance, headaches, anticholengeric effects (tachycardia, insomnia, dry mouth, constipation)
During the RN's assessment the patient reports hearing voices that are stating "kill all of the doctors". What is the priority while caring for this patient and what is this?
Safety! this patient is experiencing command hallucinations at risk for injury to self or others. The nurse may need to initiate a 1:1 or notify the provider
Your have established a nursing diagnosis of "Disturbed sensory perception" for your patient with schizophrenia. Name two possible interventions for this diagnosis.
Observe for signs of hallucinations (listening pose, laughing or talking to self, stopping in midsentence). Ask, “Are you hearing something else?” Or “Are you hearing other voices?”
Avoid touching the patient without warning him or her that you are about to do so
An attitude of acceptance will encourage the patient to share the content of the hallucination with you. Ask, “What do you hear the voices saying to you?”
Try to distract the patient from the hallucination.
How many phases of schizophrenia are there according to your textbook? (Page 443 in 10th edition)
Four! Premorbid, prodromal, active psychotic and residual phase
Name this speech alteration: words jumbled together with little meaning or significance to listener(ex: hip hooray the flip is cast)
Word salad. Other alterations in speech are clang association, echolalia, neologisms and associative looseness
EPS is another side effect of first generation/ typical antipsychotics. What would the RN monitor if they suspected EPS?
dystonia, akathisia, tardive dyskinesia and pseudoparkinsonism
What are two things patients should avoid consuming/buying while taking antipsychotic medications?
Alcohol and OTC medication can interact with antipsychotics. Alcohol should be avoiding completely. OTC medications should be approved by PCP (many interact with antipsychotics and can be harmful)
This is often a co-occurring problem with someone who has schizophrenia
What is substance use disorder?
Name environmental factors linked to schizophrenia
What are low socioeconomic status, cannabis use, stressful life events?
State the difference between auditory hallucinations and command hallucinations
Auditory hallucinations are "false perceptions of sounds" ie, voices, music, noises, etc. Command hallucinations are voices that issue commands to the patient and are potentially dangerous
Name two other medications a patient with schizophrenia may be prescribed to treat their symptoms?
antidepressants (depression), mood stablizing agents (positive/negative symptoms), benzodiazipines (anxiety) or third generation antipsychotics (positive/negative symptoms)
Why is pregnancy planning and teaching important to a patient taking antipsychotics?
Antipsychotics readily cross the placental barrier and cause adverse effects to a fetus. There are possible risks of taking antipsychotics while pregnant and safe use during pregnancy is not established. If pregnancy is suspected, planned or confirmed notify the physician.
This is the inability to realize one is ill—an inability caused by the illness itself. It is common in severe mental illness. It may lead the patient to resist or stop treatment, making care more challenging and frustrating to others. It can interfere with requesting or accepting help.
What is Anosognosia?
What are some general medical conditions that may cause psychotic symptoms?
Brain abscesses, Cerebrovascular disease, CNS infections, CNS trauma, Cushing’s syndrome, Deafness, Encephalitis, Fluid or electrolyte imbalances, Hepatic disease, Herpes encephalitis, Huntington’s disease, Hypoadrenocorticism, Hypoparathyroidism or hyperparathyroidism, Hypothyroidism or hyperthyroidism, Meningitis, Metabolic conditions (e.g., hypoxia; hypercarbia; hypoglycemia), Migraine headache, Neoplasms, Neurosyphilis, Normal pressure hydrocephalus, Renal disease, Systemic lupus erythematosus, Vitamin deficiency (e.g., B12)
What are negative and positive symptoms in schizophrenia?
Positive symptoms refer to symptoms that are present (“added”) in people with schizophrenia and not typically present in people without the disease. Negative symptoms are referred to as deficits or impairments (things “taken away” by the illness) in individuals with schizophrenia.
This is a movement disturbance that is more prevalent with first generation antipsychotics, is particularly troubling because it is a permanent, incurable side effect most of the time
What is tardive dyskinesia?
This is considered an essential evaluation for a patient with schizophrenia
What is suicidal risk assessment?
These therapeutic techniques attempt to decode incomprehensible communication patterns
What is seek validation and clarification?