Term
|
Definition
| delusions, prominent hallucinations, disorganized speech or catatonic behavior |
|
|
Term
| what are the types of psychotic disorders? |
|
Definition
1. schizophreniform disorder
2. brief psychotic disorder
3. shizoaffective disorder
4. delusional disorder
5. shared psychotic disorder |
|
|
Term
| what can psychosis be induced by? |
|
Definition
substances:
1. alcohol
2. medications
3. toxins
medical:
1. delirium
2. hepatic and renal disease |
|
|
Term
| schizophreniform disorder |
|
Definition
has the same essential characteristics of schizophrenia except:
1. duration is for at least 1 month but less than 6
2. impaired social and occupational functioning during the illness may not be apparent
3. prognosis may or may not be good |
|
|
Term
|
Definition
| is a sudden onset of psychotic symptoms such as hallucinations, delusions, and disorganized speech, or grossly disorganized or catatonic behavior for at least one day but less than 1 month. Person returns to normal functioning level after onset. Usually occurs after a very stressful event. |
|
|
Term
|
Definition
| is an uninterrupted period of illness with a depressive, manic, or mixed symptoms concurrent with those of schizophrenia. These symptoms must not be due to drug use/abuse or any general medical condition |
|
|
Term
|
Definition
| delusions of situations that happen in real life such as being loved at a distance, being cheated on by a spouse, infected, or being followed |
|
|
Term
|
Definition
| having a non-bizarre delusion for at least 1 month. person's behavior or functioning is not markedly impaired, odd, or bizarre. common delusions seen are of grandeur, persecution, jealousy, somatic, and mixed. |
|
|
Term
| shared psychotic disorder (folie a deux) |
|
Definition
| when a person who is in a relationship with a person with a psychotic disorder and delusions comes to share the delusional beliefs of the person either in total or partially. other than sharing the delusional belief, the person without the psychotic disorder is not unusual or odd, and is usually less impaired than the individual with the psychotic disorder. the cult phenomenon Waco and Jonestown is an example |
|
|
Term
| what is the organ of weakness in psychotic disorders? |
|
Definition
|
|
Term
| what differences in the brain are seen in a schizophrenic individual? |
|
Definition
1. chemistry
2. activity
3. composition
4. atrophy in the frontal and temporal lobes and the cerebullum and cortical
5. increase in the size of the fissures |
|
|
Term
| the likelihood for a psychotic disease increases in people with |
|
Definition
| relatives who are positively diagnosed |
|
|
Term
| what are some non-genetic factors that contribute to psychotic disease? |
|
Definition
| viral infections, birth injuries, and nutritional factors |
|
|
Term
| is schizophrenia a single disease? |
|
Definition
| no it is an array of syndromes involving several neurological abnormalities |
|
|
Term
| when the symptoms of a psychological disorder beings, what happens to the development that takes place according to Erikson's theory? |
|
Definition
|
|
Term
| the developmental levels of the patient can give us insight to the |
|
Definition
disease onset
severity level
patient's current condition |
|
|
Term
| what developmental stage do schizophrenics have problems with? |
|
Definition
trust vs mistrust
they have problems trusting others |
|
|
Term
|
Definition
|
|
Term
| is a psychological disorder, what happens to sleep |
|
Definition
| there is an offset in sleep or deprivation |
|
|
Term
| in patients with a psychotic disorder, a relationship with God has a __________ and __________ are improved. Also the body is more nourished and sustained throughout _________. It helps them to achieve stability and change. However if the patient is ________ it is hard to tell if the relationship is genuine. |
|
Definition
| in patients with a psychotic disorder, a relationship with God has a positive effect and thought processes are improved. Also the body is more nourished and sustained throughout impairment. It helps them to achieve stability and change. However if the patient is delusional, it is hard to tell if the relationship is genuine. |
|
|
Term
| in a patient with a psychotic disorder, their normal line of defense (NLOD) is |
|
Definition
| that of a pt with a serious and persistent neurological disease |
|
|
Term
| in a person with a psychotic disorder, their lines of defense are |
|
Definition
|
|
Term
| stressful life events in a person with a psychological disorder causes |
|
Definition
| the onset, increases severity and relapse rate and it also inhibits coping mechanisms |
|
|
Term
| what is the effect of schizophrenia on pregnancy and birth? |
|
Definition
|
|
Term
| what is the effect of children with a father that was older than 55 years old? |
|
Definition
| were 1.84 times more likely to develop schizophrenia |
|
|
Term
| 50% of homeless people are |
|
Definition
|
|
Term
| what is the leading cause of premature deaths in individuals with a psychological disorder? |
|
Definition
|
|
Term
| what disorder is highest in people with psychological disorders? |
|
Definition
|
|
Term
| what are some comorbidities associated with schizophrenia or psychological disorders? |
|
Definition
| suicide, homelessness, nicotine addiction, substance abuse, incarceration, infection/HIV, and violence |
|
|
Term
T or F:
schizophrenia appears in mostly American cultures and Western countries? |
|
Definition
False!
schizophrenia appears in all cultures and in all countries |
|
|
Term
| does schizophrenia have a gender preference? |
|
Definition
|
|
Term
| is schizophrenia curable? |
|
Definition
| no, shizophrenia is TREATABLE not curable |
|
|
Term
| when does the onset of schizophrenia usually occur? |
|
Definition
|
|
Term
| under the mental health continuum, schizophrenia is defined as |
|
Definition
|
|
Term
|
Definition
| is a disorder of neurocognition and information processing |
|
|
Term
| what is most complexing psychopathology? |
|
Definition
|
|
Term
| what is schizophrenia NOT? |
|
Definition
it is NOT
1. a disturbance in intellect
2. dissociative identity disorder or multiple/split personality disorder because with this, the ego is intact |
|
|
Term
| is compartmentalization accurate of schizophrenia? |
|
Definition
|
|
Term
| according to the DSM-IV-TR, how long must the duration of the symptoms be in order to meet the standards of schizophrenia? |
|
Definition
| for at least 6 months with at least one month of the active phase |
|
|
Term
| what are the 4 A's of schizophrenia? |
|
Definition
1. affect
2. associative looseness
3. autism
4. ambivalence |
|
|
Term
affect
how is it affected in schizophrenia? |
|
Definition
affect is the outward manifestation of your feelings and emotions.
