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Schizophrenia nursi

Schizophrenia flash cards

Age at onset late adolescence, early adulthood
Commons symptoms of psychosis hallucinations delusions difficulty with thought organization
Most common cause of psychosis Schizophrenia
Schizophrenia is not characterized by a changing personality, it characterized by... a deteriorating personality
Perceptual disturbance hallucinations
Thought process disturbance thought derailment
Reality testing disturbance delusions
Feeling disturbance flat or inappropriate affect
Behavior disturbance social withdrawal
Attention disturbance inability to concentrate
Motivation disturbance cannot initiate or persist in goal-directed activities
Bleuler's Four A's of Schizophrenia Affective disturbance: inappropriate, blunted, flat affect Autism: preoccupation with self, with little concern for external reality Associative looseness: stringing together of unrelated topics Ambivalence: Simultaneous opposite feelings
Stages of Schizophrenia Acute phase Stabilizing phase Stable phase
DSM-IV Subtypes of Schizophrenia Paranoid Disorganized Catatonic Undifferentiated Residual
DSM-IV Criteria: Paranoid Schizophrenia Preoccupation with one or more delusions or frequent auditory hallucinations (content frequently persecutory and/or grandiose)
DSM-IV Criteria: Disorganized Schizophrenia * worst prognosis All of the following are prominent: disorganized speech, disorganized behavior, flat or inappropriate affect
DSM-IV Criteria: Catatonic Schizophrenia * best prognosis At least two of the following: 1. motoric immobility, wavy flexibility, or stupor 2. excessive motor activity (purposeless) 3. extreme negativism or mutism 4. peculiar movements, stereotype of movements, prominent mannerisms, or prom
DSM-IV Criteria: Undifferentiated Schizophrenia Characteristic symptoms (motoric immobility, wavy flexibility, or stupor) are present but criteria unmet for paranoid, catatonic, or disorganized subtypes not met
DSM-IV Criteria: Residual Schizophrenia A. Characteristic symptoms (motoric immobility, wavy flexibility, or stupor) are no longer present; criteria are unmet for paranoid, catatonic, or disorganized subtypes B. Continuing evidence of disturbance, such as presence of negative symptoms or chara
Echolalia the automatic repetition of vocalizations made by another person
Echopraxia the automatic repetition of movements made by another person
Positive Symptoms are the embellishment of normal cognition and perception
Negative Symptoms are an absence or diminution of that which should be
Pathoanatomy decreased cerebral blood flow (CBF) increased ventricular brain ratios (VBR)s (use MRI and CT) cerebral atrophy
Objective Signs Alterations in Personal Relationships Alterations of Activity
Objective Signs- Alterations in personal relationships decreased attention to appearance and social amenities R/T introspection and autism Inadequate of inappropriate communication Hostility Withdrawal
Objective Signs- Alterations of activity psychomotor agitation catatonic rigidity echopraxia sterotypy (repetitive acts or words) anergia (- energy)
Subjective Symptoms Altered perceptions Alterations of thought Altered Consciousness Alterations of affect
Subjective Symptoms- Altered perception hallucinations (auditory most common *visual could indicate toxicity) illusions paranoid thinking
Subjective Symptoms- Alterations of thought loose associations retardation blocking autism ambivalence delusions poverty of speech ideas of reference mutism concrete thinking
Subjective Symptoms- Altered Consciousness confusion incoherent speech clouding sense of "going crazy"
Subjective Symptoms- Alterations of affect inappropriate, blunted, flattened, or labile affect apathy ambivalence overreaction anhedonia (apathy)
Paranoid personality disorder vs. Paranoid delusions Personality- can be corrected with facts
Somatic delusion After medical tests confirm otherwise, a patient still insists, "I have cancer in my stomach."
Grandiose delusion "I am the president."
Religious delusion "The devil told me to kill my children."
Nihilistic delusion "I am dead." "If you are dead, how can you talk?" "I don't know, but I am dead."
Delusion of reference "The TV is talking about me. The guests on Oprah are making fun of me."
Delusions of influence "I can control her with my thoughts."
Paranoid delusion "They all think I'm a homosexual."
Schizophrenic overreact to normal events because they have to in order to overcome mental and social inertia
Key objectives for Tx Schizophrenia work with the family treat depression (75%) minimize stressful interactions treat substance abuse avoid lengthy, intense verbal interactions
Leading cause of premature death for Schizophrenic pts Suicide
Psychosis-Induced Polydipsia between 4-10 L/day -hyponatremia S/S: lightheadedness, weakness, lethargy, muscle cramps, N/V, confusion, convulsions, coma I: frequent weigh-in restrict fluid intake sodium replacement positive reinforcement
Psychotherapeutic management is aimed at helping patients becoming stronger than their symptoms
Nurse-Patient Relationship -be calm when talking -accept patients as they are, but do not accept all behaviors -keep promises -be consistent -be honest -do not reinforce hallucinations/ delusions -orient x3 -do not touch w/o warning -avoid whispering/laughing when pt cannot
Milieu Mgmt- Disruptive Patients -set limits -decrease environmental stimuli -observation -take away objects that are possible weapons -restraints-> evaluate for hydration, nutrition, elimination, circulation
Milieu Mgmt- Withdrawn Patients -nonthreatening, physical activities -arrange furniture to facilitate conversation -assist decision making -reinforce grooming/ hygiene -psychosocial rehab (social skills, community living, health care skills)
Milieu Mgmt- Suspicious Patients -matter-of-fact -laughter/ whispering -no touch w/o warning -consistent -maintain eye contact
Milieu Mgmt- Impaired Communication -be patient -dont pressure them to make sense -provide opportunities for purposeful psychomotor activity
Milieu Mgmt- Hallucinations -provide distracting activities -discourage conversation about hallucinations with other patients -monitor tv selection -monitor for command hallucinations -have staff available for listening
Milieu Mgmt- Disorganized Patients -less stimulation -calm environment -safe, simple activities
Created by: rkasiejka27