Nursing Assessment and Interventions for Bipolar, Schizophrenia and other psychotic disorders (review)

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What three characteristics distinguish mania from hypomania? (Hint: these relate to mood, positive signs, and interpersonal functioning)

1. Mania = expansive, extremely elevated mood vs Hypomania = not as expansive mood
2. Mania = psychosis present; hallucinations vs.
Hypomania = no psychosis, no hallucinations
3. Mania = difficult to function (socially, in occupation, disturbs sleep and eating patterns) vs. Hypomania = more functional because of less severe disturbances to sleep, eating, social and occupational aspects of life

What are the three stages of mania? Name three defining characteristics of each stage.

1. Hypomania: increased libido, extroversion, increased distractability (others include loudness, laughing a lot, lacking depth of personality, flightiness, being very cheerful)

2. Acute Hypomania: being extremely "high on life", emotionally labile, pressured speech (others include racing thoughts, poor attention span, grandiose delusions, decreased sleep, excessive spending, auditory or visual hallucinations of music, hyper-sexuality, and poor hygiene)

3. Delirious Mania: sleep deprivation, disorientation and confusion, extreme lability of mood

Wandering in busy traffic and jumping off subway platforms on to electric rails are examples of what stage of mania?

Stage 3, Delirious Mania

A patient unbuttoning her shirt in front of an interviewing nurse or inappropriately touching a physician would be viewed as behavior from what stage of mania?

Stage 1, Hypomania

Hearing music in the distance, spending $3,000.00 on halloween decorations on Ebay in one night, and theorizing that the universe is held together by invisible spiderwebs are hallmark thoughts and behaviors of which stage of mania?

Stage 2, Acute Hypomania

Which kind of bipolar patients may benefit from using ECT instead of psycho-pharmaceuticals? (Hint: sex of patients matter in a certain stage of life)

Pregnant women

Why is it not a good idea to give bipolar patients only antidepressants (without mood stabilizers)?

Because antidepressants affect the serotonin levels in the patient's brain and can put them into a manic state without the balancing effect of mood stabilizers

A patient with bipolar disorder complains that he is not able to sleep because his thoughts are racing and he feels the need to keep moving his legs. What are the best nursing interventions you could offer the patient? Select three.

1. Offer patient a Unisom sleeping pill.
2. Ensure that the patient's room is kept dimly lit and quiet during night time hours.
3. Offer earplugs and an eye mask.
4. Establish a sleeping and waking routine with predictable night time routines, over a period of several days.
5. Engage the patient in a 30 minute spinning class an hour before bedtime to use up excess energy.

2, 3, 4; these interventions ensure that the patient's environment limits stimuli that would disturb sleep and creates a predictable night time routine that helps facilitate the psychological component of preparedness to sleep (See Disturbed sleep pattern diagnosis in NANDA book for more good interventions)

A patient becomes agitated, aggressive and threatens to throw his belongings at nurses and other patients on the floor. As a nurse, what can you do to de-escalate his behavior? Choose all that apply.
1. Calmly talk to the patient and convince him to do jumping jacks with you.
2. Offer the patient pillows to punch.
3. Argue with him and tell the patient that he has no right to endanger your safety.
4. Leave the room when it becomes imminent that he will throw the chair and seek the help of other staff or family members, then return in a few minutes after it seems he has calmed down.
5. Emphasize expectations of appropriate behavior while at the hospital and the consequences of not meeting those expectations.

1, 2, 4, 5; these are distraction techniques that offer a non-threatening way to deal with the patient's behavior. 4 is a means of safely exiting the scene and gaining help in a non-confrontational way (See Risk for Violence in NANDA book for more intervention ideas)

Your patient has not eaten much for two days. You are worried about their nutrition and want to intervene. What are the best actions you can take? Select all that apply.
1. Make food readily available to the patient as snack boxes, 24 hours a day.
2. Offer familiar, favorite and finger foods often.
3. Make the patient sit alone at mealtimes so you can closely observe their eating habits.
4. Serve food restaurant style (portions predetermined), as opposed to family style (self-serve).
5. Monitor and record patient's food intake only at meal times and not during snack times.

1, 2. Number 4 is not a good answer because this doesn't emphasize the patient's choice and independence. Family style food serving is also associated with increased intake. (See Imbalanced Nutrition, less than body requires in NANDA book)

While you are trying to get a patient's psychosocial history, the patient continually says that he hears the soundtrack to his life playing in the distance, and states, "it's awesome, my life is a movie playing on the Sundance Channel". He also states that he is has been gifted with the ability to fast forward time and create time warps. How do you respond to his behavior? Select all that apply.
1. "You may be hearing music but I don't hear any music. We are in a room that is quiet."
2. "What do you mean you hear music? What is it like? Is Def Leppard playing? Are the musicians singing about you?"
3. "Tell me when you started to feel this way, that your life was a movie playing on the Sundance Channel.
4. "I understand that you think you have these special powers, but I need to continue to ask you questions. Please help me answer them."
5. "You can't fast forward time. I dare you to do that right now."

