PSYCHE NURSING
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| positive symptoms of schizophrenia | delusions, hallucinations, thought d/o, movement d/o
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| negative symptoms of schizophrenia | flat affect, withdrawn, lack of initiative, lack of content of speech
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| dx of schizophrenia | must have 2 or more of the following (delusions, hallucinations, disorganized speech, grossly d/o or catatonic behavior) present for 1 month (if treated) or 6 months.
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| schizoaffective d/o | schizophrenic symptoms combined w/ a mood disorder
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| brief psychotic d/o | sudden onset of psychotic symptoms after a severe psychosocial stressor. symptoms continue for less than 1 month then client goes back to pre morbid level of f(x).
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| schizophreniform d/o | same signs as schizophrenia but duration is at least 1 month but less than 6 months.
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| delusional d/o | prominent non bizarre delusions. subtypes are erotomanic, grandiose, jealous, persecutory, and somatic.
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| shared psychotic d/o | folie a deux. delusional system develops in second person due to close relationship w/ a person who already has a psychotic d/o w/ prominent delusions.
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| extra pyramidal symptoms (EPS), | pseudoparkinsonism akinesia akathisia dystonia oculogyric crisis tardive dyskinesia
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| akinesia, | complete or partial loss of muscle movement
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| acute dystonia, | muscle cramps hypersalivation/ abn eye movements/ spasm of tongue neck back legs/ painful treat with Benadryl
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| akathisia, | pacing/fidgeting/restlessness treat with Beta Blockers like Propranolol or give Cogentin
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| Pseudoparkinsonian symptoms, | stiffening of muscles/rigid movement/masklike face treat with Cogentin or Symmetrel
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| tardive dyskinesia, | abn irregular muscle movements/ lip smacking/ tongue darting/ cheek puffing/ chewing with no food present. treatment is to d/c meds or decrease them. no cure.
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| clozaril(clozapine), | decreased negative symptoms/ increased impulse control/ reduced violence to self and others/improved quality of life/effective at treating refractory schizophrenia. main worry is agranulocytosis.
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| neuroleptic malignant syndrome (NMS), | signs: hyperpyrexia/severe rigidity/HTN/tachycardia/diaphoresis/elevated creatinine phosphatase . treat w/ parlodel. Can happen if stop neuroleptic drug cold turkey.
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| neuroleptic meds, | teach client not to stop drug abruptly/wear sunscreen/report weekly for labs/do not take if pregnant/do not drink EtOH
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| paranoid schizophrenia, | paranoid delusions/patn may be argumentative hostile aggressive/projection is most common defense mechanism
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| disorganized schizophrenia, | flat or inappropriate affect/silly giggly/bizarre behavior/poor reality contact/ poor grooming/disorganized speech/disorganized inappropriate uninhibited behavior.
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| catatonic schizophrenia, | extreme psychomotor retardation/posturing is common/ rigid or waxy flexibility/echopraxia. can have catatonic stupor or excitement
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| undifferentiated schizophrenia, | active phase both positive and negative symptoms present. bizarre behavior that won't fit into the other categories of schizophrenia.
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| residual schizophrenia, | hx of at least 1 episode of schizophrenia w/ prominent psychotic symptoms. no active positive symptoms. demo only negative symptoms.
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| major depressive d/o (MDD), | depressed mood/loss of interest/social occupational f(x) impaired at least 2 weeks. no hx of mania. can't be attributed to substance abuse or another med. condition.
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| childhood depression, signs: | feeding problems/tantrums/ not playful/accident prone/aggressive/clingy/morbid thoughts/excess worry
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| adolescent depression, signs: | angry/aggressive/run away/social withdrawal/delinquency/sexual acting out/substance abuse/apathetic/restless. behavioral change lasts for several weeks.
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| mild depression signs, | anger/anxiety/preoccupied with loss/anorexia/insomnia
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| moderate depression signs, | slowed down physically/ slumped posture/limited verbalization/retarded thinking processes/trouble concentrating/anorexia/overeating/sleep disturbance/headaches
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| severe depression signs, | feelings of total despair/worthlessness/flat affect/psycho motor retardation/fetal position/no communication/delusional thinking w/ delusions of persecution/somatic delusions/confusion/suicidal thoughts
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| MAOIs, | reduce activity of enzyme MAO/effective at treating depression and anxiety disorders/restrictive diet/take up to 4 wks to start working/ex. Marplan, Nardil, Parnate, Emsam
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| SSRIs, | block re uptake of serotonin/good for minor depression/can cause insomnia agitation headache wt loss sexual dysf(x). ex. Celexa, Prozac, Paxil, Zoloft. do not take 2 diff. SSRIs at once or risk serotonin syndrome
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| serotonin syndrome signs, | restless, tachycardia, diaphoresis, tremors
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| what happens if you combine SSRI with MAOI? | malignant HTN
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| bipolar 1 d/o signs: | is having or has had a full syndrome of manic or mixed symptoms, may also have had periods of depression.
