Summary Exam 2 Study Guide CGCC NUR 172, Dr Staggar Fall 2021 A+ guide
Exam 2 Study Guide CGCC NUR 172, Dr Staggar Fall 2021 Schizophrenia & Related Disorders: Psychosis: a state in which a person experiences hallucinations, delusions, or disorganized thoughts, speech, or behavior. Psychosis is the key diagnostic factor in schizophrenia spectrum disorders. These are the positive symptoms of schizophrenia. Brief Overview of Types: Schizophrenia Psychotic symptoms that last at least 1 month Schizoaffective Disorder Mood-related symptoms and symptoms of schizophrenia occur simultaneously Delusional Disorder Delusions only, no other psychotic symptoms Brief Psychotic Disorder Symptoms like schizophrenia, but only lasts 1 month Schizophreniform Disorder Symptoms equivalent to those of schizophrenia except the duration and the absence of a decline in functioning (between 1 and 5 months) Substance/medication-induced psychotic disorder Psychotic symptoms caused by a substance or medication Schizotypal Personality Disorder Pervasive pattern of deficits including social and interpersonal (impaired capacity for close relationships), cognitive or perceptual distortion, and eccentricities. SCHIZOPHRENIA: DISTORTION OF THINKING, PERCEPTION, BEHAVIOR AND EMOTION. AFFECTS MEN MORE THAN WOMEN, DIAGNOSED IN LATE ADOLESCENCE OR EARLY ADULTHOOD HAVE DIFFICULTY MAINTAINING GAINFUL EMPLOYMENT Prodromal Period: The state of early changes that are the precursor to the disorder and may begin in early childhood. Symptoms such as tension, nervousness, lack of interest in eating, difficulty concentrating, disturbed sleep, decreased enjoyment, loss of interest, restlessness, forgetfulness, depression, social withdrawal. Acute Illness: Usually occur in late adolescence or early adulthood. Episodes of staying up all night for several nights, incoherent conversations, aggressive acts against self or others. As symptoms worsen, they are less able to tend to daily care needs and become dependent on family. They are high risk for suicide in this stage. Initial treatment focuses on alleviation of symptoms with medications, decreasing risk of suicide through safety measures. Stabilization: After diagnosis and initiation of treatment, stabilization of symptoms becomes the focus. Symptoms may be less acute but still present. Treatment is intense during this time as medication regimens are established and they begin to adjust to the new diagnosis. Recovery: Medications generally diminish the symptoms and allows the person to work toward recovery however no medications will cure schizophrenia. Medication and therapy adherence as well as family support and involvement are crucial for recovered. Relapses: Can occur at any time and are detrimental to management. Diagnostic Criteria: Characterized by positive and negative symptoms that are present for a significant portion of a 1-month period and continuous signs of disturbance for at least 6 months. 1 of the symptoms must be either delusions, hallucinations or disorganized speech 1. Two or more of the following: Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression or avolition) 2. Level of functioning in one or more major areas is markedly below level previous achieved prior to onset 3. Continuous signs of the disturbance persist for at least 6 months and this 6 months must include 1 month of symptoms that meet criteria 1 (above). 4. Schizoaffective and bipolar disorder have been ruled out 5. The disturbance is not attributed to substance or another medical condition. Target symptoms: Inappropriate affect Loss of interest of pleasure (anhedonia) Dysphoric mood (anger, anxiety, or depression) Disturbed sleep patterns Lack of interest in eating or refusal of food Difficulty concentrating Some cognitive dysfunctions, such as confusion, disorientation, or memory impairment Lack of insight Depersonalization, derealization, and somatic concerns Motor abnormalities. Associated Physical Examination Findings: Physically awkward Poor coordination or mirroring Motor abnormalities Cigarette-related pathologies-emphysema, COPD, Cardiac problems Associated Laboratory Findings Enlarged ventricular system and prominent sulci in the brain Decreased temporal and hippocampal size Increased size of basal ganglia Decreased cerebral size Slowed reaction times Abnormalities in eye tracking Positive Symptoms: hallucinations, delusions, and disorganized thinking Hallucinations: involve one or more of the five senses Command Hallucinations: Auditory hallucination