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nur 202 MODULE A - Schizophrenia and Other Psychotic Disorders part II

Application of the Nursing Process Assessment: Content of thought
- Delusions:False personal beliefs
-Religiosity:Excessive demonstration of obsession with religious ideas and
-Paranoia:Extreme suspiciousness of others
-Magical thinking:Idea that if one thinks something, it must be true
Form of thought -Associative looseness:
Shift of ideas from one unrelated topic to another
Form of thought-Neologisms:
Made-up words that have meaning only to the person who invents them Nupher
Form of thought -Concrete thinking:
Literal interpretations of the environment
Form of thought -Clang associations:
Choice of words is governed by sound (often rhyming)
Form of thought -Word salad:
Group of words put together in a
random fashion
Form of thought-Circumstantiality:
Delay in reaching the point of a communication because of unnecessary and tedious details "More money from
corn to carry bottles for all the little
children of paradise."
Form of thought-Tangentiality:
Inability to get to the point of
communication due to introduction of many new topics
Form of thought-Mutism:
Inability or refusal to speak
Form of thought -Perseveration:
Persistent repetition of the same word or idea in response to different questions
Form of thought-Perception: Hallucinations:
False sensory perceptions not associated with real external stimuli.
Form of thought-Perceptions: Illusions:
Misperceptions of real external stimuli
Affect: Emotional tone
-Inappropriate affect:
Emotions are incongruent with circumstances
Affect: Emotional tone -Bland or flataffect:
Weak emotional tone
Affect: Emotional tone -Apathy:
Lack of interest in environment
!Sense of Self:
The uniqueness and individuality
a person feels
Repeating words that are heard
Repeating movements that are
Sense of Self-Identification and imitation:
Taking on the form of behavior one observes in another
Sense of Self-Depersonalization:
Feeling of unreality
Sense of Self-Volition:
Impairment in ability to imitate goal-
directed activity
Sense of Self-Emotional ambivalence:
Coexistence of opposite emotions toward same object
Impaired interpersonal functioning and relationship to the external world
-Autism:the focus inward on a
fantasy world while distorting or
excluding the external environment
-Deterioration in appearance:
impaired personal grooming and
self-care activities
Psychomotor behavior -Anergia:
Deficiency of energy
Psychomotor behavior -Waxy flexibility:
Passive yielding of all movable parts of the body to any effort made at placing them in certain positions
Psychomotor behavior -Posturing:
Voluntary assumption of inappropriate or bizarre postures
Psychomotor behavior -Pacing and rocking:
Pacing back and forth and rocking the body
Associated features -Anhedonia:
Inability to experience pleasure
Associated features -Regression:
Retreat to an earlier level of development
Positive and negative symptoms
-Positive symptoms:
Excess or distortion of normal functions
e.g., Hallucinations and delusions
Positive and negative symptoms-Negative symptoms:
Deficitor loss of normal functions
e.g., Flat affect; anhedonia
Nursing Diagnosis: Disturbed thought processes
related to
inability to trust, panic anxiety, possible hereditary or biochemical factors
Nursing Diagnosis: Disturbed Sensory-Perceptual: Auditory and visual related to
panic anxiety, extreme
loneliness, and withdrawal into self
Nursing Diagnosis: Social isolation related to
inability to trust, panic anxiety, weak ego development, delusional thinking, regression
Nursing Diagnosis: Risk for Violence: Self-directed or other-
directed related to:
-Extreme suspiciousness
-Panic anxiety
-Catatonic excitement
-Rage reactions
-Command hallucinations
Nursing Diagnosis: Impaired verbal communication related to:
-Panic anxiety
-Disordered unrealistic thinking
Nursing Diagnosis: Self-Care Deficit related to:
-Panic anxiety
-Perceptual or cognitive impairment
-Inability to trust
Disabled family coping
related to
difficulty coping with client's illness
Nursing Diagnosis: Ineffective health maintenance related to
disordered thinking or delusions
Nursing Diagnosis: Impaired home-maintenance related to:
-Lack of knowledge or resources
-Impaired physical cognitive functioning
Schizophrenia and Other Psychotic Disorders: Outcomes: The client:
-Demonstrates an ability to
relate to others satisfactorily
-Recognizes distortions of reality
-Has not harmed self or others
-Perceives self realistically
-Demonstrates ability to perceive the
environment correctly
-Maintains anxiety at a manageable level
-Relinquishes need for
delusions and hallucinations
-Demonstrates ability to trust others
-Uses appropriate verbal communication in interactions with others
-Performs self-care activities
Nursing interventions for the client with schizophrenia or other psychotic disorder are aimed at:
-Decreasing anxiety and establishing trust
-Assisting client to define and test reality
-Encouraging interaction with others
-Ensuring safety of client and others
-Meeting client's self-care needs
-Promoting adaptive family coping
-Some institutions are using a case
management model to coordinate care. In case management models, plan of care may take the form of a critical pathway.