in schizophrenia, the affect may be flat, blunted, inappropriate, or bizarre |
|
|
Term
|
Definition
| represents haphazard and confused thinking that is manifested by jumbled and illogical speech, looseness of association |
|
|
Term
|
Definition
| refers to thinking that is not bound by reality and reflects the private perceptual world of the individual. such as delusions, hallucinations, and neologisms in a schizophrenic patient |
|
|
Term
|
Definition
| simultaneously holding two opposing positions on a person, place, or thing. normally happens in all relationships. can be paralyzing due to constantly battling between two positions |
|
|
Term
| what are the 5 types of schizophrenia? |
|
Definition
1. paranoid
2. disorganized
3. catatonic
4. undifferentiated
5. residual |
|
|
Term
|
Definition
- is the most common type of schizophrenia
- higher functioning
- good response to treatment |
|
|
Term
| disorganized schizophrenia |
|
Definition
| -very regressed and disorganized behavior |
|
|
Term
|
Definition
- go from stupurous to excited
- waxy flexibility
- not common anymore due to medications |
|
|
Term
| undifferentiated schizophrenia |
|
Definition
| does not fit into any other of the categories |
|
|
Term
|
Definition
- have had at least one episode
- are not currently psychotic
- seen to have poor grooming, eccentric behavior, and negative symptoms, but not the positive |
|
|
Term
| schizophrenia is a disease of recurring acute |
|
Definition
| manifestations of psychotic symptoms |
|
|
Term
| what are the three phases of schizophrenia? |
|
Definition
1. acute
2. maintenance
3. stabilization |
|
|
Term
| acute phase of schizophrenia |
|
Definition
| prodromal and acute symptoms as well as periods of florid positive and negative symptoms |
|
|
Term
| maintenance phase of schizophrenia |
|
Definition
| when the acute symptoms decrease in severity |
|
|
Term
| stabilization phase of schizophrenia |
|
Definition
| major symptoms appear to be in remission |
|
|
Term
| what are the types of prodromal symptoms or prepsychotic symptoms? |
|
Definition
1. positive
2. negative
3. cognitive
4. depressive/mood related symptoms |
|
|
Term
| the cognitive symptoms of schizophrenia can really be grouped as |
|
Definition
|
|
Term
| although prodromal symptoms are precursors, |
|
Definition
| they do not always lead to the disease |
|
|
Term
| at what developmental level does schizophrenia have its onset? |
|
Definition
|
|
Term
| what is a positive symptom of schizophrenia? |
|
Definition
| one that stands out or is due to excessive functioning |
|
|
Term
| what are negative symptom of schizophrenia? |
|
Definition
| defects or diminished functioning |
|
|
Term
| when do the positive symptoms of schizophrenia manifest? what about the negative symptoms of schizophrenia? |
|
Definition
positive manifest in the acute stages
negative manifest gradually overtime and are less obvious but more debilitating in how they affect normal lifestyle |
|
|
Term
| list some positive symptoms of schizophrenia |
|
Definition
hallucinations
delusions
disorganized speech patterns
bizarre behavior
pt never really know what is real |
|
|
Term
|
Definition
| unchanging facial expression, no vocal inflection, and decreased spontaneous movements |
|
|
Term
|
Definition
| poverty of speech, and content of speech and blocking |
|
|
Term
|
Definition
inability to participate in goal directed activities, no motivation
impaired grooming and hygiene, lack of persistence at school or work, and physial anergia |
|
|
Term
|
Definition
| inability to experience pleasure, asociality |
|
|
Term
| what symptoms are more hard to assess and evaluate in the acute phases of a psychotic episode? |
|
Definition
|
|
Term
| which symptoms are more crippling? |
|
Definition
|
|
Term
| positive symptoms such as paranoia, delusions, hallucinations, etc are usually associated with |
|
Definition
acute onset
normal CT and neuropsychological test findings, and social functioning during remissions, and normal premorbid functioning
and respond favorably to antipsychotic medications |
|
|
Term
| positive symptoms appear early in the..... and precipitate.... |
|
Definition
| positive symptoms appear early in the first phase of the illness and precipitate hospitalization |
|
|
Term
| which symptoms are the least important prognostically and can respond to antipsychotic medication? |
|
Definition
|
|
Term
| what is the focus during stage 1 of schizophrenia for the nurse? |
|
Definition
1. assess safety
2. crisis intervention
3. assessing for command hallucinations, anxiety, violence, rage, panic, or extreme suspicion
4. symptom and medical stabilization |
|
|
Term
| what is important during phases II and III of schizophrenia? |
|
Definition
1. adherence to the medication regimen
2. address relapse
3. encourage involvement in psyhcoeducational activities with the family
4. understanding the disease |
|
|
Term
| primary interventions for schizophrenia |
|
Definition
- educate patient and support systems
- provide stabilization and safety
- address immediate crisis issues |
|
|
Term
| secondary interventions for schizophrenia |
|
Definition
Therapies:
Recommended:
-group (maybe later on, not at first due to stimuli) but is good for socialization, sharing, and support and education
- mileu- used in the hospital to promote reality testing, communication, and competency in ADLs and is a structured environment
- conditional behavioral therapy- help gain control over unwanted behaviors
Not Recommended:
-support therapy or insight oriented therapy
Focus:
- safety
- medication regiment compliance to help control their behavior
- social skills and ADLs
- nutritional and sleep habits
- crisis intervention
- least restrictive environment |
|
|
Term
| tertiary interventions for schizophrenia |
|
Definition
1. assess patient baseline before discharge
2. assess where patient is going and relocate if it is more stress than pt can handle
3. stress med/treatment compliance to prevent relapse, which will increase resistance to meds and cause a poor response to treatment |
|
|
Term
| each relapse causes the psychosis to be more |
|
Definition
|
|
Term
| what are the two types of antipsychotic drugs? |
|
Definition
| typical (standard) and atypical |
|
|
Term
| how long does it take the typical antipsychotic drugs to reach their full potential? |
|
Definition
|
|
Term
| what are some different names for antipsychotic drugs? |
|
Definition
| neuroleptics, major tranquilizers |
|
|
Term
| do antipsychotic drugs cure the illness of schizophrenia? |
|
Definition
|
|
Term
| how antipsychotic drugs work? |
|
Definition
| by blocking the post synaptic receptors from receiving dopamine. in other words they block dopamine transmission causing movement abnormalities |
|
|
Term
| what do typical antipsychotic drugs target? |
|
Definition
they target the more flagrant positive symptoms of schizophrenia. Such as:
-delusions
-hallucinations
-disorganized speech
Do NOT work as well on the negative symptoms |
|
|
Term
| what can typical antipsychotic drugs can a reduction in? an improvement in? |
|
Definition
reduction in: disruptive behavior and the intensity of paranoid reactions
improvement in: sleep patterns and sedation |
|
|
Term
| what are the side effects of typical antipsychotic drugs? |
|
Definition
1. EPS: extrapyramidal side effects: In the basal ganglia, D2 plays a major role in movement. So blockage of D2 leads to motor abnormalities
2. Increased prolactin caused by a decrease in dopamine to inhibit it.
a. In women causes amenorrhea (lack of menstruation) and galactorrhea
(spontaneous flow of milk from the breast)
b. In men causes gynecomastia (development of male mammary glands)
3. cardiac effects such as hypotension, vasodilation, and orthostatic hypotension
because of blocking of the alpha 1 receptors for norepinephrine
4. toxicity
5. weight gain and sedation by blocking H1 histamine receptors
***these lead to high noncompliance rates*** |
|
|
Term
| what are the different types of EPS? |
|
Definition
1. parkinsonism
2. akinesia
3. akathesia
4. dyskinesia
5. tardive dyskinesia
6. dystonia |
|
|
Term
| after the administration of typical or first generation or standard antipsychotic drugs, what should nurses monitor their patients for? |
|
Definition
| abnormal involuntary movements such as EPS |
|
|
Term
| what tool can be used to assess abnormal movements? |
|
Definition
| abnormal involuntary movements scale (AIMS) |
|
|
Term
|
Definition
1. mask like face
2. pill rolling
3. shuffling gait
4. stiffening of the muscles of the face, body, and limbs |
|
|
Term
|
Definition
| slowness OR absence of movement |
|
|
Term
|
Definition
| inner restlessness, patient feels restless, is fidgeting, rocking back and forth, or pacing, repeatedly |
|
|
Term
|
Definition
| acute contractions of the face, tongue, neck, and back |
|
|
Term
|
Definition
| difficulty or distortion in voluntary movements like a tic |
|
|
Term
|
Definition
protruding and rolling of tongue, licking, smacking, and spastic facial movements
is more serious and is not always reversible |
|
|
Term
| what is a side effect that is caused by ALL typical antipsychotic drugs? |
|
Definition
|
|
Term
| what special precaution should be taken with what type of patient when giving standard or typical antipsychotics? |
|
Definition
| should be taken with caution in people with seizure disorders because it can lower the seizure threshold |
|
|
Term
| give some examples of typical antipsychotic drugs: |
|
Definition
1. phenothiazines
2. thorazine
3. stelazine
4. haldol
5. melleril
6. prolixin
7. navane |
|
|
Term
| what type of antipsychotic drugs are used more today? |
|
Definition
| atypical because of the many undesirable side effects of the typical |
|
|
Term
| what do atypical antipsychotic drugs target? |
|
Definition
| BOTH negative and positive |
|
|
Term
| atypical antipsychotics are first line meds and used before the use of typicals because typical have so many bad SE. however, which atypical is generally NOT a first line atypical antipsychotic, and why? |
|
Definition
| Clozaril is NOT a first line atypical med because it causes seizures and agranulocytosis |
|
|
Term
| name some examples of atypical antipsychotics: |
|
Definition
1. risperidol
2. seroquel
3. geodon
4. abilify
5. zyprexa
6. clozaril |
|
|
Term
| what are the downsides to atypicals? |
|
Definition
| more expensive and zyprexa causes weight gain and metabolic abnormalities |
|
|
Term
|
Definition
is a long acting form an antipsychotic drug if often given weekly
typicals: haldol and prolixin decanoate
atypicals: risperidone decanoate: Consta |
|
|
Term
| what drugs are assosicated with anticholinergic effects, lowered seizure threshold, and orthostasis? |
|
Definition
|
|
Term
| what are the treatments for EPS? |
|
Definition
1. benzotropine (cogentin)
a. number 1 choice
b. standing order for all pts for EPS, PO or IM
c. takes care of reaction in 30 minutes
2. artane
a. only PO
3. benedryl
a. PO or IM |
|
|
Term
| if a medication is causing tardive dyskinesia, the symptoms usually have to do with the ________ and the medication may have to be __________. |
|
Definition
| dyskinesia, the symptoms usually have to do with the MOUTH and the medication may have to be DISCONTINUED. |
|
|
Term
| what are the rare and toxic affects of antipsychotic drugs? |
|
Definition
1. neuromalignant syndrome (NMS)
2. agranulosytosis and seizures with Clozaril
3. cholestatic jaundice and liver involvement |
|
|
Term
| what does NMS usually start with? |
|
Definition
|
|
Term
what are the clinical manifestations of NMS?
