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NSG211 Test 2 study guide
Health Care Concepts II (NSG 211)
Germanna Community College
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NSG 211 Test 2 Study Guide: Psychosis and Cognition Schizophrenia: Brain disease effecting thinking, language, emotions, social behavior, and reality perception Chronic treatable but not curable No difference in regard to race, social status, culture, gender, or environment substance abusers, nicotine dependence, depressive disorders, anxiety disorders, and polydipsia common Suicide is 20 times more likely in people with schizophrenia DSM Criteria: Must meet 2 of the following 5 criteria for a period of at least 6 months 1. Delusions 2. Hallucinations 3. Disorganized speech 4. behaviors 5. Negative symptoms Additionally, 1 of the 5 must be 1, 2, or 3. Phases: Prodromal phase: early social withdrawal, deterioration in function, perceptual disturbances, magical thinking, and peculiar behavior Lasts from a few weeks to a few years adult men tend to begin earlier Ideas of reference phase: psychotic symptoms are prominent Delusions Hallucinations Impairment in work, social relations, and Residual phase: symptoms similar to prodromal phase Flat affect and impairment in role functioning Negative symptoms may remain Risk factors: Pregnancy and birth complications Prenatal viral infections, poor nutrition, toxins Stress Use of street drugs Poverty Common symptoms Positive: added psychotic symptoms Hallucinations (auditory, command, visual, etc.) misperceptions of real external stimuli (thought of a snake when it is a shoelace) ideas of everything referred to you Thought like a radio, everyone knows what thinking Thought someone putting random thought inside you (the telling you what to think) Thought stolen thought Bizarre speech o Associative thinking is haphazard, illogical, and confused o made up words o Echolalia and mimic language and movement o Clang meaningless rhyming of words o Word jumble of words random sentences that make sense o persistent word repetition Personal boundary difficulties o feeling that person is unreal o feeling that environment has changed Bizarre behaviors o Extreme motor ex. pacing o Stereotyped ex. constantly sweeping the floor o Automatic obedience o Waxy ex. put arm down after taking can lead to not can kill! state of near unconsciousness Negativism Negative taking away from baseline Changes in affect o Flat affect o Inappropriate emotional response incongruent to situation o Blunted affect o Bizarre grimacing, giggling, mumbling Apathy Anhedonia Poor social functioning Poverty of thought Increased risk of violence: self or Extreme suspiciousness Panic anxiety Catatonic extreme restlessness motor movement Rage reactions Command find out who is telling them this and who they are telling them to hurt Communication guidelines: not touch, do not Dealing with schizophrenia o Lower anxiety Catatonic symptoms are directly attributable to the physiological consequences of a general medical condition The catatonic features specifier: Catatonic features associated with other psychotic disorders Symptoms: stupor and muscle rigidity or excessive, purposeless motor activity, waxy flexibility, negativism, echolalia, and echopraxia blend of schizophrenia symptoms and affective symptoms An uninterrupted duration of illness during which there is a major mood episode (manic or depressive) in addition to criterion A for the major depressive episode must include depressed mood Can be either bipolar type or depressive type, depending on the symptoms The symptoms that meet criteria for depressive or manic episodes are present for over half of the illness duration with schizoaffective disorder Episodes of psychotic symptoms instead of consistent symptoms symptoms last more than 1 month but less than 6 months, a briefer version of schizophrenia, diagnosed before schizophrenia psychotic Treatment: Acute planning strategies to ensure patient safety and stabilize symptoms Maintenance planning strategies to provide patient and family education Stabilization planning strategies to prevent relapse Psychotherapy Group successful if Behavior therapy Social skills training Daily living skills training Milieu therapy Family therapy Program of Assertive Community Treatment (PACT) aka Big Mac team Used to avoid going to the hospital Group of professionals drive in a bus and meet patients in a public setting ex. McDonalds to give medication or therapy Available 24 hours a day, 365 days a year The recovery belief to achieve Concept of healing and transformation enabling a person with a mental illness to live a meaningful life in the community while striving to achieve their full potential Focus is on the level of functioning in areas of relationships, work, independent living, and other kinds of life functioning Recovery is a continuum that is lifelong Drug therapy: Conventional (first gen) target