1,3,4; these use therapeutic communication techniques to set boundaries, present reality in a non-confrontational way and not challenge his delusions

What are the four phases of schizophrenia?

1. Schizoid personality
2. Prodromal phase
3. Schizophrenic phase
4. Residual phase

At what phase of the four schizophrenia phases can the disorder be "reversed" or better controlled?

Phase 2, prodromal

What are some key characteristics of the prodromal phase of schizophrenia?

Person does not verbalize delusions, though they are more socially isolated than in the previous stage, they are more guarded and develop more strange mannerisms or speech patterns

Identify the schizophrenia type by the description:
Symptoms set in at or under 25 yrs, patient has poor personal hygiene and repeats words or phrases often, is difficult to communicate with; the patient may have strange physical habits, like constantly pulling on earlobes or hand clapping.

Disorganized

Identify the schizophrenia type by the description of behavior:
Patient moves very slowly, rarely speaks if at all, voids all over themselves, and when walking to the day room will sometimes "freeze" in place for an extended period of time.

Catatonic (patient's behavior is "catatonic stupor")

What are five characteristic symptoms of schizophrenia?

1. Delusions 2. Hallucinations 3. Disorganized speech (frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (avolition, alogia, flattened affect)

How do neuroleptics like haloperidol and chlorpromazine reduce schizophrenic symptoms in patients?

They lower levels of dopamine in the brain by blocking dopamine receptors.

Which psychotic disorder has symptoms that are a blend of both schizophrenia and a mood disorder?

Schizoaffective disorder

What definitive symptom do schizoaffective patients have that schizophrenic patients do not?

Mood swings

Symptoms of this disorder last at least one day but less than one month and are usually sudden onset that may or may not be preceded by a psychosocial stressor. Name this disorder!

Brief psychotic disorder

How is schizophreniform disorder different from schizophrenia? (hint: think duration)

Symptoms of schizophrenia that correlate to the stages of schizophrenia last for at least one month but less than 6 months. The diagnosis changes to schizophrenia when the patient has had the symptoms for more than 6 months.

Delusional disorders have which of the following characteristics?
1. Prominent hallucinations
2. Flat affect
3. One or more non-bizarre delusions
4. Delusions that persist for at least 1 month

3, 4; Hallucinations may or may not be present and when they are, they are not prominent. Flat affect is not a characteristic of this disorder.

What common drugs may induce psychosis? Select from the following:
1. Alcohol, amphetamines, antihistamines, and antimicrobials
2. Corticosteroids, chemotherapy agents, carbon dioxide and caffeine
3. Muscle relaxants, sniffing paint, anticonvulsants, and placebos

1. Placebos and caffeine do not cause psychosis, but everything else listed has been shown to do so (refer to chart in book, p. 498)

What of the following are classified as negative symptoms of schizophrenia? Select all that apply.
1. Laughing at a funeral
2. Bad breath and foul odor from body because of lack of personal hygiene
3. Pacing the halls and rocking in a chair
4. Not speaking (mutism)
5. Paranoia that there are "bugs in the ceiling"

1,2,3.
4,5 are positive symptoms (see p. 499 in book)

What nursing diagnosis would you assign to the following behaviors? Withdrawal, sad affect, preoccupation with own thoughts, and expressions of feeling alone or rejected.

Social Isolation

If a client is highly suspicious, which of the following can you do to promote trust?
1. Use the same staff as much as possible
2. Touch the client to reassure them.
3. Provide canned food with a can opener and serve foods family style.
4. Play competitive games like Monopoly or Scrabble.
5. Maintain a friendly, cheerful attitude.

1, 3. The other options can degrade trust among a suspicious patient.

A short term goal for the nursing diagnosis of Disturbed Sensory Perception: Auditory/Visual would be: (select one)
1. The patient will discuss the content of the hallucinations with the nurse within one week.
2. The patient will be able to define and test reality.
3. The patient will verbalize the understanding that the voices are a result of his or her illness and demonstrate ways to interrupt the hallucination.

1. The patient will discuss the content of the hallucinations with the nurse within one week.

Milieu therapy emphasizes a patient's rights to set _____ and and to have _______ of movement and _______ relationships with staff.
1. Boundaries, ability, healthy
2. Goals, freedom, informal
3. Cultural beliefs, laterality, comfortable

2. Goals, freedom, informal (see p. 509)

True or False:
Drugs are typically successful in treating positive symptoms of schizophrenia but not as effective in treating negative symptoms.

True.

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