what are the treatments? |
|
Definition
S/S:
1. loss of urine
2. hyperpyrexia: fever
3. labile HTN
4. tachypnea
5. tachycardia
6. drooling
7. diaphoresis
8. decreased LOC
9. increased muscle tone
Treatment:
1. early detection
2. discontinue antipsychotic agent
3. monitor fluid balance
4. reduce temperature
5. monitor for complications
In mild cases: (Bromocriptine) Parlodel
In more severe cases: (Dantrium) Dantrolene IV and even electroconvulsive therapy |
|
|
Term
| if NMS is left untreated... |
|
Definition
| the patient can be unconscious and even dead in 12 hours |
|
|
Term
| you have a patient who is on antipsychotic drugs and develops a fever, you would |
|
Definition
-assess temperature, vital signs, and LOC frequently
- notify MD STAT
-if it is NMS: get to the ER NOW! |
|
|
Term
| clozaril is the best drug to fight |
|
Definition
| psychotic symptoms including the negative symptoms. it also helps with positive symptoms, but is best with the negative |
|
|
Term
| what was the first atypical antipsychotic drug? |
|
Definition
|
|
Term
| what is clozaril's association with EPS, seizures, and agranulocytosis? |
|
Definition
- virtually causes no EPS
- lowers the seizure threshold
- can cause agranulocytosis which can be fatal |
|
|
Term
| list some of the negative side effects of clozaril use |
|
Definition
1. low seizure level
2. hypersalication
3. hypotension
4. tachycardia
5. constipation
6. can lead to agranulocytosis which can be fatal |
|
|
Term
| what are the criteria for taking clozaril? but first, why are there criteria in the first place? |
|
Definition
there must be criteria because clozaril has potentially fatal side effects, including agranulocytosis.
criteria:
1. MD must have tried 2 neuroleptics before trying clozaril
2. patient must be willing to take it PO since an IM form in not available
3. patient must agree to have their blood drawn either weekly or monthly to watch for agranulocytosis |
|
|
Term
| what are the S/S to assess for if a patient possibly has agranulocytosis? |
|
Definition
| sore throat, fever, and flu like symptoms |
|
|
Term
| what are the nursing implications for a patient who is on clozaril? |
|
Definition
1. assess for S/S of agranulocytosis: fever, sore throat, and flu like symptoms
2. monitor labs constantly
3. hold the medication if they refuse to allow their blood to be drawn OR is WBC < 3000 or if neutrophils are less than 1500
4. take BP before AND after administration
5. place patient on seizure precautions |
|
|
Term
| needing to be in control produces |
|
Definition
|
|
Term
T or F:
alcohol affects the respiratory and cardiac systems |
|
Definition
FALSE!
alcohol affects ALL of the systems |
|
|
Term
cocaine users suffer from
1.
2.
and they are at risk for
1.
2. |
|
Definition
cocaine users suffer from
1. malnutrition
2. weight loss
and they are at risk for
1. MI
2. stroke |
|
|
Term
| the route of administration of an abused drug by a drug abuser correlates to the |
|
Definition
|
|
Term
| do all alcoholic drinkers become alcoholics? |
|
Definition
|
|
Term
| what is the organ of weakness in substance abuse/addiction? |
|
Definition
|
|
Term
| what is the normal line of defense (NLOD) for substance abusers? |
|
Definition
|
|
Term
| in substance addiction, is the person addicted to a drug? |
|
Definition
| NO, they are addicted to the sense of euphoria that they cannot achieve without the drug/chemical |
|
|
Term
| what is behavioral theory? what is its focus? |
|
Definition
patient seeks euphoria to escape life's stressors and once they discover the euphoric state, they will continue to use despite the dire consequences
focus: is to assess the stressors in a patient's life |
|
|
Term
|
Definition
looks at the differences and rate of substance abuse among vaious groups
also that user may feel a sense of belonging to subculture of drug abuse |
|
|
Term
|
Definition
1. loss of control of substance consumption
2. substance use despite associated problems
3. tendency to relapse |
|
|
Term
|
Definition
| the need for higher and higher doses to achieve the desired effect |
|
|
Term
|
Definition
| after a long period of continued use of a substance, a cessation or reduction in the substance causes specific physical and psychological effects |
|
|
Term
according to the DSM-IV-TR criteria for substance abuse and substance tolerance are the same in that they both are:
But are different in that: |
|
Definition
they are both maladaptive patterns of substance use that lead to clinically significant impairment or distress.
different:
for substance abuse: must meet 1 or more criteria over a 12 month period
for substance tolerance: must meet 3 or more of the criteria over a 12 month period |
|
|
Term
|
Definition
| transitory recurrences of perceptual disturbances caused by past hallucinogenic drug use (like LDS) while in a drug free state |
|
|
Term
|
Definition
| when two drugs of a different class are taken together and have a more powerful effect than they would by themselves |
|
|
Term
| give an example of synergistic combinations |
|
Definition
1. alcohol and a benzodiazepine
2. alcohol and an opiate
3. alcohol and a barbituate
ALL of these drugs are CNS depressants and when taken together, they all cause further CNS depression than each one could cause individually |
|
|
Term
| mixing cocaine and heroine (speedball) causes what type of effect? why? |
|
Definition
| has an antagonistic effect because cocaine is a CNS stimulant while heroine is a CNS depressant. The heroin is meant to soften the intense let down from the withdrawal of cocaine |
|
|
Term
| naloxone (narcan) is what type of drug? |
|
Definition
| is an atagonist against narcotics also known as opioids. so it is used to reverse the severe respiratory depression that is caused by opioid overdose |
|
|
Term
|
Definition
| an ovveresponsible and infatuated family member or close one to a substance abuser |
|
|
Term
|
Definition
| having a substance abuse disorder and a psychiatric illness |
|
|
Term
| in a patient with a dual diagnosis, which diagnosis should be treated first? |
|
Definition
| none, they are both to be treated simultaneously |
|
|
Term
| what is the prognosis and compliance rate for individuals with a dual diagnosis? |
|
Definition
| very low and suicide rate is high |
|
|
Term
in the practice guidelines for a dual diagnosis, 1. is a dual diagnosis the exception?
2. is one disorder considered primary, or more important than the other?
3. does recovery happen automatically?
