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56 Cards in this Set
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Schizophrenia
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a multifaceted psychosis typically with onset in early adulthood
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General Characteristics of Schizophrenia
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S elf-care often fails
S ocial adjustment is impaired O rientation to the environment is lost B oundaries between self/others dissolve E xternal/internal stimuli are confused (delusions/hallucinations) R eality testing fails |
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Schizo-Etiologies
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Genetic
Bio-DOPamine hydrochloride - too much neurotransmitter for neural activity research has suggested abnormalities of neurotransmitters norepinephrine, serotonin, acetylcholine, and gamma aminobutyric acid (GABA) Psychosocial-prefrontal lobes of the brain are extremely responsive to environmental stress poor relationships with primary caretaker dysfunctional family systems double-bind communication stressful life events decreased socioeconomic status |
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Schizo- Findings- Psychotic
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Hallucintations, Delusions, flat affect, catatonic/ hyperactive behavior, incoherence
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Schizo- Findings-Positive
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reflect an excess or distortion of normal function
hallucinations delusions looseness of associations agitated or bizarre behaviors |
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Schizo- Findings-Negative
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reflect a decrease or loss of normal function
apathy poverty of speech or content of speech poor social functioning anhedonia social withdrawal |
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Schizo- Findings-Cognitive
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alterations in thinking, such as disorganized thoughts, difficulty concentrating, memory problems
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Types of Delusions
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ideas of reference
persecution grandeur somatic delusions jealousy control/being controlled thought-broadcasting thought insertion thought withdrawal associative looseness neologisms concrete thinking echolalia clang association word salad |
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Types of Schizo- Type 1
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acute onset of primarily positive symptoms
normal premorbid functioning normal social functioning during remission normal CT scan normal neuropsychological test results favorable response to antipsychotic medications appear early in illness often precipitate hospitalization alterations in thinking, perceiving, and behavior |
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Types of Schizo- Type 2
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insidious onset of primarily negative symptoms
premorbid history of emotional problems chronic deterioration demonstration of atrophy on CT scan abnormalities on neuro-psychological testing poor response to antipsychotic medications interferes with person's ability to: initiate and maintain relationships initiate and maintain conversations hold a job make decisions maintain adequate hygiene and grooming |
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Psychotic Disorder Treatment
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psychopharmacology, individual psychotherapy, group therapy, social skills training, vocation/rehab, family therapy
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Nursing Interactions for Schizo
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Protection
Medication Reality- orientation, setting realistic goals Hygiene |
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Mania
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person's elevated mood described as euphoric
inflated self-esteem impaired judgment constant physical activity pressured speech racing thought patterns requires hospitalization |
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Hypomania
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findings less severe
does not impair social, occupational, or interpersonal functioning treated in outpatient setting |
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Mood Disorders (mania, depression, bipolar
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elevated or depressed mood, with disturbances in behavioral response
divided into bipolar and depressive disorders |
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Bipolar Disorders
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mood disorders that include one or more manic or hypomanic episodes and usually one or more depressive episodes
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Mania
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period of abnormal and persistently elevated mood or irritability
at least three of these six signs grandiosity decreased sleep hyper-talkative, with pressured speech and flight of ideas or racing thoughts highly goal-directed activity (sexual, work) highly distractible pursues pleasure, but overestimates own skill and luck |
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Depression
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depressed mood most of the day
markedly diminished interest or pleasure in all, or almost all, activities most of the day significant weight loss or weight gain, or decrease in appetite nearly every day insomnia or hypersomnia nearly every day psychomotor agitation or retardation nearly every day fatigue or loss of energy feelings of worthlessness diminished ability to think recurrent thoughts of death, suicidal ideation or attempted suicide |
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Treatment for mania
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ithium carbonate (Lithane), carbamazepine (Carbatrol), valproic acid (Depakene)
antipsychotics: chlorpromazine (Thorazine), haloperidol (Haldol) occupational therapy recreational therapy |
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Treatment for Depression
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ricyclic antidepressants - amitriptyline HCl (Elavil), doxepin (Sinequan), imipramine (Tofranil)
monoamine oxidase inhibitors - phenelzine (Nardil), tranylcypromine (Parnate) selective serotonin reuptake inhibitors (SSRI) - fluoxetine (PROzac), sertraline (Zoloft) electroconvulsive therapy (ECT) psychotherapy occupational therapy recreational therapy cognitive therapy |
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Nursing Interventions with Mania
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Medicate properly, Protect others and client from harm, Set limits, DO NOT change Sodium intake due to lithium, increase fluids 2000-3000 ml/day bc of lithium, teach client proper ways of dealing with anger-including pacing