instructing the patient to act in a certain way Visual, Auditory, Gustatory (taste), Olfactory (smell), Tactile/Somatic (feeling/sensation) Delusions: Involve only thoughts Grandiose: the belief that one has exceptional powers, wealth, skills Nihilistic: the belief that one is dead, or a calamity is impending Persecutory: the belief that one is being watched, ridiculed, harmed, or plotted against Somatic: beliefs about abnormalities in bodily functions or structures Disorganized Thinking: Echolalia: Repetition of another’s words (parrot like) Circumstantiality: extremely detailed and lengthy discourse about a topic Loose Associations: absence of normal connectedness-sudden shifts without connections Tangentiality: topic of conversation is changed to entirely new topic and never returns Flight of Ideas: topic changes repeatedly and rapidly-one right after the other Word Salad: stringing together words that are not connected in any way Neologisms: words that are made up and have no common meaning Paranoia: suspiciousness and guardedness -unrealistic and often accompanied by grandiosity Referential Thinking: a belief that neutral stimuli have special meaning to the individual Autistic Thinking: restricts thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else Concrete Thinking: lack of abstraction in thinking inability to understand punch lines metaphors and analogies Verbigeration: purposeless repetition of words or phrases Metonymic Speech: use of words with similar meaning interchangeably Clang Association: repetition of words or phrases that are similar in sound but in no other way Stilted language: overly and inappropriately artificial formal language Pressured Speech: speaking as if the words are being forced out, often rapidly Disorganized Behavior: Aggression: behaviors or attitudes that reflect rage hostility and the potential for physical or verbal destructiveness Agitation: inability to sit still or attend to others accompanied by heightened emotions and tension Catatonia: psycho motor disturbances such as stupor mutism posturing or repetitive behavior Catatonic Excitement: a hyperactivity characterized by purposeless activity and abnormal movements such as grimacing and posturing Echopraxia: involuntary imitation of another person's movements and gestures Stereotypy: repetitive purposeless movements that are idiosyncratic to the individual and to some degree outside the individual’s control Hypervigilance: sustained attention to external stimuli as if expecting something important or frightening to happen Waxy Flexibility: posture held in an odd or unusual fixed position for an extended period Negative symptoms: diminished expression, social isolation, blunted affect, alogia (poverty of speech, and avolition (lack of interest or motivation in goal directed behavior like getting dressed, going to work.) Affective deficits, anhedonia Neurocognitive Impairment: May be present & Independent of positive and negative symptoms. Longterm memory is not necessarily affected but low intellectual functioning is common and may be related to educational deficiencies/lack of access. Most often manifested in disorganized symptoms. Inability to learn new things, remember things, maintain focused attention, can’t process social cues, difficulty with understanding Causes: interaction of a biologic predisposition or vulnerability and environmental stressors Biologic Theories: neuroanatomic (brain anatomical changes) o Familial Patterns: 1st Degree relative up to 10 times higher risk (identical twin 50%) o Genetic Associations: susceptibility (not necessarily causation), response to treatment o Neurodevelopment: utero development in 1st and 2nd trimester. Neurotransmitters, pathways, receptors, dopamine dysregulation, GABA Psychosocial Theories: social factors can contribute to brain function that result in schizophrenia o Childhood trauma o Living in an urban environment o Minorities o Prenatal exposure to hunger Environmental Theories o Exposure to viral infection o Exposure to lead Nursing Assessment Physical Health: Underlying medical disorders (DM, hypertension, cardiac disease, cancer, family history of those disorders) Smoking related illness Physical Functioning: Self-care (ADLs, hygiene, cooking, food, exercise) Sleep Nutrition: Eating habits and preferences History of diabetes Baseline weight Exercise Habits Medications can lead to excessive calorie consumption Medication: Complete list of RX, OTC, Herbal medications/supplements (St. Johns Wort) that can