4. are all treatments, recoveries, and outcomes the same? |
|
Definition
1. you should EXPECT a dual diagnosis, it is NOT the exception
2. BOTH the substance abuse addiction and the mental disorder are considered primary and require simultaneous treatment that integrates treatment for BOTH disorders
3. recovery occurs in stages
4. all treatments, recoveries, and outcomes are ALL individualized to the patient |
|
|
Term
|
Definition
when someone uses both drugs AND alcohol to get high
is worse than just alcoholism and has increased fatalities
they go through more risks to get the drugs and are in EXTREME denial |
|
|
Term
| what must happen to denial before abstinence and sobriety can occur? |
|
Definition
|
|
Term
| addicts must be warned that what type of drug can AND will cause addiction to that particular drug? |
|
Definition
| addicts must know that any mood altering drug including OTC drugs and prescription medications can and will lead them to an addiction to that particular mood altering drug along with halting and delaying recovery |
|
|
Term
| interventions for substance abuse or the chemically impaired |
|
Definition
primary:
1. education
2. teach the young to learn healthy problem solving skills and and how to form healthy interpersonal relationships
3. support the elderly and stress
secondary:
1. detox is for 3-5 days
a. during detox watch for
i. physical status
ii. safety
iii. nutrition & hydration
iv. sleep
v. hygiene
2. after detox, due to insurance they will probably do an outpatient place that must be DRUG FREE!
a. with lots of confrontation or tough love
b. will help manage health
c. family education and involvement
tertiary
1. focus is on the prevention of relapse
2. relapse is common, expected, AND needs to be addressed during the treatment phase
3. during a relapse, do not reject the patient, but instead help them to learn NEW coping skills such as:
a. assertiveness
b. relaxation
c. finding support NON-using friends
4. help client see that relapses can lead to a renewed and refined effort to change |
|
|
Term
| as a nurse it is important to know that a patient may still use the substance and experience embarrassment and guilt which will increase ___________ and cause ____________ to come to the forefront. |
|
Definition
| as a nurse it is important to know that a patient may still use the substance and experience embarrassment and guilt which will increase anxiety and cause ego defense mechanisms to come to the forefront. |
|
|
Term
| as a patient who is chemically impaired or abusing substances comes to be physically stable, what is the HALLMARK sign? |
|
Definition
| they will begin to either subtly or overtly deny that they have an illness |
|
|
Term
| as a nurse it is important to help that patient in a nonjudgmental and caring way correlate |
|
Definition
| their failures, losses, and disappointments to the drinking or substance abuse |
|
|
Term
| is depression and suicide more common when a substance abuser is sober or when they are intoxicated? |
|
Definition
|
|
Term
| are nurses exempt from codependency? |
|
Definition
|
|
Term
T or F
denial is low and almost absent in nurses |
|
Definition
|
|
Term
| what should be done when dealing with an impaired nurse whom you believe is using/stealing patient drugs or abusing substances? |
|
Definition
|
|
Term
| a nurse who is in the Intervention Project for Nurses has to follow what guidelines? |
|
Definition
1. needs outpatient treatment
2. drug screens
3. not allowed narcotic keys
4. can only work the day shift
5. will have a 5 year work contract |
|
|
Term
| most substance abusers feel __________ and fear ___________. |
|
Definition
| most substance abusers feel threatened and fear rejection |
|
|
Term
|
Definition
|
|
Term
opioid derivatives
synthetic opioids |
|
Definition
opioid derivatives:
heroin
morphine
codeine
synthetic opioids:
demerol
methadone |
|
|
Term
|
Definition
| CNS: central nervous system and ANS autonomic nervous system |
|
|
Term
| consistent use of opioids will cause |
|
Definition
|
|
Term
| what age group uses opioids and why? |
|
Definition
| ALL age groups for their sedative and euphoric effects |
|
|
Term
what drugs are used by ALL age groups?
what drugs are used by younger populations? |
|
Definition
ALL:
1. opioids
2. OTC drugs
3. CNS depressants
YOUNG:
1. hallucinogens
2. inhalants
3. CNS stimulants (young to middle age) |
|
|
Term
withdrawal is unpleasant and NON-life threatening for which drugs?
for which drugs is withdrawal life-threatening and unpleasant? |
|
Definition
withdrawal is unpleasant and non-life threatening for which drugs?
1. opioids
2. CNS stimulants
for which drugs is withdrawal life-threatening and unpleasant?
1. CNS depressants |
|
|
Term
|
Definition
naturally occurring drugs from mescaline: peyote cactus, psilocybin, mushrooms, morning glory and angel trumpet
synthetic: LSD, MDMA- ecstasy, and PCP or angel dust |
|
|
Term
| why are hallucinogens used? |
|
Definition
| to distort reality and induce hallucinations by producing abnormal phenomena in the cognitive and perceptual spheres |
|
|
Term
| are hallucinogens addictive? |
|
Definition
| NO, they are not generally addictive. |
|
|
Term
| the use of hallucinogens can cause anxiety that can lead to |
|
Definition
| acute psychosis and suicidal tendencies |
|
|
Term
| inhalants are volatile and damaging to the |
|
Definition
|
|
Term
| some examples of inhalants |
|
Definition
nailpolish remover
magic markers
glue
gas
hairspray |
|
|
Term
| inhalants are frequently used by what population? why? |
|
Definition
| used by the younger population because they have limited access to other drugs for their euphoric effects |
|
|
Term
| why is the diagnosis and treatment of inhalant use so critical? |
|
Definition
| to prevent further abuse and prevent further brain damage |
|
|
Term
what drugs are addictive?
what drugs are not addictive? |
|
Definition
addictive:
opioids, CNS depressants AND stimulants
not addictive: hallucinogens |
|
|
Term
|
Definition
| accelerate body functioning |
|
|
Term
| are CNS stimulants addictive? why? |
|
Definition
| YES they are because they can become psychologically addictive |
|
|
Term
| what population is CNS stimulants used by? why? |
|
Definition
| the young to middle aged population for their euphoric effects |
|
|
Term
| what are some examples of the CNS stimulants? |
|
Definition
1. amphetamines- benzadrine and dexedrine
2. nonamphetamines- ritalin and cylert
3. methamphetamines- crystal meth and ice
4. cocaine- crack cocaine is the MOST potent and the LEAST expensive
5. nicotine
6. caffeine |
|
|
Term
| describe if a user of CNS stimulants can go cold turkey? what is the exception? |
|
Definition
| yes they can it is not life threatening but will be uncomfortable, however if they are extremely paranoid is may cause a safety issue |
|
|
Term
| name some CNS depressants: |
|
Definition
1. alcohol (ETOH)
2. barbituates (nabutal, amytal)
3. benzodiazepines (valium (diazepam), ativan (lorazepam), xanax (alprozolam), and librium)
4. sedative hypnotics (halcion, restorial, quaalude) |
|
|
Term
| what is used more often in hospitals for its sedative hypnotic effects: restoril or quaalude? |
|
Definition
|
|
Term
| what age group uses the CNS depressants? why? |
|
Definition
| all age groups for sedation and relief of anxiety |
|
|
Term
| what happens when CNS depressants are taken in small doses? large doses? |
|
Definition
small doses: causes relaxation and a loss of inhibitions
large doses: causes a decreased LOC that leads to death due to respiratory depression |
|
|
Term
| are CNS depressants addictive? what is the outlook for withdrawal? what are the symptoms for withdrawal? |
|
Definition
are CNS depressants addictive?
YES, highly
what is the outlook for withdrawal?
unpleasant, life-threatening, and associated with morbidity and mortality
what are the symptoms for withdrawal?
