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Mental Health 2

The Schizophrenias Part 2

QuestionAnswer
For the acute phase of schizophrenia, the overall goal is client safety and medical stabilization
In the maintenance and stabilization phases the focus is on Helping the client to adhere to medication regimens, to understand schizophrenia, and to participate in available psychoeducation activities for both the client and the clients family.
During the stabilization phase the outcomes target the negative symptoms
What kind of outcomes would reduce the patient's vulnerability to psychosis? Maintain a regular sleep pattern, reduce alchohol, drug, and caffeine intake; keep in touch with supportive friends and family; stay active; have a routine daily and weekly schedulte including enjoyable activities; take meds regulary.
Planning during the maintenance and stabilization phases identifies what ______, ______, ________, and ________ skills are needed as well as how and where these needs can best be met within the community. social, interersonal, coping, and vocational skills
A key component of long term card of an individual with schizophrenia relies on what three things? medications, nursing interventions, and community support
_____ ____ which is a part of nursing inteventions as well as community support is a key component of effective treatment of schizophrenia. family psyhoeducation
Interventions for the schizophrenic patient are always geared toward the client's strengths and healthy functioning as well as to areas of deficiency
During the acute phase of schizophrenia, the nurse should maintain ____ ______ call the client by name, and speak simply but in a louder voice thatn usual. eye contact
When the nurse attempts to see the world as it appears through the eyes of the client, it is easier to understand the client's delusional experience
When clients sleep at home and attend treatment sessions during the day or evening. partial hospitalization
clients live in the community with a group of other clients, sharing expenses and responsibilities. halfway houses
Patients live in a halfway house or on their own, sometimes with home visits, or in residentioal programs. Patients attend a structured program during the day. day treatment programs
The single most important factor in the prevention of relapse in a person suffering from schizophrenia. medication maintenance
This improves the level of social activity, foster new social contacts, improve quality of life, and help lower anxiety. Social skills training (SST)
This appears to improve cognitive dysfunction, helping individuals better cope with symptoms, the disorder itself, and everyday problems. cognitive remediation
a novel technique aimed at improving adaptive functioning and compensating for the cognitive impairment associated with schizophrenia. cognitive adaption training (CAT)
This aims to change abnormal thoughts or responses to hallucinations through coping strategies such as listening to music. cognitive-behavioral therapy (CBT)
The conventional (traditional) antipsychotics target the positive symptoms of schizophrenia such as hallucinations, delusions, disordered thinking, and paranoia.
Atypical (novel) antipsychotics diminish the negative symptoms of schizophrenia
_______ antipsychotics have fewer side effects and thus are better tolerated. atypical
Antipsychotic agents usually take effect __________ after the regimen is started. 3 to 6 weeeks
This atypical antipsychotic increases the risk for agranulocytosis and seizures. clozapine (Clozaril)
These drugs permit control of the most alarming symptoms of schizophrenia and they also allow for improbement in the quality of life of people with schizophrenia. atypical antipsychotics
Because of the risk for agranulocytosis and seizures, patients taking clozapine (Clozaril) are required to to have what kind of testing? Weekly WBC for the first 6 months, then frequent monitoring thereafter.
What are the disadvantages of AAP's? They have a tendency to cause significant weight gain in clients and they are more expensive than traditional antipsychotics.
What kind of a drug is Risperidone? AAP
What are the two advantages of conventional antipsychotics? Cost, and they come in depot forms
These antipsychotic medications are D2 antagonists. conventional antipsychotics
Akathisia, dystonia, parkinsonism, and tardive dyskinesia are __________ side effects. Extrapyramida Side Effects
Other side effects of conventional antipsychotics besides EPS's are anticholinergenic effeccts, orthostasis, and lowered seizure threshold.
