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
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
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:
Tardive Dyskinesia (TD) - clinical manifestations include?
Treatment includes?
Involvuntary tonic movement- usually spams in the face and jaw
Tounge and lip-smacking
Uncontrollable biting, chewing or sucking motions
STOP Medication!
Medications are same as with EPS - benztropine, trihexyphenidyl, diphenhydramine
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
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
Stimulant (meth, cocaine, etc) abuse can lead to patients experiencing what types of complications?
Hallucinations
Violence/Aggression (potential for violence)
Impaired judgment
Severe to panic levels of anxiety
What are foods/products a client should avoid when taking disulfiram?
What are signs they may have consumed alcohol when taking this medication?
Anything containing alcohol:
- mouthwash
- hand sanitizer
-food extracts
- cough medicine
Signs: Flushing, headache, nausea and vomiting, hypotension, diaphoresis, tachycardia, vertigo
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
Clients experiencing anxiety tend to have an increase in what neurotransmitters?
Serotonin & Norepinephrine
Goals for treatment of a patient with OCD include what?
Reduction of the compulsive behavior
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
When working with patients who have a substance abuse diagnosis, what are some ways we can help with relapse prevention?
- Identify triggers
-Practice health coping skills
-Role play potentially triggering situations
-Develop a plan AHEAD of time
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 NMS (FEVER)
Buspirone works on what receptors? What types of situations do we use this medication for?
Serotonin
Long-term treatment of anxiety
Benzo work on GABA and can be used in acute situations
SSRI or SNRI
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
Alcohol withdrawal can begin during what time frame?
Opioid withdrawal can begin during what time frame?
Alcohol: 8-12 hours after the last drink (or significant decreased consumption)
Opioids: as little as 1 hour; but various (can sometimes be as long as 12 hours)