altered thought process nurs 211
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| schizophrenia: this is considered the most challenging what; can it be treated; is there a genetic predisposition; | mental disorder; yes; yes;
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| schizophrenia: biochemical dysfunction- there is an excess of ___ in the neurons; what 2 reseaons | dopamine; increased reception or more being produced
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| schizophrenia: the abuse of ____ can cause this; | substances, stimulants;
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| schizophrenia: causes physiological- certain viruses can cause this in whom; what in regards to age of father when child conceived can increase the risk | when mom has virus when fetus in vivo this mau cause; older father
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| schizophrenia: does psychosocial stress cause this | no, may contribute to it though
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| schizophrenia: how does it disturb the thought process; how does it disturb perception; | they have command hallucinations; see things differently, smell things differently
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| schizophrenia: how is their affect different; what does blunted mean; | it is blunted; the affect is flat and inappropriate;
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| schizophrenia: what are the 4 A's of it' | affect, autistic thinking, anahydonia, associated loosesness
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| schizophrenia: 4As: what is affect; what is autistic thinking; what is anahydonia; | blunted; withdrawn to themselves, withdrawn into their own fantasy world; inability to enjoy life
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| schizophrenia: 4 As: what is associated looseness; | they are not deep thinkers and cannot think logically;
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| schizophrenia: this coorilates with what other mental illnesses; their life expectancy is ___ yrs less then average; most of ___ population are mentally ill | depression and anxiety; 10; homeless;
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| schizophrenia: there is a severe detioration of ___ and ___ functioning | social and ocupational
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| schizophrenia: transactional model- def; | schizophrenia most likely results from combination of biological, psychological and environmental influences on a person who is already vulnerable to illness;
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| schizophrenia: how many phases; | 4;
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| schizophrenia: premorbid phase- what is the personality in this phase; what type of ppl are these; do these ppl have close relationships with others | schizoid personality; cold, loner, aloof; no
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| schizophrenia: prodromal phase- these ppl are withdrawn how; what is there behavior like; what is neglected; what is the affect; what is bizarre; lack of what | socially; peculiar or eccentric behavior; personal hygiene; blunted; ideas; initiation
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| schizophrenia: with all of these behaviours what needs to be ruled out first | any medical issues prior to mental illnes
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| schizophrenia: third phase: what is the name for this; this is the active or passive phase; what s/s are prominent; what are s/s; hallucinations are most often visual or auditory | schizophrenia; active; psychotic s/s; delusions, hallucinations, impairement at work,social relations, self care; auditory
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| schizophrenia: 3rd phase: what is a late sign of it in regards to hallucinations | olfactory
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| schizophrenia: residual phase: these s/s are similar to what other phase; what tx helps them get to this phase; this phase mostly only occurs with what; what is this person like | prodromal phase; meds; tx; flat affect and impairment in role functioning are prominent;
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| types of schizophrenia: disorganized schizophrenia- what is the affect; is behavior; what else is coming; what is wrong socially | chronic variety with flat or inappropriate; bizarre, social interaction impaired; silliness and giggling; the interaction was impaired;
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| types of schizophrenia: catatonic- this is aka; what is it; what is diff with speech; what is different with posturing | catatonic stupor; characterized by extreme psychomotor retardation; mute; stands in a pose
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| schizophrenia: what age do these typically occur | <25 yo
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| types of schizophrenia: catatonic- what deficit is there; what do they repeat; def eccolalia; def eccopraxia | self care; phrases and movements from others; repeating things the heard; repeating movements they see
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| types of schizophrenia: catatonic- what is the posing called | waxy flexability
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| types of schizophrenia: catatonic excitement- there is extreme ___ agitation; there is purposeless what; they may appear like what other mental disorder; they are at risk of injuring whom; these ppl need stat IM dose of what | psychomotor; movements; manics; themselves and others; zyprexa and geodon
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| types of schizophrenia: paranoid- this is characterized by what; what is there behavior; do they trust; | paranoid delusions of persecution; argumentative, hostile, aggressive, intense and suspicious; no;
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| types of schizophrenia: paranoid- we need to make sure they do not respond to what; is their social impairment worse or better then other types; why should we not argue with them; we need to always state what | command hallucinations; better; they many become violent; reality
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| types of schizophrenia: undifferentiated- def; | they exhibit all of the symptoms but don't fit into one particular category;
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| schizophrenia: physicians tend to worry less about the ____ and more about the ____ | dx, tx response
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| types of schizophrenia: residual- used to dx a person who has at least how many episodes of schizo; what are their s/s; this is the acute or chronic stage of disease; | 1; psychotic; chronic;