positive symptoms only Thiothixene (navane) Fluphenazine (Prolixin) Haloperidol (Haldol) Pirozide (Orap) Trifluoperazine Chlorpromazine (Thorazine) Thioriadizine (Mellaril) Perphenazine (Trilafon) Loxaine (Loxitane) Molidone (Moban) Major side effects: Extrapyramidal symptoms (EPS) Tardive dyskinesia: tongue movements, lip smacking with uncontrollable biting, chewing, or sucking for NCLEX it is not treatable Acute dystonia: muscle cramps of head and neck (like a stone) MEDICAL EMERGENCY Akathisia: internal and external restlessness Pseudo parkinsonism: stiffened extremities, fine motor tremors, shuffling gate Oculogyric crisis: eyes stuck up and rolled back Treatment of EPS Give Benztropine mesylate (Cogentin) or Diphenhydramine hydrochloride (Benadryl) Lower dose of antipsychotic or prescribe an antiparkinsonian drug Major side effects cont. Neuroleptic malignant syndrome (NMS): decreased LOC, muscle rigidity, high fever, HTN, sweating, tachycardia, drooling messed up infection can kill Orthostasis Use Abnormal involuntary movement scale (AIMS) for early recognition of EPS Atypical antipsychotics: treats positive and negative symptoms Clozapine can cause agranulocytosis Aripiprazole (Abilify) Risperidone can cause gynecomastia Advantages Minimal EPS Positive and negative symptoms Help improve cognitive deficits, decrease anxiety and depression, and decrease suicidal behavior Disadvantages Metabolic syndrome o Weight gain o Dyslipidemia o Altered glucose o Diabetes o Hypertension o Atherosclerosis o Increase in heart disease o Kills slowly More expensive Education LACK OF EYE CONTACT, HAND FLAPPING, TOE WALKING, PARALLEL PLAY Pharmacological atypical antipsychotics Risperidone: side drowsiness, weight gain, increased appetite, nasal congestion, fatigue, gynecomastia and lactation Aripiprazole: side sedation, fatigue, weight gain, vomiting, somnolence, tremors ADHD Difficult to diagnose before age 4 Inattention Hyperactivity Impulsivity Pharmacological interventions Adderall, Concerta, Ritalin, Daytrana o Decreases appetite and rate of growth and development o Take in the morning after breakfast and weigh child weekly Atomoxetine (Strattera) Bupoprion (Wellbutrin) Clonidine (Catapres) Drug holiday: stops medication for a short time to ensure it is working Interventions: Assess mental status Ensure they are protected from injury Limit stimuli Administer after meals and 6 hours before bedtime Weigh regularly Disruptive Behavior Disorders Oppositional Defiant Disorder Defiant behavior toward authority figures without seriously violating rights of others Not just a teenage attitude Multiple settings to multiple people for a period of time Conduct Disorder Pattern of behavior in which rights of others and societal norms or rules are violated Stealing, hurting animals, set fires Lacks empathy and guilt of Meds for disruptive behavior disorders Antipsychotics, lithium carbonate Interventions child from provide for needs key milestone of trust vs Treatment for all cognitive disorders: Always have parental involvement ABA CBT Group, milieu Cognitive Disorders in the Adult: Delirium: Disturbed consciousness coupled with cognitive difficulties Almost always an underlying cause Rapid onset Transient disorder Can treat underlying cause and return to baseline Illusions, hallucinations, increased vital signs, hypervigilance, mood swings, agitation and anger Antipsychotics (Haldol, Risperdal) Lack of sleep, meds, dehydrated, alcohol abuse Substance intoxication Substance withdrawal Due to another medical condition Due to multiple etiologies Communication guidelines Always identify yourself Speak slowly with short, simple words Reinforce reality Prevent physical harm Use supportive measures to relieve stress Dementia: Syndrome of impaired cognitive function marked slowly deteriorating social and occupational functioning of dementia are irreversible and primary Primary ex. Secondary ex. HIV, cerebral trauma ex. Stroke, depression, medications, nutrition, metabolic disorders Symptoms: o Impaired abstract thinking, judgement, and impulse control o Social conduct disregarded o Hygiene neglected o Personality changes o Defensive denial, confabulation, perseveration, avoidance of questions Lewy body dementia vs vascular dementia: Lewy protein deposits in nerve cells impaired blood flow to brain as a result of significant cerebrovascular disease o More abrupt onset of all cases of NCD Delirium Rapid Fluctuating reversible altered Inattention, lack of concentration Immediate recall impaired vs Onset Course Duration Consciousness Attention Dementia Insidious Progressive Irreversible Often normal Often normal Memory Hyperactive or hypoactive Often reversed Psychomotor Changes Cycle Immediate recall often normal Not usually present Often normal
NSG211 Test 2 study guide
Course: Health Care Concepts II (NSG 211)
University: Germanna Community College
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