NURS 222 Week 2

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What is schizophrenia and what is the average lifespan?
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Terms in this set (90)
What is schizophrenia and what is the average lifespan?
- thought disorder
- average lifespan on 53 years
If a person has a mental disorder, what should the nurse do FIRST?
- Assess: medications, alcohol withdrawal, UTIs, sepsis, dementia, injury, trauma
Cormorbidity
-the appearance of multiple simultaneous psychological disorders in the same person
-Substance abuse disorders
Nicotine dependence
Alcohol abuse
Anxiety disorder (OCD)
Major Depressive Disorder
Physical illness
Suicide
Brain Structure Abnormalities Course of the Disorder: Prodromal
Early symptoms
¡ Decrease functioning's, onset of psychotic symptoms- hallucinations, delusions, eccentric (odd), social withdrawal, irritable, anxious
¡ Fast onset= increases morbidity
¡ The younger the patient is onset, the worse the prognosis
Neurobiological and brain abnormality theory
- common among schizophrenics
- Disruptions in the pathways of the brain is schizophrenia are thought to be severe. It is possible that structural abnormalities cause such disruptions.
Structural brain abnormalities such as:
-Enlargement of the lateral cerebral ventricles, Third ventricle dilation, and/or ventricular asymmetry
-Reduction in the cortical, frontal lobe, hippocampal and/or cerebellar volumes
-Reduced cortical thickness and reduced connectivity in various brain regions
-Increased dopamine activity in the mesolimbic system (good to know these facts)
Phases of Schizophrenia: Phase 1
- Acute
- Onset or exacerbation of symptoms - premorbid symptoms, hallucinations, delusions, disorganized behavior, perception problems = may need hospitalization
Phases of Schizophrenia: Phase 2
- Stabilization
- Symptoms diminishing
- Movement toward previous level of functioning
Phases of Schizophrenia: Phase 3
- Maintenance
- At or near baseline functioning- get person on discharge = outpatient level of care, follow up with psychiatrist, get pt to stay on meds, and prevent reoccurance of hospitalization
DSM-5 Criterion
-Symptoms present for at least 6 months
-Active-phase symptoms present at least 1 month.
-Symptoms are defined as positive and negative
Positive Symptomsnormal functioning individual, it is something that is added on or extrapositive symptoms of schizophreniadelusions, alterations in speech, alterations in perceptiongrandiose delusionsfalse, persistent beliefs that one has superior talents and traits "I am the best instructor"persecutory delusionsbeliefs of being targeted by othersreferential delusionsthe belief that external events have special meaning for the person "they're pretty into me"somatic delusionsbelieves that his body is changing in an unusual way "I'm growing a third arm" "I have words eating my stomach"jealous delusionsdelusions that the individual's sexual partner is unfaithful "I just know they are cheating on me"nihilistic delusionsinvolve the conviction that a major catastrophe will occur "the government is after me, and will put a chip in my brain"Erotomanic delusionspatently false beliefs that another person, often someone famous or of higher status or authority, is in love with the individualclang associationsrhythmic patterns associated with psychotic speechword saladIncoherent mixture of words, phrases, and sentencesneologismsmade up wordsecholaliaautomatic and immediate repetition of what others sayinsertion symptomsinsert thoughtswithdrawaltake away thoughtsDepersonalizationfeelings of detachment from one's mental processes or body Ex) I feel like I'm watching my life like it's a movie, do I exist, who am I, I am nobody and everybody is, I feel like I am floating on earthDerealizationexperiences of unreality or detachment with respect to surroundings, environment, the world Ex) This room seems so bigger than it used to, is the furniture smaller, I feel like I am in a dreamlike statHallucinations- bodily sensations without external stimuliAuditory (Command) Hallucinationsmost common* -hearing sounds that are not presentVisual Command Hallucinations- Seeing something that is not presentTactile Command Hallucinations- Feeling something that is not presentOlfactory Command Hallucinations- Smelling something that is not