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| types of schizophrenia: schizoaffective disorder- the s/s also have s/s of what other mental disorder; physician is not sure of what; what are s/s; | bilpolar; if pt is bipolar or schizo; hallucinations,delusions, paranoia and still depression
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| types of schizophrenia: brief psychotic disorder- this is a sudden onset of what; these psychosis s/s follow what;ex of stresser; it lasts > ___ and <___; | psychosis; a severe psychosocial stressor; loss of job, loss of spouse; > 1day and <1 mo;
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| types of schizophrenia: bried psychotic episode- how long do the physicians follow pts; do these pt have prior hx of mental illness | about 6mo-1yr; no
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| types of schizophrenia: schizophreniform disorder these pt have same s.s as what; what is diff in regards to duration; do they have all of the phases; are the s/s more mild or more severe | schizophrenia; the disorder lasts >1 mo but < 6 mo; yes; mild
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| types of schizophrenia: delusional disorder- there is an existence of what type of delusions; what is a subtype of this; what is a erotomanic type | nonbizarre; erotomanic type; they think someone is in love with them
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| types of schizophrenia: phsychotic disorder can be due to ___ condition too; what needs to be ruled out first prior to looking at psychosis | general medical condition; medical dx
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| substance induced psychotic disorder: the presence of prominent hallucinations delusions that are directly attributed to what; | physiological effects of a substance
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| psychosis: def positive s/s; def negative s/s; | they are not positive in a good way, they normally present but now they are out of control; they are normally present but now they are out of control
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| psychosis: positive s/s- def delusions; def | are firmly held erroneous belief due to distortions or exaggerations of reasoning and or misinterpretations of perceptions or experiences;
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| psychosis: positive s/s- def hallucinations; what kind of hallucinations are most common; what is second most common | are distortions or exaggeration of perception in any of the senses, auditory; visual
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| psychosis: positive s/s- def disorganized speech/thinking; aka | not putting words together well, word salad; thought disorder, loosening of associations
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| psychosis: positive s/s- def grossly disorganized behavior; def catatonic behaviours; | included difficulty in goal directed behavior; overly excited
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| psychosis: negative s/s- def affective flattening; def alogia; def avolition; | our personal responses and reactions are flat, voice monotone, body language dull; poverty of speech, not having much to say in a conversation; not able to initiate goal related activity, they have no motivation;
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| what assessment data do we look at | content of thought, form of thought, perception, affect, associated features, sense of self, avolition, impaired interpersonal functioning, psychomotor behavior
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| content of thought: what are they | delusions, religiosity, paranoia, magical thinking
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| form of thought: def association looseness; def neologism; def concrete thinking; def clang associations; | idea shift from unrelated subjects without pts awareness; new works invented; literal interpretations; sounds, rhyming (bing-bong, ding-dong);
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| form of thought: def word salad; def circumstantiality; def tangentiality; def perseveration; def mutism | grouped of words put together in random fashion without logical connection; delayed in reaching point due to details but does get to the point; never gets to the point all other the place; persistently repeats idea/word; refusal to speak
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| def perception | hallucinations, illusions
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| def affect | inappropriate affect, bland or flat
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| def sense of self | ecolalia, echopraxia, identification and imitation, depersonalization;
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| def avolition | an impairment in the ability to initiate goal directed activity
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| what are ex of impaired functioning | autism, deteriated appearance
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| what are examples of psychomotor behavior | anergia, waxy flexibility, posturing, pacing/ rocking back and forth
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| what are characteristics of altered thought processes; | delusions, hallucinations, disorganized speech thought disorder, grossly disorganized behavior, catatonic behavior, negative s/s; also social occupation dysfunction and duration
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| DSM guidelines: there needs to by how many areas of previous assessment findings; there needs to be persistent signs for how many months | 2; 6 months (often hospitalization helps too) to dx shizo
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| which of the following are positive symptoms of schizophrenia A) flat affect andself care deficits B) hallucinations and delusions, C) social isolation and anhedonia D) withdrawal and alogia | C
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| nursing dx: disturbed sensory-perceptual (auditory and visual) r/t what; social isolation r/t; | panic, anxiety, extreme lonliness; inability to trust, panic, anxiety, week ego development, delusional thinking, regression;
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| why do we need to ask pt what the voices say | we want to make sure they are not having command hallucinations
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| nursing dx: risk for violence r/t; impaired verbal communication r/t | extreme suspiciousness, panic anxiety, catatonic excitement, rage reaction, command hallucinations; panic anxiety, regression, withdrawal disordered unrealistic thinking
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| nursing dx: self care deficit r/t; disabled family coping r/t; | withdrawal, regression, panic anxiety, perceptual or cognitive impairment, inability to trust; difficulty coping with client's illness