Client/Family Education: Nature of the illness
-What to expect as illness progresses
-Symptoms associated with illness
-Ways for family to respond to behaviors associated with illness

Client/Family Education: Management of the illness
Connection of exacerbation of symptoms to times of stress
-Appropriate medication management
-Side effects of medications
-Importance of not stopping medications
Management of illness
-When to contact health care provider
-Relaxation techniques
-Social skills training
-Daily living skills training
Client/Family Education: Support services
-Financial assistance
-Legal assistance
-Caregiver support groups
-Respite care
-Home health care
!Evaluation questions
-Has client established trust with at least one staff member?
-Is anxiety level maintained at a manageable level?
-Is delusional thinking still prevalent?
-Is client able to interrupt escalating anxiety with adaptive coping mechanisms?
-Is client easily agitated?
-Is client able to interact with others
Treatment Modalities: Psychological Treatments: Individual psychotherapy
Long-term therapeutic approach difficult because of client's impairment in
interpersonal functioning
Treatment Modalities: Psychological Treatments: Group therapy:
Some success if participating over the
long-term course of the illness; less successful in short-
term treatment
Treatment Modalities: Psychological Treatments: Behavior therapy:
Chief drawback has been inability to generalize to community setting after
client has been discharged home from therapy
Treatment Modalities: Psychological Treatments: Social skills training:
Use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture, and so on, aimed at improving relationship development
Treatment Modalities: Social Treatment -Milieu (environment) therapy:
Best if used in conjunction with
Treatment Modalities: Social Treatment -Family therapy:
Aimed at helping family members
cope with long-term effects of illness
Treatment Modalities: Assertive Community Treatment
(ACT) A program of case management that takes a team approach in providing comprehensive, community-based
psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness.
Treatment Modalities: Assertive Community Treatment (ACT) Services include:
-Substance abuse treatment
-Psychoeducational programs
-Family support and education
-Mobile crisis intervention
-Attention to health-care needs
Treatment Modalities: Assertive Community Treatment (ACT): Services are provided by a multidisciplinary team of:
-Social workers
-Vocational rehabilitation therapists
-Substance abuse counselors
-Services are available 24 hours
a day, 365 days a year
Treatment Modalities: Assertive Community Treatment (ACT): Services are provided wherever assistance by the client is required:
-In the person's home
-Within the neighborhood
-In local restaurants
Treatment Modalities: Assertive Community Treatment: The primary goals of ACT include:
1. To meet basic needs and enhance quality of life
2. To improve role functioning
3. To enhance independent living
4. To lessen family burden of providing care
5. To decrease debilitating symptoms of mental illness
6. To minimize recurrent acute episodes of the illness
Treatment Modalities: Psychopharmacology: Antipsychotics
-Used to decrease agitation and psychotic symptoms
Antipsychotics: Side Effects:
- Anticholinergic effects
- Nausea; GI upset
- Skin rash
- Sedation
- Orthostatic hypotension
- Photosensitivity
- Decreased libido
- Retrograde ejaculation
- Gynecomastia
- Amenorrhea
- Weight gain
- Reduction in seizure threshold
- Agranulocytosis
- Extrapyramidal symptoms
- Tardive dyskinesia
- Neuroleptic malignant syndrome
Antipsychotics: Extrapyramidal symptoms (EPS) include:
- Pseudoparkinsonism
- Akinesia
- Akathisia
- Dystonia
- Oculogyric crisis
Antiparkinsonian agents may be prescribed to counteract _____.
Antipsychotics: Other medications that have been used in the treatment of schizophrenia:
-Lithium carbonate
Antipsychotics: Client/Family Education: The client should:
-Not stop taking the drug abruptly
-Use sunscreens and wear protective clothing when spending time outdoors
-Report weekly (if receiving clozapine therapy) to have blood levels drawn and to obtain a weekly supply of the drug.
-Be aware of possible risks of taking neuroleptics during pregnancy.
-Not drink alcohol while receiving neuroleptic therapy
-Not consume other medications (including over-the-counter drugs) without the physician's knowledge