Low Potency Conventional Antipsychotic drugs= high sedation, high ACh and low EPS's
High Potency Conventional Antipsychotic Drugs = low sedation, low ACh and high EPS's
All conventional antipsychotic drugs can cause tardive dyskinesia
Conventional antipsychotic drugs can lower the seizure threshold
muscle cramps of the head and neck acute dystonia
internal restlessness and extenal restless pacing or fidgetting akathisia
stiffening of the muscular activity in the face, body, arms, and legs pseudoparkinsonism
Commonly used drugs to lower the occurance of EPS's are the antiparkinsonian drugs: Artane, Cogentin, Benedryl, Akineton, Kemadrin, Parlodel, and Symmetrel
Blurred vision caused by traditional antipsychotics usually abates in 1 to 2 weeks
Tetanic heightening of entire body, head and belly up opisthotonos
eyes locked upward oculogyric crisis
A serious and irreversible side effect of the phenothiazines and related drugs that consists of involuntary tonic muscle spasms typically involving the tongue, fingers, toes, neck, trunk or pelvis. tardive dyskinesia
Symptoms of this rare toxic effect of traditional antipsychotics include sore throat, fever, malaise, and mouth sores. Flulike symptoms. agranulocytosis
The prodromal symptoms of ______ ____ are fever, malaise, nausea, and abdominal pain; jaundice appears 1 week later. cholestatic jaundie
Sever extrapyramindal effects, hyperpyrexia and autonomic dysfunction are indicative of what somewhat rare, but potentially fatal effect of traditional antipsychotics? Neuroleptic malignant syndrome(NMS)
An EPS that usually appears after prolonged treatment and is more serious and is not always reversible. tardive dyskinesia (TD)
Tardive dyskinesia is most frequently seen in women and older patients
Early symptoms of tardive dyskinesia are constant smacking of the lips
It is believed that the acute reduction in brain dopamine activity plays a role in the development of neuroleptic malignant syndrome
A decreased level of consciousness, greatly increased muscle tone, and autonomic dysfunction, including hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling. neuroleptic malignant syndrome
Use of benzodiazepines with antipsychotic medications can improve positive and negative symptoms by about 50%.
Use of _________ adjunct to antipsychotics may diminish anxiety, agitation, and possibly psychosis. Clonazapam (benzodiazepine)
Any intense and strongly defended irrational suspicion can be regarded as paranoia
The most common defense mechanism used by people who are paranoid. Projection
______ _______ is one of the primary paranoid disorders. paranoid schizophrenia
When the patient frequently misinterprets the messages of others or gives private meaning to the communications of others. ideas of reference
Abnormal motor behivior. Clients show either extreme motor agitation or extreme psychomotor retardation. catatonia: withdrawn phase
The onset of catatonia is usually abrupt
Posturing, waxy flexibility, sterotyped behavior, extreme negativism or automatic obedience, echolalia and echopraxia are some behaviors associated with catatonia: withdrawn phase
The ability to hold distorted postures for extensive periods. waxy flexibility
If someone raises the patients arm over his head, the patient maintaining that position for hours or longer is called waxy flexibility
During this stage of catatonia, the person talks or shouts continually, and verbalizations may be incoherrent. catatonia: excited phase (acute phase)
The most regressed and socially impaired of all the schizophrenias. Disorganized schizophrenia
A person diagnosed with this type of schizophrenia may have marked looseness of associatins, grossly inappropriate affect, bizarre mannerisms, and incoherence of speech and may display extreme social withdrawl. disorganized schizophrenia
This type of schizophrenia has an earlier age of onset and often develops insidiously. disorganized schizophrenia
Often patients diagnosed with this type of schizophrenia are either homeless or live in state hospitals. disorganized schizophrenia
a sudden cessation in the train of thought. Blocking
When active signs of the the disorder of schizophrenia (positive or negative) are present, but the individual does not meet the criteria for paranoia, catatonia, or disorganized type. undifferentiated schizophrenia
When active phase symptoms are no longer present, but evidence of two or more residual symptoms persists. residual type of schizophrenia
To plan appropriate interventions the nurse must know that depersonalization and derealization are examples of personal boundary difficulties
What symptomsof schizophrenia are most amenable to treatment with both low and high potency antipsychotic medications? hallucinations and delusions
A nursing diagnosis that is universally applicable to clients with schizophrenia during the prodromal and acute phases is Disturbed Thought Process
_______ symptoms include the crippling symptoms of affective blunting, anergia, anhedonia avolition, poverty of content of speech, poverty of speech, and thought blocking. Negative
What is the most common course of schizophrenia? Initial episode followed by recurrent acute exacerbations and deterioration
The causation of schizophrenia is currently understood to be a combination of inherited and nongenetic factors
________ symptoms are the attention-getting symptoms such as hallucinations, delusions, bizarre behavior, and paranoia. Positive
What side effect of antipsychotic medication has no known treatment? tardive dyskinesia
A client with paranoid schizophrenia refuses food. He states the voices are telling him the food is contaminated and will change him from a male to a female. A therapeutic response for the nurse would be "I understand that the voices are very real to you, but I do not hear them."
A client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as neologism
When a client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be "It must be frightening to think something is going to harm you."
A desired outcome for a client with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will Begin to question his or her own altered perceptions by seeking input from staff
Antipsychotic medications may cause _______________, the first manifestation of which may be a sore throat and flulike symptoms. agranulocytosis