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86 Cards in this Set

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Schizophrenia affects the folowing five things differently in each person depending on if it's an acute (psychotic phase) or if it's chronic (long-term phase) so nursing interventions are affected as well.
thought processes and content
perception
emotion
behavior
social functioning
The nurse should NOT make ______ about the client's abilities based solely on the medical diagnosis of schizophrenia.
assumptions
A nurse may handle a patient with positive signs and another patient with negative signs differently even though they have the same diagnosis as schizophrenia.
okay
Is a patient experiencing the following displaying positive or negative signs?

appears frightened
hears voices
makes no eye contact
mumbles constantly
positive (psychotic)
Is a patient experiencing the following displaying positive or negative signs?

lacks energy for daily tasks
feelings of lonliness and
isolation
negative
The nurse may ask baseline questions concerning?
history of schizophrenia...
age of onset (younger have poorer outcomes)...
previous hospital admissions
and response to hospitali-
zation....
previous suicide attempts (10% of all diagnosed succeed)...
Ask if there is a history of schizophrenia in the following way for baseline study.
history with schizophrenia

"How do you usually spend your time?"
"Can you describe what you do each day?"
Concerning suicide attempts, the nurse might ask in the following way?
"Have you ever attempted suicide?"
"Have you ever heard voices telling you to hurt yourself?"
The nurse might ask about aggression or violence in the following way?
"What do you do when you are angry, frustrated, upset, or scared"?
The nurse may assess if the client has been using current support systems by asking the following questions?
Has the client kept in contact with family or friends?
Has the client been to scheduled groups or therapy appointments?
Does the client seem to run out of money between paychecks?
Have the client's living arrangements changed recently?
The nurse can assess the client's perception of his current situation by asking?
"What do you see as the primary problem now?"
"What do you need help managing now?"
Appearance of clients may vary widely from normal to inappropriate. Client may exhibit agitation and pacing or appear unmoving (catatonia).
okay
Term for unmoving.
Example: Client may appear catatonic.
catatonia
A client may demonstrate seemingly purposeless gestures (stereotypic behavior) and odd facial expressions such as grimacing.
okay
The client may imitate movements and gestures of someone whom he or she is observing. This is termed?
echopraxia
The client may ramble and make no sense to the listener.
okay
The client may exhibit psychomotor retardation which means?
a general slowing of all movements
Sometimes the client may be almost immobile, curled into a ball resembling?
fetal position
Clients with the catatonic type of schizophrenia can exhibit waxy flexibility which means?
they maintain any position in which they are placed, even if the position is awkward or uncomfortable
The client may exhibit an unusual speech pattern that is jumbled words and phrases that are disconnected or incoherent and makes no sense to the listener.
word salad
The client may exhibit echolalia which is?
repetition or imitation of what someone else says.
Speech of a client may be slowed or accelerated in rate and volume; the client may speak in whispers or hushed tones or may talk loudly or yell.
okay
What is the term used to refer to hesitation before the client responds to questions. May last 30 or 45 seconds and usually indicates the client's difficulty with cognition or thought processes.
latency of response
Ideas that are related to one another based on sound or rhyming rather than meaning is termed?

Example: "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill."
clang association
A combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Example: "Corn, potatoes, jump up, play games, grass, cupboard."
word salad
The stereotyped repetition of words or phrases that may or may not have meaning to the listener.

Example: "I want to go home, go home, go home, go home."
verbigeration
The persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase, or word, even when another person attempts to change the topic.

Example: Nurse: "How have you been sleeping lately?"
Client: "I think people have been following me."
Nurse: "Where do you live?"
Client: "At my place people have been following me."
Nurse: "What do you like to do in your free time?"
Client: "Nothing because people are following me."
perseveration
Words invented by the client.
Example: "I'm afraid of grittiz. If there are any grittiz here, I will have to leave. Are you a grittiz?"
neologisms
The client's imitation or repetition of what the nurse says.
Example: Nurse: "Can you tell me how you're feeling?"
Client: "Can you tell me how you're feeling, how you're feeling?"
echolalia
Use of words or phrases that are flowery, excessive, and pompous.
Example: "Would you be so kind, as a representative of Florence Nightingale, as to do me the honor of providing just a wee bit of refreshment, perhaps in the form of some clear spring water?"
stilted language
What term is used for no facial expression?
flat effect
What term is used for having few observable facial expressions?
blunted affect
Clients with schizophrenia report and demonstrate wide variances in _____ and _____.
mood
affect
The typical facial expression often is described as ____-____.
mask-like
The affect also may be described as ____, characterized by giddy laughter for no apparent reason.
silly
The client may exhibit an inappropriate _____ or _____ incongruent with the context of the situation. This incongruence ranges from mild or subtle to grossly inappropriate. For example, the client may laugh and grin while describing the death of a family member or weep while talking about the weather.
expression
emotions
The client may report feeling depressed and having no pleasure or joy in life which is termed?
anhedonia
A client may report feeling all-knowing, all-powerful, and not at all concerned with the circumstance of the situation.
okay
It is common for the client to report exaggerated feelings of well-being during episodes of _____ or delusional thinking and a lack of energy or pleasurable feelings during the _____ or long-term phase of the illness.
psychotic (acute)
chronic
The primary feature of schizophrenia is referred to as ______ disorder.
thought

