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Nsg 212 Ch. 14

Schizophrenia

QuestionAnswer
Define Schizophrenia severe, chronic, disabling brain disease, split mind. Usually occurs late adol, early adulthood
Onset of Sz can show what s/s? loss of ambition, inability to plan, incr social isolation, altered perception of reality, loss of self-awareness, hallucinations, delusions, disorganized thoughts/speech.
What is number one early s/s? What is dangerous s/s of medications? change in sleep patterns Polydipsia, can get water intoxicated
What are positive s/s? Attention getting behaviors: hallucinations, delusions, ambivalence, looseness of associations, flight of ideas, ideas of reference, echopraxia, perseveration
What are negative s/s? Render pt inert and unmotivated: alogia, anhedonia, apathy, blunted affect, catatonia, flat affect, avolition
What is most common type of hallucinations? Other types? auditory other: visual, olfactory, tactile, gustatory
Define delusion False personal beliefs not subj to reason
types of delusions: persecutory/paranoid false beliefs they are being cheated, harassed, poisoned, conspired against, or they or family is focus of persecution
Grandeur believes is famous or important person
somatic bizarre body phenomena, like losing eyelashes or infested with insects
Religous Ideas of reference? believe occurences are related to them, people on tv are directing special messages to them or their thoughts are being broadcast aloud to others
types of disorganized thinking: Tangentiality: Word Salad Clang Association 1. items connect but points are not made 2. words w/o meaning 3. speech wtih rhyming words/sounds
Loose associations? Derailing 1. pt only knows meaning of word 2. doesn't stay on track
Types of Sz: Paranoid? Disorganized? 1. persecutory or grandiose delusions, hallucinations, hostile, aggerssive beh. 2. Inappropriate or flat affect, loose associations, disorg. beh. incoherence
Catatonic? Undifferentiated? Residual? 1. motionless or excessive motor, waxy flexibility(can mold into position), stupor, rigidity, posturing 2. delusions and hallucinations, mix 3. continuation of s/s following Sz episode
what is alogia? avolition? anhedonia? echopraxia? perseveration? 1. mute, low speech, blocking 2. apathy in grooming/hygiene, work 3. lack of pleasure, joy to life 4. mimic mvmts 5. get stuck on topic
Related disorders: schizoaffective disorder? schizophreniform? delusional disorder? brief psychotic disorder? Shared psychotic disorder? 1. both psychotic s/s and criteria for major affective/mood disorder(depr, mania 2. s/s of sz noted < 6 mos 3. nonbizarre delusions
In new researuch, what drug is being used for toxoplasmosis infections and Sz? anti-malarial drugs and clindamycin
Diff. cultural views of Sz Lower doses of Haldol? W. Africa? Native Am.? Latin America? china? N. Africa? 1. Asians 2. Boufee 3. Ghost sickness- preoccupation w/ death 4. Locura 5. Qi-gong 6. Zar
First Generation drug therapy and SE? 2nd? 3rd? 1st: Chlorpromazine(Thorazine)for +, not - s/s 2nd: Haldol, Moban, higher EPS s/s 3rd: clozaine(Clozaril) dopamine and serotonin antagonists
types of EPS(extrapyramidal s/s): dytonia? pseudoparkinsonism? akathisia? 1. torticollis(twist neck), oculogyric crisis(eyes roll back in head) 2. shuffle, cog-wheeling, aknesia(slow mvmt) 3. can't sit still
What drug is best for EPS? Cogentin, PO or IM Benedryl Inderol for akathisia
Tardive Dyskinesia? 1. involuntary mvmts, lip smacking, tongue protrusion, grimacing, later in tx and can be permanent
What are main SE of Clozapine? seizures Neuroleptic Malignant Syndrome: fever, muscle rigidity...stop med, give Dantrium agranulocytosis: have weekly white counts for 1st 6mos of therapy, then q 2wks. If <3500, stop drug. Diabetes risk
Three types of thought content: thought blocking? thought broadcasting? thought withdrawal? 1. pt stop talking mid sentence 2. others can hear thoughts 3. others stealing thoughts
thought insertion? tangential thoughts? flight of ideas? 1. others insert thoughts against will 2. veering off from topic w/ some thread 3. change subjects w/ no thread
Preferred outcomes? prevention of relapse tx of s/s independence success and safety
Intv for delusions est trust, assure safety, pursue meaning of delusion, ask for evidence, reflect feeling, decr paranoia wtih distraction, express you don't agree, but pt sees it that way.
Intv for hallucinations trust, observe beh, make observations, reflect feelings, help see voices are chemical part of disease, teach coping
Impaired verbal communication intv use words pt understands, be congruent with verbal and non-verbal comm, validate meaning of comm, look for themes in comm, set limits for derogatory statements
SE of meds and intv for seizures? Neuroleptic malignant syndrome? stop med, notify Dr. protect w/ seizures
Intv and SE for drugs to treat EPS: Benadryl? Valium? Ativan? Inderal? 1. observe for sedation, tx dry mouth 2. watch sedation, risk for abuse 3. watch sedation, risk for abuse 4. assess palpitations, dizzy, cold hands/feet
what is new psychosocial therapy called cognitive enhancement terapy (CET)? combines computer-based cognitive training wtih group sessions that allow pt to practice adn dev social skills
Nurse assessment of Sz pt includes baseline data, age of onset, suicide attempts, support systems, pt perception of problem
Intv for delusions include? set expectations/rules, no promises, explain things, recognize delusions as pt perception, 1 to 1 activty, then group, ask if pt sees delusions interfere with life
Intv for Sz prioritized safety, trust, clarify feelings
Created by: palmerag