Patho/Etiology
There is a single treatment to cure schizophrenia...True or False?
False! "Effective treatment requires a comprehensive multidisciplinary effort, including pharmotherapy and various forms of pyschosocial care" (Morgan & Townsend, 2020)
Name a positive symptom seen in schizophrenia
hallucinations, delusions, bizare behavior or speech alternations
Name a second generation (atypical) antipsychotic medication used in schizophrenia
Risperdone, clozapine, aripiprazole, olazapine, etc..
Name a nursing diagnosis for someone suffering from schizophrenia (hint: table 15.1)
Disturbed sensory perceptions, social isolation, risk for violence, impaired communication, ineffective health maintenance, disturbed thought process, etc
Match this intervention to a nursing dianosis: "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?
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
affect, energy, anhedonia, avolition (lack of motivation), (alogia) lack of speech
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? hint: NMS
neuroleptic malignant syndrome is an idiosyncratic reaction causing irregular pulse, tachycardia, tachypnea, muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood pressure..this is life threatening!
True or False: While caring for a patient living with schizophrenia and AVH the nurse should go along with delusions and agree so they dont anger the patient.
False! The RN should ask directly about AVH and present reality (but not argue with the patient). Attempt to focus the conversations on relaity-based subjects. "I understand you think that is true"
Discharge planning starts as soon as the patient is admitted. What are some support services a schizophrenic patient may require on discharge?
financial assistance, housing, legal assistance, home healthcare, caregiver support groups, respite care
The ___________ hypothesis suggests schizophrenia may be caused by excess of what neurotransmitter?
Excess of dopamine! Antipsychotics lower brain levels of dopamine by blocking dopamine receptors. Postmortem studies show a significiant increase of dopamine receptors in 2/3 of schizophrenia patients. However, other neurotransmitters play a role in the etiology.
Alterations in thought (delusions) are common in schizophrenia. Define Grandeur.
the patient believes they are all powerful or important, like a god
Second generation antipsychotics are currently the drug of choice for psychotic disorders. Name a side effect of second generation antipsychotics.
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?
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 goal of "Distubed Thought Process" for your patient with schizophrenia. Name two possible interventions for this diagnosis. (pg. 356)
Do not share their beliefs, do not argue, reinforce/focus on reality, mouth checks for cheeking, establish rapport, low stimuli, observe behaviors, etc
Name one environmental and one physical risk factor for psychosis
environmental: living in a city, lower social class, using drugs (cannabis and cocaine especially), stress
physical: genetics, viruses (autoimmune), CNS diseases, intrauterine
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
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)
The nurse is caring for a client with medication induced psychosis when the spouse asks "what medications cause psychosis?". What are some examples the nurse could tell the family?
Parkinsons drugs, anesthesia, opioids, steroids, muscle relaxers, antihistamines, etc. Psych meds like anticonvulsants and antidepressants can also raise dopamine and cause psychosis
Name a disease that could cause psychosis or psychotic symptoms
brain disease (encephalopathy, migraines, epilepsy) F&E imbalances, Herpes, syphilis, CNS infection/trauma, Lupus, Deafness, Cushings/Huntington's, hypo/hyperthyroidism, substance use disorder, vitamin deficiencies, etc
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? (hint: page 79 ATI)
antidepressants (depression), mood stablizing agents (positive/negative symptoms), benzodiazipines (anxiety) or third generation antipsychotics (positive/negative symptoms)
Why is pregnancy planning/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.
A client with schizophrenia has physician’s orders for haloperidol (Haldol) 5 mg. IM STAT and then 1 mg benztropine prn. Why is benztropine ordered?
to prevent and treat Extrapyramidal Symptoms (EPS) like restlessness (akathisia), trouble moving (akinesia), muscle spasms (dystonia), tardive dyskinesia and pseudoparkinsons