withdrawal symptoms are the same for all CNS depressants |
|
|
Term
| withdrawal symptoms from CNS depressants will be time delayed if used in combination with |
|
Definition
|
|
Term
| in withdrawal from CNS depressants, what are the effects on the younger population? older? |
|
Definition
younger: more severe symptoms
older: withdrawal symptoms may occur for longer periods |
|
|
Term
| what is the drug of choice, the most prevalent drug abuse disorder, and is abused by all age groups? |
|
Definition
|
|
Term
| alcohol use while pregnant can causes |
|
Definition
|
|
Term
| to effectively assess a patient who you suspect of drug use you must assess |
|
Definition
1. the type of drug/s used
2. amount of drug/s ingested
3. when the drug/s was last used |
|
|
Term
| what are the 2 alcohol withdrawal syndromes? |
|
Definition
1. alcohol withdrawal
2. alcohol withdrawal delirium (DTs) |
|
|
Term
|
Definition
|
|
Term
| when do the S/S of alcohol withdrawal become apparent and how long do they last? |
|
Definition
| appears within a few hours and can last up to 48 hours |
|
|
Term
| what are the S/S of alcohol withdrawal? |
|
Definition
1. nausea/vomiting
2. anxiety
3. transient hallcinations (visual, auditory, tactile) and illusions
4. agitation
5. diaphoresis
6. tachycardia
7. insomnia
8. tremors
9. "feeling shaky inside"
10. headaches
11. grand mal seizures |
|
|
Term
| what tool can be used to assess a patient in alcohol withdrawal? |
|
Definition
| CIWA: clinical institute withdrawal assessment |
|
|
Term
| projecting a calm and supportive manner to a patient in alcohol withdrawal will be |
|
Definition
|
|
Term
| what drug is commonly used in alcohol withdrawal either PRN or qxh (around the clock)? |
|
Definition
| ativan (lorazepam) a benzodiazepine |
|
|
Term
| what are the S/S of alcohol withdrawal delirium? |
|
Definition
same S/S as with alcohol withdrawal, with the addition of:
1. nausea and diarrhea
2. fever
3. hypertension
4. aversion to eating
5. decreased and fluctuating LOC
6. perceptual disturbances
7. can end up in a seizure |
|
|
Term
| a BAL level of 0.10 means? 0.08? |
|
Definition
0.10 means 100 mg/dl
and is the general BAL for intoxication
0.08 means 80 mg/dl is the intoxication level for Florida |
|
|
Term
| if a patient has a high BAL but is showing no expected clinical manifestations, then that means they have a |
|
Definition
|
|
Term
| when can DTs manifest? how long does it last? |
|
Definition
| within 2-3 days of cessation and can 2-3 days? |
|
|
Term
T or F:
DTs or alcohol withdrawal delirium is an expected event that does not treatment. |
|
Definition
FALSE:
DTs is a medical emergency that must be prevented and treated ASAP |
|
|
Term
| a person with DTs usually dies from |
|
Definition
| sepsis, MI, electrolyte imbalance, perivascular collapse, aspiration pneumonia, and suicide |
|
|
Term
| what are the interventions to be taken when dealing with DTs? |
|
Definition
secondary: treat the DTs
1. substitute the drug with a drug in the same class (a CNS depressant)
2. can use benzodiazepines: ativan and librium are the most common but ativan is more preferred because it does NOT use the liver. if a benzodiazepine can't be used you can use phenobarbitol!
3. titrate down to slowly allow for acclamation to normal
4. give them a multivitamin along with folic acid and thiamine to treat them for malnutrition, but it will NOT help the DT's |
|
|
Term
| Wernicke-Korsokoff syndrome |
|
Definition
| caused by a thiamine deficiency. causes psychosis, stupor and then death. So give patients with alcohol withdrawal. DTs vitamin B1 to prevent this and treat malnutrition. Note: giving thiamine or vit B1 will NOT treat the DTs it will only treat malnutrition. |
|
|
Term
|
Definition
| clinical institute withdrawal assessment, used to assess severity of alcohol withdrawal |
|
|
Term
a CIWA score below 15=
above 15= |
|
Definition
below 15 is not bad
above 15 is bad and probably will be given ativan or a benzodiazepine around the clock |
|
|
Term
| what should be done ASAP when a substance abuser or suspected one comes into the hospital |
|
Definition
|
|
Term
|
Definition
| one drug that prevents withdrawal symptoms from another drug |
|
|
Term
| what are two drugs used to help alcoholism? |
|
Definition
disulfiram (antabuse)
naltroxone (ReVia) |
|
|
Term
|
Definition
is antabuse and uses classical conditioning by producing undesirable effects when alcohol enters the body to discourage chronic drinker from consuming alcohol.
it is helpful in the impulsive driner
can last 2-5 weeks after last dose
educate patient on sources of alcohol like in food, meds, OTC meds, perfumes, skin applications |
|
|
Term
|
Definition
ReVia blocks the place in the brain that allows the person to get high since it is an opiate receptor antagonists. patient has not reason to buy or take drugs because it will have no effect
is used for increased cravings and somatic symptoms |
|
|
Term
|
Definition
| helps patients abstain from alcohol use by allowing their brains to function normally again |
|
|
Term
| for alcoholics who are recovering, psychotherapy alone |
|
Definition
|
|
Term
|
Definition
offers insight and coping skills
is often not effective in the beginning stages or alone in alcoholics |
|
|
Term
| on discharge, was is recommended to alcholics? |
|
Definition
|
|
Term
although schizophrenia has no gender preference,
(18-25)
(25-30) |
|
Definition
people with an early onset (18-25) tend to be males and have poorer outcomes
people with a late onset (25-30) tend to be females and have better outcomes |
|
|
Term
| nicotine dependence is very high in |
|
Definition
|
|
Term
| nicotine addicted schizophrenics have a high rate of |
|
Definition
| emphysema and other pulmonary and cardiac problems |
|
|
Term
| depressive symptoms occur frequently in |
|
Definition
|
|
Term
| psychosis-induced polydipsia |
|
Definition
| often seen in people with a chronic mental illness and is a compulsive drinking of water of about 4 to 10 L a day |
|
|
Term
| amphetamines, cocaine, ritalin, levodopa are all ____________ that cause an increase the activity of _________ in the brain and exacerbate the symptoms of _______ in psychotic patients and can even stimulate symptoms of _______________ in a person without it. |
|
Definition
| amphetamines, cocaine, ritalin, levodopa are all CNS stimulants that cause an increase the activity of dopamine in the brain and exacerbate the symptoms of schizophrenia in psychotic patients and can even stimulate symptoms of paranoid schizophrenia in a person without it. |
|
|
Term
| what is the main dopamine receptor that is blocked with the use of antipsychotic medications? what are the other ones? |
|
Definition
D2 is the one blocked with the use of antipsychotic medications
there are D1, D2, D3, D4, D5 |
|
|
Term
| why is the dopamine hypothesis for schizophrenia no longer considered conclusive? |
|
Definition
| because dopamine-blocking agents do not improve all of the symptoms |
|
|
Term
| the development of atypical antipsychotic drugs that block dopamine and well as ____________ suggests that this neurotransmitter may play a role in causing the symptoms of __________. |
|
Definition
| the development of atypical antipsychotic drugs that block dopamine and well as serotonin suggests that this neurotransmitter may play a role in causing the symptoms of schizophrenia |
|
|
Term
| PCP induces a state that closely resembles |
|
Definition
|
|
Term
| is a crucial neurotransmitter during periods of neural maturation |
|
Definition
|
|
Term
| abnormal maturation of the CNS is considered to be central in the development of |
|
Definition
|
|
Term
| children of nonschizophrenia parents who are place in a foster home with a foster parent who later on develops schizophrenia ______ show an increased rate of schizophrenia. |
|
Definition
| children of nonschizophrenia parents who are place in a foster home with a foster parent who later on develops schizophrenia do NOT show an increased rate of schizophrenia. |
|
|
Term
| MRI and CT scans show that brains of schizophrenic people have a _________ brain volume and ___________ cerebrospinal fluid (CSF) than in the brains of normal people |
|
Definition
| MRI and CT scans show that brains of schizophrenic people have a LOWER brain volume and MORE cerebrospinal fluid (CSF) than in the brains of normal people |
|
|
Term
| what types of atrophy are seen in the brain of a schizophrenic? |
|
Definition
| frontal, cortical, cerebellar, and temporal |
|
|
Term
| PET scans show that there is a _________ rate of blood flow and glucose metabolism in the __________ of the cerebral cortex which govern planning, abstract thinking, ________, and decision making |
|
Definition
| PET scans show that there is a decreased rate of blood flow and glucose metabolism in the frontal lobes of the cerebral cortex which govern planning, abstract thinking, social adjustment, and decision making |
|
|
Term
| postmortem studies on brains of schizophrenics showed a decrease in the volume of _______ especially in the temporal and _____ lobes. The most tissue lost = the _______ symptoms. |
|
Definition
| postmortem studies on brains of schizophrenics showed a decrease in the volume of grey matter especially in the temporal and frontal lobes. The most tissue lost = the worst symptoms. |
|
|
Term
| prenatal risk factors that may contribute to the development of schizophrenia include: |
|
Definition
viral infection
exposure to toxins
malnutrition or starvation
decreased oxygenation |
|
|
Term