presentGustatory Command Hallucinations- Tasting something that is not presentCatatonia-a state of unresponsiveness to one's outside environment - use lorazepam (Ativan)Echopraxiaimitating another's actionsnegative symptoms of schizophrenia (start with A)the absence of appropriate behaviors (expressionless faces, rigid bodies) -anhedonia, avolition, anergia, alogia, affectAnhedoniainability to feel pleasureAvolitionlack of motivationAnergialack of energyAlogialack of speechAffect-lack of expression -Flat -Blunted -Inappropriate -Bizarrejudgmentpoor choices, poor decisionsinsightunderstandingAffective symptoms (mood disorder)-Anxiety -Dysphoria- unease, dissatisfaction -Suicidality -Agitation -Assessment for depression is crucial -----May herald impending relapse -----Increases substance abuse -----Increases suicide risk -----Further impairs functioningSchizotypalpersonality disorder, eccentric (odd)Schizophreniformschizo features fewer than 6 monthsSchizoaffectivecognitive and mood disorderA patient with schizophrenia says, "There are worms under my skin eating the hair follicles." How would you classify this assessment finding?positive symptomYou believe that the young man you are admitting to your unit is suffering from command hallucinations. What would be some questions to ask him?-Tell me more -Who's voice is it -Schizophrenic could have ineffective copingPositive symptoms nursing diagnoses-Disturbed sensory perception -Disturbed thought process -Risk for self-directed or other-directed violence -Impaired verbal communicationNegative symptoms nursing diagnosesSocial isolation Chronic low self-esteemAfter an acute admission, discharge is being planned for this patient. What are some things that need to be considered?Environment at home, safety, referrals, resources availablePresident Obama is in love with me, he should leave Michelle and be with me."Grandiose, erotomaniacThe FBI is following my every move because I killed the presidentpersecutory"The voices are getting louder; I can't stand it anymore!"auditory hallucinations"The doctor removed my organs and replaced them with someone else's organs" (no observable scars)somatic delusion"I see shadows walking back and forth by that window"visual hallucinationsFrontal lobebehavior, intelligence, memory, movementFrontal lobotomytake out frontal lobe due to behavioral issuesMechanisms of Action of Antipsychotic Medications First-Generation Antipsychotics-Dopamine antagonists (D2 receptor antagonists) -Target positive symptoms of schizophreniaSide effects of First-Generation Antipsychotics-Extrapyramidal side effects occur at occupancy > 80% -Anticholinergic side effects (warm and dry)- dry mouth, dry skin, blurred vision, urinary retention, dizziness, confusion = risk for falls or injury/ orthostatic hypotension -Do not handle heavy machinery, or drive -Photosensitivity- sunscreen, sunglasses -Tardive dyskinesia -Weight gain, sexual dysfunction, endocrine disturbancesTypical/first generation antipsychotics- Most end in -zineLow potency typical antipsychotics- need more mg - Chlorpromazine (Thorazine) - Thioridazine (Mellaril) - Mesoridazine (Serentil)Side effects for low potency typical antipsychotics-HIGH: sedation, anticholinergic, hypotension -LOW: EPSEsHigh potency typical antipsychotics (HFTT PLMP)Haloperidol (Haldol) Fluphenazine (Prolixin) Thiothixene (Navane) Trifluoperazine (Stelazine) Perhenazine (Trilafon) Loxapine (Loxitane) Molindone (Moban) Pimozide (Orap)Side effects for high potency typical antipsychotics-LOW: Sedation, Anticholenergic -HIGH: EPSEs (high vs low potencyFirst-Generation Antipsychotics Long Acting Depot Therapy-Haloperidol Decanoate (Haldol Decanoate) Q4 Weeks - Fluphenazine Decanoate (Prolixin Decanoate) Q2 to 4 WeeksMechanisms of Action of Second-Generation Antipsychotics- Treat both positive and negative symptoms - Fewer to no extrapyramidal side effects (EPS) or tardive dyskinesiaUses of Atypical Agents- Schizophrenia and psychotic spectrum illness - Differential for first episode patients - Bipolar disorder, depressed, mania, maintenance - Behavioral disruptions connected to dementia - Irritability with autism - Tourette's disorder - Anorexia nervosa - Borderline Personality DisorderAtypical/ Second-Generation Antipsychotics-ends in -apine and -done -Clozapine (Clozaril, FazaClo) ) -Olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv) -Quetiapine (Seroquel) -Risperidone (Risperdal, Risperdal M-Tab) -Paliperidone (Invega) -Ziprasidone (Geodon)Ziprasidone (Geodon)- Increases/ prolongs QT waves (arythmias) - Do an EKG prior, pulse, palpitations - Take with food (500 cals or more)Clozapine (Clozaril, FazaClo)S/E: - Agranulocytes- life threatening - Decrease in WBCs and neutrophils - Sedation - Wt gain - Hypersalivation WBC range: 4,500-11,000 Neutrophils range: 1,500- 8,000 ¡ Give meds when in range ¡ Hold, document, and notify MD when out of rangeSecond-Generation Antipsychotics Depot Therapy-Long Actingo Risperidone Consta (Risperdal Consta) ¡ Q2 Weeks o Paliperidone Sustenna (Invega Sustena) ¡ Q 4 Weeks o Zyprexa Relprevv (Q2 or Q4 weeks depending on the dose) Monitor for 3 hours after injectionThird-Generation AntipsychoticAripiprazole (Abilify) o Quick disolve: dismelt o Long acting injection: Maintena every 4 weeks o Improves positive and negative symptoms and cognitive function o Minimal risk for EPS, tardive dyskinesia or hyperprolactinemia. o Common side effects are insomnia and akathisiaExtrapyramidal Side Effects (EPS) and Interventions (list them)-Acute dystonia -Akathisia -Pseudoparkinsonism -Tardive dyskinesiaAcute dystonia-occurs withing 48 hours usually among 1st gen antipsychotic -muscle rigidity -muscle contractions (torticollis) -back spasms (apisthotonos) -prolonged involuntary upward -movement of the eyes (oculogyric crisis) -laryngospasm = call rapid response teamHow do you treat acute dystonia?ABCs/TBD IM Artane (trihexyphenidyl) Benadryl (diphenhydramine) Congentin (benztropine)Akathisia- occur after 3 weeks after treatment - cannot stay still, lower body restlessness (tapping leg or foot)How do you treat Akathisia?ABCs/TBD IM Artane (trihexyphenidyl) Benadryl (diphenhydramine) Congentin (benztropine)Pseudoparkinsonism- occur after 3 weeks after treatment -Tremors -masklike appearance -drooling -rigidity -pill rolling -shuffling gaitHow do you treat Pseudoparkinsonism?ABCs/TBD IM Artane (trihexyphenidyl) Benadryl (diphenhydramine) Congentin (benztropine)Tardive dyskinesia-Abnormal invol movements mainly of face and trunk -Excessive blinking -Grimacing -Lip smacking -Tongue protrusion -Thrusting -Use AIMS (abnormal invol movement scale)Metabolic syndromewt gain, metabolic derangement, type II DM, increase lipids.Neuroleptic malignant syndrome (NMS): Medical Emergency FARM:Fever Autonomic- increased vitals Renal Muscle Rigidity) -Rare- usually happens during first generation -Hold medication: Life threatening-> seizure Use cooling measures-> not heatThe nursing student heard in report that her patient had "Loose associations" Which indication is the nurse referring to? paranoia. mood instability. depersonalization. poorly organized thinking.poorly organized thinking.The nurse is admitting a patient in the locked unit after a suicide attempt. Which assessment finding represents a negative symptom of schizophrenia? Avolition Delusion Poor memory recall HallucinationAvolitionA nurse is caring for a pt who has schizoaffective disorder. Which of the following statements indicate the client is experiencing derealization? A. "My thoughts do not feel like my own." = thought insertion B. "I am a superhero and I am immortal." = grandiose C. "I know that you are stealing my thoughts." = thought withdrawal D. "I feel like I'm in a dream, observing others."DA nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which action should the nurse take first? A notify the nurse manager B. Provide an in-service program about confidentiality C. Tell the nurse to stop discussing the behavior D. Complete and incident reportCA nurse is caring for a pt who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medication to help with negative symptoms? A. Thiothixene (Navane) B. Chlorpromazine (Thorazine) C. Risperidone (Risperdal) 2nd gen med D. Haloperidol (Haldol)C. Risperidone (Risperdal)A nurse is researching the etiology of schizophrenia. Which of the following supports the neurobiological and brain abnormality theory? Select all that apply. A. Enlarged lateral ventricles B. Prenatal exposure to the influenza virus C. Low socioeconomic status D. Increased dopamine activity in the mesolimbic system E. Venticular asymmetry F. Third ventricle atrophyADE