(thought and information processing is disrupted)
Term used when a client suddenly stops talking in the middle of a sentence and remains silent for several seconds to 1 minute.
thought blocking
Term used when a client states they believe others can hear their thoughts.
thought broadcasting
Term used when a client states others are taking their thoughts.
thought withdrawal
Term used when a client says others are placing thoughts in their mind against their will.
thought insertion
Term used when clients veer onto unrelated topics and never answer the original question.

Example: Nurse: "How have you been sleeping lately?"
Client: "Oh, I try to sleep at night. I like to listen to music to help me sleep. I really like country-western music best. What do you like? Can I have something to eat pretty soon? I'm hungry."
Nurse: "Can you tell me how you've been sleeping?"
tangential thinking
________ may be evidenced if the client gives unnecessary details or strays from the topic but eventually provides the requested information.

Example: Nurse: "How have you been sleeping lately?"
Client: "Oh, I go to bed early, so I can get plenty of rest. I like to listen to music or read before bed. Right now I'm reading a good mystery. Maybe I'll write a mystery someday. But it isn't helping, reading I mean. I have been getting only 2 to 3 hours of sleep at night."
Circumstantiality
Term used to describe poverty of content or lack of any real meaning or substance in what is said by client.

Example: Nurse: "How have you been sleeping lately?"
Client: "Well, I guess, I don't know, hard to tell."
alogia
What is the term used for fixed, false beliefs with no basis in reality...occurs in psychotic phase of illness?
delusions
A common characteristic of schizophrenic delusions is the _____, _____, and total _____ with which the client holds these beliefs, and will act accordingly.

Example: A delusional client with persecution will probably be suspicious, mistrustful, and guarded about disclosing personal information; may examine the room periodically or speak in hushed, secretive tones.
direct
immediate
certainty
External, contradictory information or facts cannot alter ______ beliefs. If asked why the client believes such an unlikely idea, the client often replies, "I just know it."
delusional
Initially the nurse assesses the _____ and ____ of the delusion to know what behaviors to expect and to try to establish reality for the client.
content
depth
When illiciting information about the client's delusional beliefs, the nurse must be careful not to ______ or _______ them.
The nurse might ask the client to explain what he or she believes by saying "Can you explain that to me?" or "Tell me what you're thinking about that."
(know)
support
challenge
Name 5 types of delusions?
grandiose
persecutory/paranoid
referential or ideas of
reference
religious
somatic
A type of delusion often centered around the second coming of Christ or another significant religious figure or prophet. These religious delusions appear suddenly as part of the client's psychosis and are not part of his or her religious faith or that of others.

Examples: Client claims to be the Messiah or some prophet sent from God; believes that God communicates directly to him or her, or that he or she has a "special" religious mission in life or special religious powers.
religious delusions
A type of delusion involving the client's belief that "others" are planning to harm the client or are spying, following, ridiculing, or belittling the client in some way. Sometimes the client cannot define who these "others" are.

Examples: The client may think that food has been poisoned or that rooms are bugged with listening devices. Somteimes the "persecutor" is the government, FBI, or other powerful organization. Occasionally, specific individuals, even family members, may be named as the "persecutor."
persecutory/paranoid
Term used involving the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her.

Examples: The client may report that the president was speaking directly to him on a news broadcast or that special messages are sent through newspaper articles.
referential delusions or ideas of reference
Term characterized by the client's claim to association with famous people or celebrities, or the client's belief that he or she is famous or capable of great feats.

Examples: The client may claim to be engaged to a famous movie star or related to some public figure such as claiming to be the daughter of the President of the United States; may claim he or she has found a cure for cancer.
grandiose delusions
A type of delusion which is generally vague and unrealistic beliefs about the client's health or bodily functions. Factual information or diagnostic testing does not change these beliefs.
Example: A male client may say that he is pregnant, or a client may report decaying intestines or worms in the brain.
somatic delusions
One hallmark symptom of schizophrenia psychosis is ________ which are false sensory perceptions, or perceptual experiences that do not exist in reality.
(know)
hallucinations
Hallucinations can involve the ____ senses and _____ sensations; can be threatening and frightening for the client, although clients less frequently report hallucinations as pleasant.
five
bodily
Initially, the client perceives hallucinations as ____, but later in the illness he or she may recognize them as hallucinations.
real
Hallucinations are distinguished from ______, which are misperceptions of actual environmental stimuli.