interfere with metabolism of medications such as haloperidol, alprazolam, and diazepam Standardized assessment of abnormal motor movements should be conducted prior to giving antipsychotic medications (AIMS, DISCUS, SARS) Substance Use: Alcohol, Tobacco, Drug Use Tobacco increases the speed that clozapine is metabolized (stopping/starting messes plasma levels of the medication) Mental Status and Appearance: Mood and Affect Flat: emotional expression entirely absent Blunted: expression of emotions present but greatly diminished Inappropriate Affect: incongruence between emotional expression and the thoughts expressed Affective Lability: abrupt, dramatic, unprovoked changed in type of emotions expressed Ambivalence: the presence and expression of two opposing feelings, leading to inaction Apathy: little emotional expression; diminished interest and desire Speech Obvious signs of delusions Loose associations Flight of ideas Neologisms Pressured or slowed Dysarthria (difficulty articulating words) (medications) Dysphagia (difficulty swallowing) (medication) Thought Process Assessment Hallucinations o Most common disturbed sensory perception is auditory (command) o False sensory perception in the absence of external stimuli Delusions o Don’t change even with strong evidence, impossible, illogical, not derived from ordinary life experiences. Bizarre: Delusions of control (someone from the outside controls their actions), thoughts broadcasting (others can read or hear their thoughts), thought insertion (someone has placed thoughts in their head), thought withdrawal (someone is removing thoughts from their head) Non-Bizarre: themes of jealousy and persecution that are derived from plausible life experiences Disorganized communication o Abrupt shifts in conversation. Impaired verbal fluency, word salad, flight of ideas, loose associations, tangentiality Cognitive impairment o Attention may be increased or sustained on external stimuli over a period of time o Diminished ability to distinguish and focus on relevant stimuli o Familiar cues may go unrecognized o Diminished information processing leading to illogical conclusions from available observations and information Memory and Orientation Impairment in memory, orientation, and abstract thinking is often present Person, Place, Time may be relatively intact unless preoccupied with delusions, etc. Insight and Judgment o Ability to recognize that their hallucinations or delusions are a symptom of mental disorder o Judgment is ability to decide how to act about a situation. If poor the person may not recognize personal vulnerabilities and engage in detrimental behavior Nursing Diagnosis: Generated from assessment data Self-Neglect Disturbed Sleep Pattern Imbalanced Nutrition: Less than body requirements (during relapse) Excess fluid volume (during relapse) Sexual dysfunction (during relapse) Chronic self esteem Ineffective coping Deficient knowledge (psychological) Acute confusion (psychological-disorganized confusion, hallucinations, illusions) Impaired social interaction (social domain) Ineffective role performance (social domain) Dysfunctional family process (social domain) Interrupted family process (social domain) Interventions: Maintain a safe environment Milieu Therapy Goals: Management of illness symptoms and enhancing emotional growth Self-Care: develop a routine, help emphasizing importance of maintaining appropriate self-care activities Encouraging activity and exercise Nutrition (acute psychosis, weight gain, monitor for DM) Thermoregulation (related to clothing selection, etc) Fluid Balance (polydipsia, frequent incontinence, obsessively drink water) Physiological needs are the primary nursing focus (nutrition, hygiene) Avoid physical contact or touching Engage patient in socialization to reduce isolation Encourage participation in unit activities, exercises, and therapy Reinforce congruent thinking and stress/validate reality Do not argue or avoid agreeing with inaccurate communication Set limits to inappropriate behavior Encourage patient to verbalize feelings and thoughts openly Communicate in calm and therapeutic but authoritative tone Teach patient about medications
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- dr staggar fall 2021
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nur 172 nursing theory and science ii
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exam 2 study guide cgcc nur 172
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schizophrenia amp related disorders