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Nursing Interventions with Depression
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Monitor for suicidal thoughts, focus on clients positive attributes, medicate properly- meds wont kick in right away, encourage sharing of feelings
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Borderline Personality DIsorder
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pervasive pattern of unstable relationships, self-image and affects
marked impulsivity frantic efforts to avoid real or imagined abandonment chronic feelings of emptiness difficulty controlling anger |
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Etiology of BPD
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impaired development of object relations; separation-individuation process is arrested
issues of dependence, independence, and control are mixed with fear of abandonment, loss of love, or engulfment by mother |
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Findings of BPD
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unstable relationships, feelings of inadequacy, uncontrolled anger, acts out and denies responsibility, poor judgment
impaired problem solving very "black or white" thinking regression marked mood swings demanding sarcastic manipulative behaves self-destructively splitting |
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Tx of BPD
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anti-anxiety agents: oxazepam (Serax)
anti-depressants: carbamazapine (Carbatrol) and Psychotherapy |
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Nursing Interventions of BPD
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use a calm, controlled approach; see that other staff stay consistent
do not argue with client encourage client to evaluate consequences of actions divert anger, or let client express anger in positive ways set limits on manipulative behaviors by communicating expected behaviors teach client medications and their side effects importance of medication compliance anger-control strategies relaxation strategies |
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Paranoid Personality Disorder
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demonstrates pervasive distrust and suspiciousness of others
assumes that others will exploit or harm them preoccupied with unjustified doubts about the loyalty or trustworthiness of friends regardless of the lack of evidence |
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Findings of Paranoia
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Suspicious of everyone, accuses mistakes of being of intentional harm, joins suspicious cults, needs to feel in control of relationship, angry/holds grudges, may have short term psychosis
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Treatment of Paranoia
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may be resistant and un-trusting of medication; anti-psychotics may relieve psychotic symptoms
psychotherapy - assess ability to tolerate any group-oriented treatment (it may be too threatening) |
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Nursing Interventions of Paranoia
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encourage a structured, predictable schedule
nurses manner needs to be detached but supportive bring medications with individual packets closed avoid arguing with the client client may be distrustful of praise, viewing the nurse as attempting to be controlling give the client an option whenever possible |
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Anxiety Disorders
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decreased ability of GABA receptors to decrease anxiety
current belief that the norepinephrine system mediates the fight/flight response; anxiety may be affected by an inappropriate activation of this system problems in the neurotransmission of serotonin may also be the cause of anxiety disorders; medications that regulate serotonin, e.g., SSRIs, have been effective in treating some anxiety disorders |
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Types of Anxiety Disorders
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Generalized, phobic, panic, dissociative disorder
somatoform disorder obsessive-compulsive disorder (OCD) post-traumatic stress disorder (PTSD) |
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Anxiety Findings
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fear, dread, or apprehension
feeling powerless crying irritability scattered thoughts, inability to concentrate or solve problems preoccupation with self rapid speech, hyperventilation, tachycardia palpitations, chest pains, jittery behavior diaphoresis insomnia diarrhea and/or urinary urgency and frequency |
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Treatment for Anxiety Disorders
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anxiolytics (antianxiety drugs) such as alprazolam (Xanax) and diazepam (Valium)
psychotherapy occupational therapy recreational therapy |
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Nursing care for anxiety disorders
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Treat fears as real, do not force client into contact with fear,allow compulsions to play out but set reasonable limits on them, provide distracting activities
allow temporary dependence speak calmly, slowly and clearly assist client in ADLs as indicated, provide exercise, give meds, limit caffeine intake, and interactions with other anxious ppl |
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Narcotics Withdrawal
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Flu like symptoms, Severe anxiety to panic; irritability
Confusion Piloerection (gooseflesh) Tremors Loss of appetite Muscle aches or cramps Tachycardia Hypertension Increased respirations Increased temperature Insomnia Yawning |
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Alcohol Withdrawal Mild
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from simple tremulousness to delirium tremens (refer to assessment tool below)
Mild withdrawal symptoms tremulousness insomnia anxiety hyperreflexia diaphoresis mild autonomic hyperactivity gastrointestinal upset |
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Moderate Alcohol Withdrawal
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intense anxiety
tremors insomnia headache tremors - especially of the hands agitation sweating - especially the palms of the hands or the face tachycardia nausea and vomiting abdominal cramps diaphoresis visual or tactile hallucinations |
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Severe Alcohol Withdrawal
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delirium tremens (DTs)
confusion disorientation agitation visual, tactile hallucinations, also known as alcoholic hallucinosis alcohol withdrawal seizures, also referred to as "rum fits" severe autonomic hyperactivity tremulousness tachycardia tachypnea hyperthermia diaphoresis |