Example: While walking through the woods, a person thinks he sees a snake at the side of the path, only to find it's a stick. Fact or reality corrected the illusion. Hallucinations, however, have no such basis in reality.
illusions
Name 7 types of hallucinations?
(know)
auditory...command...MOST COMMON
visual (SECOND MOST COMMON)
olfactory
tactile
gustatory
cenesthetic
kinesthetic
A type of hallucination involving a taste lingering in the mouth or the sense that food tastes like something else. The taste may be metallic or bitter or may be represented as a specific taste.
gustatory hallucinations
A type of hallucination involving seeing images that do not exist at all, such as lights or a dead person, or distortions such as seeing a frightening monster instead of the nurse. They are the second most common type of hallucination.
visual hallucinations
A type of hallucination that involves smells or odors. They may be a specific scent, such as urine or feces, or more general such as a rotten or rancid odor. In addition to clients with schizophrenia, this type of hallucination often occurs with dementia, seizures, or cerebrovascular accidents.
olfactory hallucinations
A type of hallucination which is the most COMMON type, involves hearing sounds, most often voices, talking to or about the client. There may be one or multiple voices; a familiar or unfamiliar persons's voice may be speaking.
auditory hallucinations
A type of auditory hallucination in which voices demand that the client take action, often to harm self or others, and are considered dangerous.
command hallucinations
A type of hallucination referring to sensations such as electricity running through the body or bugs crawling on the skin. Tactile hallucinations are found most often in clients undergoing alcohol withdrawal; they rarely occur in clients with schizophrenia.
tactile hallucinations
A type of hallucination involving theh client's report that he or she feels bodily functions that are usually undetectable.
Examples would be the sensation of urine forming or impulses being transmitted through the brain.
cenesthetic hallucinations
A type of hallucination occurring when the client is motionless but reports the sensation of bodily movement. Occasionally the bodily movement is something unusual such as floating above the ground.
kinesthetic hallucinations
During episodes of psychosis, clients are commonly disoriented to _____ and sometimes ______.
time
place
Term used for the most extreme form of disorientation in which the client feels detached from his behavior. Although the client can state their name correctly, they feel as if their body belongs to someone else or that their spirit is detached from the body.
depersonalization
Assessing the ______ processes of a client with schizophrenia is difficult while experiencing a psychosis. The client usually demonstrates poor ______ functioning as a result of disordered thoughts. The nurse should not assume the client has limited ______ capacity based on impaired thought processes. It may be that the client cannot focus, concentrate, or pay adequate attention to demonstrate ______ abilities accurately. Wait until thought processes are clearer.
(know)
intellectual
intellectual
intellectual
intellectual
Clients often have difficulty with _____ thinking and may respond in a very literal way to other people and environment.

Nurse: "Interpret a stitch in time saves nine."
Client: "I need to sew up my clothes."

Instructions may be misinterpreted, esp. concerning medications.

Nurse: "It is always important to take all of your medications."
Client: (may take the entire supply of meds at one time.
abstract

(be very concrete when speaking to the client)
______ is based on the ability to interpret the environment correctly, and so it follows that the client with disordered thought processes and environmental misinterpretations will have great difficulty with it, posing a safety hazard or neglect of Maslow's hierarchy.
Judgment
_____ can be severely impaired, esp. early in illness, when family doesn't know what is happening.
Over time, some clients can learn about the illness, anticipate problems, and seek appropriate assistance....otherwise failure to do so results in life long and consistent management
Insight
One of the major problems with schizophrenia is the deterioration of ___-____.
self-concept
The client may suffer from "loss of ego boundaries" which describes the client's lack of a clear sense of where his or her own body, mind, and influence end and where those aspects of other animate and inanimate objects begin. This lack of ego boundaries is evidenced by _______, _______ and ideas of ______.
depersonalization
derealization
reference
Term used to mean environmental objects become smaller or larger, seem unfamiliar...one of the points discussed in the phrase "loss of ego boundaries".
derealization
______-_____ may be distorted to the extent that the patient believes they are fused with another person or object, may not recognize body parts as their own, or may fail to know whether they are male or female. These difficulties are the source of many bizarre behaviors such as public undressing or masturbating, speaking about oneself in the third person, or physically clinging to objects in the environment. Body image distortion also may occur.
Self-concept
Term used for excessive water intake?
polydipsia
Polydipsia can lead to _____ intoxication.
water
With polydipsia, serum 1 _____ levels can become dangerously low, leading to 2_____.
1 sodium
2 seizures
Polydipsia is usually seen in clients who have had _____ and _____ mental illness for many years as well as ____-___ therapy with antipsychotic meds.
severe
persistent
long-term
_______ may be caused by the behavioral state itself or be precipitated by the use of antidepressant or antipsychotic medications.
Polydipsia