| what can precipitate schizophrenia in a vulnerable individual? |
|
Definition
|
|
Term
| do all people with schizophrenia have the same symptoms? |
|
Definition
|
|
Term
| the course of schizophrenia usually includes acute |
|
Definition
| exacerbations of psychosis |
|
|
Term
| prodromal symptoms may appear __________ to a __________ before a psychotic break |
|
Definition
| prodromal symptoms may appear 1 month to a year before a psychotic break |
|
|
Term
| preoccupation with homosexuality is associated with _______ but is more prominent in ________. |
|
Definition
| preoccupation with homosexuality is associated with ALL psychoses but is more prominent in paranoid schizophrenia |
|
|
Term
| is there a single symptom that is always present in all cases of schizophrenia? if so, what is it? |
|
Definition
| NO, there is not a single symptom that is always present in all cases of schizophrenia |
|
|
Term
| the younger the client is at the onset of schizophrenia, |
|
Definition
| the more discouraging the prognosis |
|
|
Term
compare these scenarios prognositc outlooks dealing with schizophrenia:
an acute and abrupt onset of symptoms with good premorbid functions, such as good social, sexual, and occupational function
OR
a slow and insidious onset over a period of 2-3 years |
|
Definition
GOOD OUTLOOK:
an acute and abrupt onset of symptoms with good premorbid functions, such as good social, sexual, and occupational function
UNFAVORABLE OUTLOOK
a slow and insidious onset over a period of 2-3 years |
|
|
Term
| a childhood that was withdrawn, eccentric, and tense causes what type of outcome in schizophrenics? |
|
Definition
| a bad one or an unfavorable diagnostic sign |
|
|
Term
| there are four types of symptoms of schizophrenia: positive, negative, cognitive, and depressive and mood related symptoms. what in general can these all be called: |
|
Definition
| treatment-relevant dimensions of schizophrenia |
|
|
Term
| florid psychotic symptoms |
|
Definition
| are the positive symptoms of schizophrenia because they capture our attention |
|
|
Term
|
Definition
| false fixed beliefs that cannot be correct by reasoning |
|
|
Term
| what are some common delusions? |
|
Definition
1. grandiosity
2. jealousy
3. ideas of reference
4. somatic
5. persecution
6. control |
|
|
Term
| what delusions are most common among schizophrenics? |
|
Definition
| persecution, grandiose, religious, and hypochondriac |
|
|
Term
| belief that one's thoughts can be heard by others |
|
Definition
|
|
Term
| believe that thoughts of others are being inserted into one's mind |
|
Definition
|
|
Term
| belief that thoughts have been removed from one's mind from an outside source |
|
Definition
|
|
Term
| belief that one's body or mind is controlled by an outside agency |
|
Definition
| delusion of being controlled |
|
|
Term
| in schizophrenia, there is an inability to use __________ and there is an overemphasis on details, referring to __________. |
|
Definition
| in schizophrenia, there is an inability to use abstract thinking and there is an overemphasis on details, referring to concrete thinking. |
|
|
Term
when a client speaks in jumbled words that make no sense and with associative looseness, the nurse should......
BUT if you cannot understand the message..... |
|
Definition
when a client speaks in jumbled words that make no sense and with associative looseness, the nurse should......
try to decode the message to help the client feel understood
BUT if you cannot understand the message.....
be honest and let the client know that you do not understand, and make an effort to show that you want to understand |
|
|
Term
| words a person makes up that have a special meaning to the person |
|
Definition
|
|
Term
| neologisms in schizophrenia represent a disruption in |
|
Definition
|
|
Term
|
Definition
echolalia- pathologically repeating one's words. often seen in catatonia.
echopraxia- repeating one's movements also seen in catatonia. |
|
|
Term
| meaningless rhyming of words often in a forceful manner. seen in schizophrenics, manic phase of bipolar, Alzheimer's, and HIV-related dementia |
|
Definition
|
|
Term
| a jumble of word that is meaningless to the listener and perhaps to the speaker |
|
Definition
|
|
Term
|
Definition
| sensory perceptions without an external stimulus |
|
|
Term
| what are the most common hallucinations? |
|
Definition
|
|
Term
| when clients with schizophrenia state that they are "merging" with others or are a part of an inanimate object this shows that |
|
Definition
| they lack a sense of were their bodies end and begin in a relationship; poor boundaries |
|
|
Term
a nonspecific feeling that a person has lost their identity and is not themselves, that the self is different or unreal.
example: a woman sees her fingers as rotting snakes or a man sees his arms as rotting wood |
|
Definition
|
|
Term
| if a man with schizophrenia looks in the mirror and instead of his face sees an animal this is an example of |
|
Definition
|
|
Term
| a false perception that the environment has somehow changed |
|
Definition
|
|
Term
| if a person believes that somehow the environment has gotten bigger or smaller and familiar surroundings are strange when in fact nothing has changed this is an example of |
|
Definition
|
|
Term
| both depersonalization and derealization can be interpreted as a |
|
Definition
| loss of ego boundaries or loose ego boundaries |
|
|
Term
| excited physical behavior such as running about in response to inner and outer stimuli that can lead to exhaustion, collapse, and even death |
|
Definition
|
|
Term
| motor patters that originally has meaning to the person (like sweeping the floor) but are now done mechanically with no purpose |
|
Definition
|
|
Term
| when a catatonic client performs simple tasks they are told to do in a robot-like fashion |
|
Definition
|
|
Term
| seen in catatonia where you move the patient and there is an excess maintenance of an unusual posture sometimes for long periods of time or until you move them in a different position |
|
Definition
|
|
Term
| state in which a catatonic person remains motionless for long periods of time and may even appear to be in a coma |
|
Definition
|
|
Term
| negativism is equivalent to |
|
Definition
|
|
Term
| when the client does the opposite of what they are told to do |
|
Definition
|
|
Term
| when the client does not do something they are supposed to do like getting out of bed, dressing, and eating |
|
Definition
|
|
Term
| passive negativism is also called |
|
Definition
|
|
Term
| slowness of movement, stupor and negativism are considered to be what type of symptoms? |
|
Definition
|
|
Term
| when client's with schizophrenia are acutely ill they often lack in controlling their ____________ which can be seen by expressing socially inappropriate _____________ such as grabbing someone else's cigarette |
|
Definition
| when client's with schizophrenia are acutely ill they often lack in controlling their impulses which can be seen by expressing socially inappropriate agitated behaviors such as grabbing someone else's cigarette |
|
|
Term
| unlike the positive symptoms which have a favorable response to antipsychotic medication, the negative symptoms have a |
|
Definition
| poor response to antipsychotic medication |
|
|
Term
| the negative symptoms of schizophrenia develop |
|
Definition
| over a long period of time |
|
|
Term
| which symptoms are harder to assess during the acute stages? which ones are more dominant? |
|
Definition
the negative symptoms are harder to assess because the positive symptoms are more obvious
even though the negative symptoms are more crippling |
|
|
Term
| which symptoms have a more insidious onset? which ones have an acute onset? |
|
Definition
negative symptoms have a more insidious and gradual onset
positive symptoms have a more acute onset and are not the primary focus since they respond favorably to antipsychotic medication |
|
|
Term
| grimacing, giggling and mumbling to oneself and is unable to relate logically to the environment |
|
Definition
|
|
Term
| involves difficulty with attention, memory, decision making, and problem solving |
|
Definition
|
|
Term
| the degree of cognitive deficit is associated with the severity of the |
|
Definition
|
|
Term
| is a good cognitive indicator that the individual will eventually function within the community because it helps with the acquisition of psychosocial skills, learning and the retention of skills |
|
Definition
|
|
Term
| what factors are associated with the onset of negative symptoms? |
|
Definition
1. insidious onset
2. atrophy in CT scans
3. premorbid history emotional problems
4. abnormal psychological tests
5. poor response to antipsychotic medications
6. chronic deterioriation |
|
|
Term
what NANDA would assign to this assessment?
hearing voices that others do not |
|
Definition
| disturbed sensory perception: auditory/visual |
|
|
Term
what NANDA would assign to this assessment?
hears voices telling him or her to hurt their self or others |
|
Definition
| risk for self/ or other directed violence |
|
|
Term
what NANDA would assign to this assessment?
thinks that others are trying to hurt them |
|
Definition
| disturbed thought processes |
|
|
Term
what NANDA would assign to this assessment?
thinks that others are trying to harm them
is this a delusion or hallucination? what type? |
|
Definition
thinks that others are trying to harm them
this is delusion of persecution
NANDA: defensive coping or disturbed thought processes |
|
|
Term
what NANDA would assign to this assessment?