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| bipolar 2 d/o signs: | individual has had recurrent periods of major depression as well as mania.
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| lithium: | therapeutic range .6-1.5, initial signs of toxicity are blurred vision/ataxia/tinnitus/N/V/severe diarrhea. be sure patn takes in plenty of Na and fluids.
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| lithium patn education: | take med regularly, do not skimp on dietary Na, drink 6-8 glasses of H2O/day, notify Dr. if V or diarrhea, get serum level checked every 1-2 months.
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| verapamil: | monitor for side effects (drowsy, dizzy, hypotension, brady, N, C). don't d/c drug cold turkey. beware of orthostatic BP, report to Dr. (irregular heartbeat, chest pain, SOB, dizzy, swelling extremities, profound mood swings, severe/persistent headache).
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| anticonvulsants (patn ed.): | don't d/c drug cold turkey. report to dr.(skin rash, unusual bleed, spontaneous bruising, sore throat, malaise, fever, dark urine, yellow skin or eyes. do not use EtOH or OTC meds w/out dr. permission.
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| resperidone: | can treat mania, schizophrenia, and irritability in autistics. do not use for dementia. monitor for side effects (dry mouth, drowsy, dizzy, constipation, increased appetite, wt. gain, ECG changes, extrapyrimidal symptoms, hyperglycemia, diabetes.
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| ECT contradictions: | don't use in someone with increased intracranial pressure, recent MI, cerebral aneurysm, severe HTN, CHF, pulmonary d/o.
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| Librium | benzodiazepine, anti anxiety agent, sedative/hypnotic. must taper off when done with med or changing to a new med.
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| paranoid personality d/o clinical presentation: | mistrustful, suspicious, on guard, hyper vigilant, trust no one, constantly tests others honesty, over sensitive (but not to others), magnifies/distorts environmental cues.
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| schizoid personality d/o clinical presentation: | inability to form personal relationships, don’t respond to others in a meaningful emotional way, indifferent, aloof, emotionally cold, no close friends, loners, shy, anxious, uneasy, too serious.
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| schizotypal personality d/o clinical presentation: | aloof, isolated, see their world via magical thinking/ideas of reference/delusions/depersonalize/superstitious/ withdraw into self, bizarre speech pattern, blame failures on others.
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| anti social personality d/o clinical presentation: | common in jails and rehab services. can't hold job, can't conform to law, exploit others for personal gain, manipulative, lack remorse, can't delay gratification, can be verbally/physically abusive.
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| borderline personality d/o clinical presentation: | form intense/chaotic relationships, patn has fluctuating attitudes about others, impulsive, emotionally unstable, self destructive, clinging/distancing behavior
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| histrionic personality d/o clinical presentation: | excitable, emotional, colorful, dramatic, self dramatizing, overly gregarious, trouble forming relationships.
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| narcissistic personality d/o clinical presentation: | exaggerated sense of self worth, lack empathy, believe they should get special treatment
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| avoidant personality d/o clinical presentation: | sensitive to rejection, social w/draw. awkward and uncomfortable in social situations.
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| dependent personality d/o- | need to be taken care of. are clingy and submissive.
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| OCD: | inflexible about the way things are done. concerned about organization and efficiency.
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| passive aggressive personality d/o- | passive resistance to authority. seek revenge if feel wronged. often are complaining, irritable, whining, argumentative, scornful, critical, discontent.
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| conduct d/o clinical presentation | use physical aggression to violate others' rights, stealing/lying/truancy are common, can't ctl anger, poor school performance, inattentive, impulsive, hyper.
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| risk factors for conduct d/o: | marital conflict/divorce, inadequate communication patterns, parental permissiveness.
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| conduct d/o assessment | kid lacks feelings of remorse or guilt, tobacco/drugs/alcohol/sex is common earlier in these kids than peers.
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| oppositional defiant d/o (ODD) | pattern of defiant, negativistic, disobedient, hostile behavior to authority.
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| ODD clinical presentation | passive aggressive, don't see themselves as the problem, stubborn, procrastinate, negative, test limits, run aways, uncooperative, skip school.
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| risk factors for ODD | parental probs. disciplining, structuring, limit setting. parent who is ODD. unavailable parents.
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| tourette's d/o clinical presentation | tics may involve head, torso, upper and lower limbs. signs may begin w/ a single motor tic often eye blinking, or with multiple symptoms. ecolalia, palilalia
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| separation anxiety d/o | anxiety exceeds that expected for the person's dev. level and it interferes w/ social, academic, occupational, or other area of f(x).
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