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Sedative-Hypnotic Withdrawal
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chronic use of benzodiazepines, barbiturates, and other sedative or hypnotics produce withdrawal symptoms on discontinuation resembling those of alcohol withdrawal
Weakness, nausea and vomiting Hypertension, tachycardia, orthostatic hypotension Gross tremors Agitation Anxiety Disorientation Hallucinations, delirium Convulsions |
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Stimulant Withdrawal
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after chronic use of amphetamines, methamphetamines, Ritalin
Behavior - sedated; apathy Psychomotor activity - retarded Mood or affect - depressed or irritable Speech - nonspontaneous Thought processes or content - linear at times with suicidal ideation and drug craving Memory - likely to be impaired due to sleep deprivation, associated fatigue, decreased attention and irritability Cravings |
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Marijuana Withdrawal
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long term abuse can lead to addiction and withdrawal symptoms
Irritability Insomnia Loss of appetite Tremors Perspiration Nausea |
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Alcohol Abuse Symptoms
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anemia
hypertension tachycardia hepatomegaly ascites cirrhosis gastritis esophagitis malabsorption syndrome fatigue depression impaired judgment and cognitive impairment tremors delirium tremens (may be life-threatening) Wernicke-Korsakoff syndrome a form of amnesia loss of short-term memory disorientation and confabulation |
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Treatment of Alcohol Abuse
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B1/Thiamine intake increased,
Phram-acute phase benzodiazepines, e.g., diazepam - to treat seizures, anxiety, tremors antipsychotic medications, e.g., haloperidol (Haldol) - if hallucinations develop Long term-disulfiram (Antabuse) alcohol abuse deterrent - client becomes ill if drinks alcohol, while taking the medication naltrexone (ReVia) or nalmefine (Revek) - lower cravings for and less pleasure from drinking Or AA |
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Nursing Care for Alcohol Abuse
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during acute withdrawal
stay with client provide quiet environment administer medications as ordered monitor vital signs - temperature over 100 degrees Fahrenheit and pulse in excess of 100 beats per minute may indicate alcohol withdrawal delirium (delirium tremens) protect the client from harm institute seizure precautions as indicated maintain adequate fluid intake monitor intake and output |
during abstinence
provide emotional support provide nutritious diet encourage the development of new coping skills teach and promote relaxation exercises inform client about support groups and rehab programs |
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Stimulant Abuse (Crack,Cocaine, Amphetamines)
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psychomotor agitation
mood swings tachycardia hypertension dilated pupils perspiration and chills insomnia impaired cognitive function seizures if discontinued, withdrawal follows overdose may cause lethal cardiac or respiratory arrest emergency care of overdose of stimulants: cardiopulmonary support |
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Depressant Abuse
(barbiturates, tranquilizers, sedatives and hypnotics) |
slurred speech
impaired cognitive function; confusion emotional lability lack of coordination cold and clammy skin |
overdose can lead to respiratory depression, coma
emergency care of overdose respiratory support keep client awake and moving |
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Narcotics (heroin, morphine, meperidine, codeine, methadone)
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euphoria
tranquility drowsiness constricted pupils clouded sensorium overdose threatens life: depresses respiratory function and alters level of consciousness emergency care includes cardiopulmonary support |
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Eating Disorder Findings
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personal relationships become superficial and distant
social contact avoided especially if food is involved preoccupation with food, meal planning, caloric intake and methods to avoid eating eats in private mood irritable and defiant exercises excessively physical findings weight falls below 85% of normal bradycardia anemia amenorrhea decreased renal function dental problems fluid and electrolyte imbalances delayed skeletal maturation |
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Treatment of Eating Disorders
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client may require hospital care
nutritional planning psychotherapy: individual and/or family group therapy occupational therapy recreational therapy |
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Nursing Interventions for Eating Disorders
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monitor weight as prescribed
monitor client's eating/record intake and output administer nasogastric feedings if ordered encourage oral hygiene set limits on eating including time allotted for meals stay with client during meals accompany client to bathroom after meals to prevent self-induced vomiting encourage client to express feelings encourage socialization monitor for findings of electrolyte imbalance or dehydration assist client to identify strengths teach client relaxation techniques alternative coping methods assertiveness skills |
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Autism Findings
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does not respond to human touch
lack of eye contact talks poorly or not at all ritualistic behavior cannot deal with change emotional lability may be self destructive (head-banging, hair pulling, finger/hand biting) failure to develop friendships or play with other children posture or gait abnormalities: poor coordination, tiptoe walking, peculiar hand movements (flapping, clapping) |
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Treatment of Autism
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special education
may need full time care |
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Nursing Interventions of Autism
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support parents emotionally
protect the child from self harm help child with hygiene and feeding as indicated maintain consistency in schedule allow ritualistic behavior |
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Cycle of Battering
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phase 1: calm (also called "honeymoon" period)
phase 2: tension building phase 3: explosion (triggering event, which could be something...or nothing) phase 4: reconciliation |
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