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| nursing dx: ineffective health maintenance r/t; impaired home maintenance r/t; | disorderedthinking or delusions; regression, withdrawal lack of knowledge or resources, impaired physical cognitive functioning
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| interventions: hallucinations- observes pt attending to what stimuli; encourage involvement in what; assess content of what; why assess content | internal with talking or smiling to self; conversation or structured activities; hallucinations; if they are command hallucinations they may be harmful
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| interventions: delusions- do not __ with pt; focus on what; accept pt need for what; if pt is paranoid same __ should be used; | argue; reality talk about real issues; belief with reinforcing it; staff
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| interventions: withdrawal- assist with what; accepting attitude will decrease what; gradualy introduce pt into what; give ____ feedback for participation; allow time for being along and provide ___ | ADLs; isolation; activities; positive; structure
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| s/s of aggression | increased pacing, clenched fists, tense expression, irritability, agitation, threatening remarks
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| interventions: aggression- decrease what in the environment; administer what; provide a safe environment how; approach pt from where; if needed do a show of what; | stimuli; prm meds and not effect; by removing danferous objects; the side; force
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| dopamine hypothesis: def; may be due to the what, do we want to use MAOi why or why not | excess of dopamine-dependent activity at neuronal synapse, overproduction, increased receptor activity or reduced activity of antagonists; no, increases dopamine
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| psychopharm: antipsychotics block what neurotransmitter receptors; | dopamine
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| what other meds are used besides atypicals and typicals for schizo | reserpine, lithium, carbamazepine, valium, propranolol
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| what agents are prescribed to conteract EPS | antiparkinsonian
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| neuroleptic malignant syndrome: def; how common; how often does it cause death; | acute reaction to dopamine receptors blockers; only 2-2.4; 22%;
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| neuroleptic malignant syndrome: cause- the drugs block what; this blockage distrupt what mechanisms; what fails; what happens to muscle | striatal dopamine receptors; regulatory mechanisms in the thermaregulatory center in hypothalamus; heat regulation; rigidity
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| neuroleptic malignant syndrome: is this a med emergency; what is temp; is pt sweating; what lab is elevated; why is CPK elevated; why is kidney function high; | yes; high; yes; CPK and high kidney function; bc of muscle breakdown; the overload of CPK can destroy the kidneys;
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| neuroleptic malignant syndrome: why is there hyperkalemia; what is HR; what should we do with drugs; maintain what | b/c kidney function destroyed; high; DC all of them; nutrition, hydration, resp
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| Anticholinergic Crisis: psych s/s; what happens to pupils; what happens to vision; what happens to face; what happens to MM; what happens to temp; what happens to hr | confusion, hallucinations; dilate; blurred; flushing; dries; high; high;
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| Anticholinergic Crisis: what happens to bp; high bp decreases what; what happens urinary; what happens GI; what happens cerbral | high; bowel sounds; retention; n/v; seizures, coma
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| Anticholinergic Crisis:what is a way to remember it; what med to give | hot as a hare, blind as a bat, mad as a hatter, dry as a bone; atropine flush
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| PSEUDOPARKINSONIAN SYMPTOMS: aka; s/s; what meds prevent or treat | lead pipe rigidity; cogwheel, shuffling gait, stooped posture, pill rolling tremor, perioral tremor; amantadine, bromocritine, diphenhydramine
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| client family education: teach with the nature of the illness; what to teach for management of the illness; | what to expect as illness progresses, symptoms associated with illness, ways for family to respond to behaviors associated with illness; connection of exacerbation of s/s to times of stress, appropriate med management, side effects of meds,
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| client family education: when should they contact the health care providers | relaxation rechniques, social skills, daily living skills training
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| when is group therapy most successful | when used over the long term course of the illness
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| what is the behavior theray drawback, | the inability to generalize to community setting after client has been discharge home from therapy
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| what is social skills training | use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture, aimed at improving relationship developmet
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| milieu therapy is best when used in conjunction with what | psychotherapy;
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| assertive community treatment: a program of case management that takes a team approach in providing what; do these ppl live in community | comprehensive, community based psychiatric treatment, rehab and support persons with serious and persistent mental illness; yes they still need close monitoring
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| assertive community treatment: what services are included; | substance abuse tx, psycheducational programs, family support and education, moble criis intervention, attention to health care needs, vocational therpay
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| assertive community treatment: what are the goals of this | to meet basic needs and enhance quality of life, improve role functioning, to enhance independent living, to lessen family burden of providing care, to decrease debilitating symptoms of mental illness, to minimize recurrent acute episodes of the illness
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