thinks he or she has powers and talents that are not real or is someone powerful or famous
is this a hallucination or delusion? what type? |
|
Definition
thinks he or she has powers and talents that are not real or is someone powerful or famous
this is a delusion of grandiosity
NANDA: defensive coping or disturbed thought processes |
|
|
Term
what NANDA would assign to this assessment?
thinks that their spouse is cheating or thinks others are cheating on them when its not true
is this a delusion or a hallucination? what type? |
|
Definition
thinks that their spouse is cheating or thinks others are cheating on them when its not true
this is a delusion of jealousy
NANDA: defensive coping or disturbed thought processes |
|
|
Term
what NANDA would assign to this assessment (s) either individually or all together:
looseness of association, clang association, echolalia, mutism, circumstantiality, or concrete thinking |
|
Definition
| impaired verbal communication or disturbed thought processes |
|
|
Term
what NANDAs would assign to this assessment (s)?
uncommunicative, withdrawn, makes no eye contact
preoccupied with own thoughts
expresses feelings of rejection or aloneness (lies in bed all day and position back to door) |
|
Definition
risk for loneliness
impaired social interaction
social isolation |
|
|
Term
| the overall goal during the acute phase of schizophrenia is |
|
Definition
| client and safety and medical stabilization |
|
|
Term
| during phase III of schizophrenia, target the |
|
Definition
| negative symptoms by including participation in social, vocational, and self care skills |
|
|
Term
| during phases II and III you want to encourage medication compliance, educate the client on what schizophrenia is and also want to encourage the client and family to attend psychosocial educational sources that will help with |
|
Definition
| family education and skills training |
|
|
Term
| relapse prevention is VITAL during the |
|
Definition
| phases II and III: maintenance and stabilization |
|
|
Term
| effective long term care of a schizophrenic involves |
|
Definition
| medication, nursing intervention, community support! |
|
|
Term
| this is a KEY component of effective treatment during phases II and III of schizophrenia treatment |
|
Definition
|
|
Term
| structured group therapy targets |
|
Definition
| negative and positive symptoms |
|
|
Term
| should a patient ever be placed in restraints as a punishment or for the ease of the staff? |
|
Definition
|
|
Term
| use of the least restrictive means of restrained for the ______________ is always the general rule |
|
Definition
| use of the least restrictive means of restrained for the SHORTEST DURATION is always the general rule |
|
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Term
| is the drug of choice for acute aggressive psychotic behavior? |
|
Definition
|
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Term
| it is useful to argue with the client about their delusions? |
|
Definition
|
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Term
| when communicating with a client who has associative looseness and you cannot understand what they are saying should you pretend to understand? |
|
Definition
| no, be honest and place the misunderstanding on yourself. don't say: "you don't make any sense", instead say, "i cannot understand what you are saying" |
|
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Term
| relapse is a sign of failure |
|
Definition
| FALSE it is a part of the illness |
|
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Term
| what is the single most important factor in the prevention of relapse in a person suffering from schizophrenia? |
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Definition
|
|
Term
| in addition to medication compliance, what other factor deceases the risks for relapse in those suffering from schizophrenia? |
|
Definition
| psychoeducation therapy or psychosocial interventions |
|
|
Term
| what are the different types of psychosocial therapies? |
|
Definition
1. social skills training
2. cognitive adaptation therapy
3. cognitive remediation therapy
4. cognitive behavioral therapy |
|
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Term
| can improve the level of social activity, foster new social contacts, improve quality of life, and help lower anxiety |
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Definition
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Term
| through practice helps clients improve cognitive dysfunction and helps them to better cope with their symptoms and the disorders itself along with everyday problems |
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Definition
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Term
| improves adaptive functioning and compensates for cognitive impairment |
|
Definition
| cognitive adaptive therapy |
|
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Term
| aims to change abnormal thoughts or responses to hallucinations through coping strategies like listening to music |
|
Definition
| cognitive behavioral therapy |
|
|
Term
| what is the most consistent factor in a schizophrenic patient's life? |
|
Definition
|
|
Term
| who often does better: families who receive psychoeducational treatment in a single family group or multiple family group? |
|
Definition
| multiple; expansion of the social network and problem solving capacity |
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|
Term
| traditional dopamine antagonists are |
|
Definition
| typical or standard antipsychotics |
|
|
Term
| serotonin-dopamine antagonists |
|
Definition
| atypical antipsychotic drugs |
|
|
Term
| what are the receptors for serotonin? |
|
Definition
|
|
Term
| what are the receptors for dopamine? which one is acted upon by antipsychotics? |
|
Definition
| D, D2 is acted on by antipsychotics |
|
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Term
| a patient on clozaril should have their blood drawn |
|
Definition
| weekly for the first six months and the periodically after that |
|
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Term
|
Definition
| clozaril, atypical antipsychotic that causes agranulocytosis and lowers the seizure threshold |
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
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Definition
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Term
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Definition
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Term
what three things do these drugs all have in common:
risperidone (risperidol), olanzapine (zyprexa), quetiapine (seroquel), ziprasidone (geodon), and aripiprazole (abilify) |
|
Definition
1. they are all atypical antipsychotics
2. do NOT have the hemotological effects that clozapine (clozaril) has
3. are all first line antipsychotic medications |
|
|
Term
| one downside to the atypical antipsychotics is that some cause weight gain and other metabolic side effects, which drugs are known to this? what are the exceptions? |
|
Definition
DO: risperidone (risperidol), olanzapine (zyprexa), and quetiapine (seroquel)
DO NOT: aripiprazole (abilify) and ziprasidone (geodon) |
|
|
Term
| what atypical drugs cause weight gain and metabolic side effects? what does this lead to? |
|
Definition
risperidol, seroquel, zyprexa
leads to:
1. glucose dysfunction which can lead to diabetes
2. hypercholesteremia which can lead to CV disease
3. weight gain which can lower self esteem and decrease med compliance
4. HTN |
|
|
Term
| the most sedating agent with fewer EPSs than any other antipsychotic drug |
|
Definition
|
|
Term
|
Definition
is a typical antipsychotic
good: most sedating agent with the least EPSs
bad: hypotension with large doses |
|
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Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| the least sedating antipsychotic agent and is often used in patients who are overly aggressive or assaultive and also has high EPSs |
|
Definition
|
|
Term
| what do chlorpromazine (thorazine) and haloperidol (haldol) have in common? how are they different? |
|
Definition
they are BOTH typical antipsychotics
differences:
(chlorpromazine) thorazine has the MOST sedating effects with the LEAST EPSs while haloperidol (haldol) has the LEAST sedating effects with the MOST EPSs
thorazine causes hypotension in large doses while haldol does not |
|
|
Term
| what should you watch for in your patient who is taking chlorpromazine (thorazine)? |
|
Definition
|
|
Term
| would a patient who is functioning at work prefer haldol or thorazine? why? |
|
Definition
| they would prefer haldol because haldol is the least sedating and does not cause hypotension. while thorazine is the most sedating and causes hypotension |
|
|
Term
typical antipsychotic drugs are usually divided into either low potency or high potency.
what are the factors? |
|
Definition
1. sedation level (sed)
2. anticholinergic effects (ACh)
3. EPSs |
|
|
Term
high potency typical antipsychotic
low potency typical antipsychotic |
|
Definition
high potency typical antipsychotic=
low sed + low ACh + high EPSs
low potency typical antipsychotic=
high sed + high ACh + low EPSs |
|
|
Term
| you should monitor patient with seizure disorders who are on typical antipsychotics because |
|
Definition
| these lower the seizure threshold |
|
|
Term
| what are some anticholinergic effects? |
|
Definition
1. dry mouth and eyes
2. urinary retention
3. constipation
4. blurred vision
5. photsensitivity
6. men cannot ejaculate or are impotent |
|
|
Term
|
Definition
| is a saliva substitute used to correct the anticholinergic side effect of typical antipsyhcotics: dry mouth |
|
|
Term
| blurred vision is an anticholinergic effect that should abate in how long? what medication should be held and discussed with the MD if a client has this? |
|
Definition
should abate in 1-2 weeks
thioridazine (mellaril) a TAP |
|
|
Term
| what interventions should be taken with a patient who is experiencing pseudoparkinsonism? what would you assess? |
|
Definition
you would assess: shuffling gait, pill rolling, mask like face, stiffening in the muscles of the face, neck, drooling and tremor
interventions: alert the medical staff and administer an anticholinergic agent such as (trihexylphenidyl) artane or (benzoptropine) cogentin |
|
|
Term
|
Definition
| artane; anticholinergic used to treat EPS and pseudoparkinsonism |
|
|
Term
|
Definition
| cogentin; anticholinergic used to treat EPS and pseudoparkinsonism |
|
|
Term
| what interventions should be taken to treat a patient who is having dystonia? what would you assess? |
|
Definition
the client is experiencing contractions of the face, neck, back, and tongue
1st choice: diphenhydramine (benedryl)
2nd choice: benzotropine (cogentin) |
|
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Term
|
Definition
| (GN: propanolol) is a sympatholytic beta blocker used to treat hypertension, anxiety and panic. |
|
|
Term
| what should be done with a patient who experiencing akathisia? what would you assess? |
|
Definition
you would see the client being restless and figetdy, either shifting from side to side or rocking back and forth
the MD may discontinue the neuroleptic and it may disappear and propanolol (inderal), diazepam (valium), or lorazepam (ativan) may be used. |
|
|
Term
| what would you do for a patient who is having tardive dyskinesia? what would you assess? |
|
Definition
you would assess the patient protruding and rolling the tongue, smacking, licking and having spastic facial movements
there is no known treatment since stoping the medication does not always work. client should be screened for tardive dyskinesia every 3 months |
|
|
Term
| you are about to give your patient their typical antipsychotic medication when you take their BP and notice the systolic is 80 mmHg what should you do? |
|
Definition
| hold the medication, especially if it is thorazine which already lowers the BP |
|
|
Term
| what typical antipsychotic drug is preferably given to patients with cardiac problems? |
|
Definition
| haloperidol (haldol) because of its low ACh effects |
|
|
Term
| what are some assessments you will see in a patient with cholestatic jaundice? what type of drug are they most likely taking? what is the outlook (is it reversible)? |
|
Definition
assessments: prodromal: fever, malaise, nausea, abdominal pain 1 week later: jaundice
they are taking a typical antipsychotic drug
it is reversible and benign if caught in time
interventions: stop the drug, give bed rest and high protein high carb diet. perform liver function tests every 6 months |
|
|
Term
| NMS occurs when taking what type of drug? |
|
Definition
|
|
Term
| which typical antipsychotic drug is not a first line drug because it is related to severe ECG changes such a prolonged QTc interval and may cause sudden death? |
|
Definition
|
|
Term
| what atypical antipsychotic drug is known to cause prolonging of the QTc interval, and ECG changes and should not be taken with other drugs that prolong the QT interval? |
|
Definition
|
|
Term
| some antiparkinsonian drugs that are used as antiocholienrgic drugs to treat EPS are |
|
Definition
| benzotropine (cogentin), trihexylphenidyl (artane), diphenhydramine (benedryl), and amantadine (symmetrel) |
|
|
Term
| treatment with antiparkinsonian drugs is benign because they intensify the |
|
Definition
| anticholinergic side effects caused by the antipsychotics |
|
|
Term
|
Definition
| parlodel; used to treat muscle rigidity caused by NMS |
|
|
Term
| what are the most trouble SE of antipsychotic drugs for outpatients? |
|
Definition
weight gain
tardive dyskinesia
sexual impotence |
|
|
Term
| what is perhaps the most common reason for male nonadherence to antipsychotic medications? |
|
Definition
| they cause impotence and sexual dysfunction |
|
|
Term
| tardive dyskinesia is an EPS that usually appears after |
|
Definition
| prolonged treatment or receiving long term high dose therapy |
|
|
Term
T or F:
tardive dyskinesia is less serious EPS that is always reversible and only has a slight chance of becoming disfiguring or incapacitating... |
|
Definition
FALSE!
tardive dyskinesia is a MORE serious EPS that is irreversible sometimes and can be both debilitating and incapacitating |
|
|
Term
| tardive dyskinesia includes involuntary tonic contractions of the |
|
Definition
| tongue, toes, fingers, neck, truck, or pelvis |
|
|
Term
| is there a cure for tardive dyskinesia? what is it? |
|
Definition
|
|
Term
| what is believed to play a role in the development of NMS? |
|
Definition
| acute reduction of dopamine in the brain |
|
|
Term
| what drugs are recommended as adjuncts along with antipsychotics for the treatment of depression? |
|
Definition
|
|
Term
| what drug have been helpful as adjuncts along with antipsychotics in suppressing episodic violence as well as targeting the more disturbing symptoms? |
|
Definition
|
|
Term
| the addition of this drug significantly enhances antipsychotic efficacy in some clients with schizophrenia that are nonresponsive to antipsychotic agents |
|
Definition
|
|
Term
| augmentation of this drug as an adjunct to antipsychotics can improve both positive and negative symptoms by 50%. Give an example. |
|
Definition
| benzodiazepines; clonazepam |
|
|
Term
| when used as an adjunt along with antipsychotics can cause a decrease in anxiety, agitation, and possibly psychosis |
|
Definition
| clonazepam, a benzodiazepine |
|
|
Term
When these circumstances are evident, what needs to be done:
1. clear LACK of efficacy in the drug regimen
2. need for supplemental medications
3. occurence of intolerable or persistent side effects |
|
Definition
| change the antipsychotic agent |
|
|
Term
| an intense and strongly defended irrational suspicion |
|
Definition
|
|
Term
| can paranoid ideas be corrected by experiences or modified by facts or reality? |
|
Definition
|
|
Term
| what is the most common defense mechanism used by people who are paranoid? |
|
Definition
|
|
Term
| when a patient who is paranoid is feeling self-critical and feel that others are being critical towards them this is an example of |
|
Definition
|
|
Term
| paranoid symptoms can be secondary too |
|
Definition
| physical illness, organic brain disease, or drug intoxication |
|
|
Term
| paranoid schizophrenia has a __________ onset and develops _________ in individuals with good premorbid functioning. |
|
Definition
| paranoid schizophrenia has a LATE onset and develops RAPIDLY in individuals with good premorbid functioning. |
|
|
Term
| what is outcome and outlook for paranoid schizophrenia |
|
Definition
|
|
Term
| what is the paranoid facade a defense against? |
|
Definition
|
|
Term
| a common defense used by paranoid individuals to maintain self esteem is too |
|
Definition
| disparage on others and dwell on the shortcomings of others |
|
|
Term
| when a client, particularly a paranoid schizophrenic gives a private meaning to the communication of others |
|
Definition
|
|
Term
in a paranoid schizophrenia, grooming, dress, and self care may....
food and rest.... |
|
Definition
in a paranoid schizophrenia, grooming, dress, and self care may.... not be a problem
food and rest.... may be an issue since they believe they are going to be poisoned or harmed |
|
|
Term
| what is the essential feature of catatonia |
|
Definition
|
|
Term
| the onset of catatonia is usually _________ and the prognosis is ___________ due to the use of drugs |
|
Definition
| the onset of catatonia is usually abrupt and the prognosis is good due to the use of drugs |
|
|
Term
| are catatonics in their withdrawal phase aware of their environment and able to accurately recall events at a later date? |
|
Definition
|
|
Term
| what are the two phases of catatonia? |
|
Definition
|
|
Term
| what is the most regressed and socially impairing form of schizophrenia? |
|
Definition
|
|
Term
| in which type of schizophrenia is these giggling to self, grimacing, odd behavior, looseness of association, along with extreme social withdrawal? |
|
Definition
| disorganized schizophrenia |
|
|
Term
T or F:
the onset of disorganized schizophrenia is insidious and the prognosis is poor. there is an association with poor premorbid functioning and a family history of psychological disorders |
|
Definition
|
|
Term
| a sudden cessation in the train of thought |
|
Definition
|
|
Term
| in disorganized schizophrenics, grooming, hygiene and social awareness is often |
|
Definition
|
|
Term
| the behavior of a disorganized schizophrenia is often described as |
|
Definition
|
|
Term
| in this type of schizophrenia, the active phase symptoms are no longer present but evidence of two or more residual symptoms persist |
|
Definition
|
|
