Psychosis

Symptoms of antipsychotic overdose

-CNS depression, hypotension, and EPSE -agitation -convulsions -hyperthermia -increased anticholinergic symptoms -arrhythmias

how to fix psychosis induced polydipsia

-Daily weight -restricted fluid intake -sodium replacement -positive reinforcement

hallmark signs of delirium

-acute onset -fluctuating LOC -slurred speech -disorientation -confusion

Types of Extrapyramidal Effects

-akathesia -akinesia -bradykinesia -dystonia -parkinsonism -tardive dyskinesia -pisa syndrome -nueroleptic malignant syndrome

types of 3rd gen antipsychotics

-aripiprazole -brexiprazole -cariprazine

pt education for antipsychotics

-avoid immersion in hot water (ortho hypotension) -use sunscreen to prevent sunburn -dress appropriately and drink H2O to prevent heat stroke -immediately report symptoms of a blood dyscrasia (sore throat, malaise, fever, bleeding)

Types of 1st gen antipsychotics

-chlorpromazine -perphenazine -fluphenazine -haloperidol

Types of 2nd gen antipsychotics

-clozapine -risperidone -paliperidone -olanzapine -quetiapine -ziprasidone -asenapine -Iloperidone -lurasidone

early warning signs of schizo

-decreased personal hygiene -bizarre behavior -irrational statements -social withdrawal -shift in personality -deterioration of social relationships -inability to cope or concentrate -excessive writing without meaning -decline in academics or althletics

delirium can be caused by the following meds

-diphenhydramine -TCAs -benztropine -lithium -divalproex

how to communicate with someone with hallucinations

-do not engage in hallucinations -state your reality -voice doubts -orient pt -do not touch pt without warning them -if pt is hearing things ask them what they are hearing

don't for nurses and pts with schizo

-do not reinforce hallucinations and delusions -do not touch pt without warning -do not whisper or laugh when pts cannot hear the conversation -do not compete with patients -do not embarrass pts

how do antipyschotics help?

-emotional quieting -sedation -decreases insomnia -freed from disturbing thoughts -decreased in hallucinations and illusions

hallmark signs of schizo

-hallucinations -delusions -disorganized thinking

What is tardive dyskinesa? Is it reversible?

-stereotypical oral-facial movements, from long term antipsychotic use. -often NOT reversible. -tongue writhing -teeth grinding -lip smacking

negative schizophrenia symptoms

-too little dopamine -alogia -anergia -asocial behavior -avolition -blunted affect -communication difficulties -difficulties with abstractions -poor rapport -decrease hygiene -poverty of speech -social withdrawal

positive schizophrenia symptoms

-too much dopamine -abnormal thoughts -agitation -bizarre behaviors -delusions -excitment -grandiosity -hallucinations -insomnia -illusions -hostility

The symptoms of tardive dyskinesia are associated with what process? A dopamine hypersensitivity A histamine blockade An elevated prolactin level An elevated alpha-1 level

A dopamine hypersensitivity

Which inheritable factor presents the greatest risk for the development of schizophrenia? Both parents affected Fraternal twin affected Sibling affected Grandparent affected

Both parents affected

Which diagnostic intervention is necessary at regular intervals during clozapine treatment? Electroencephalogram (EEG) Electrocardiogram (ECG) Lipids Complete blood count (CBC)

CBC

what to avoid with antipsychotics

CNS depressants: -alc -antihistamines -antianxiety drugs -SSRI -MAOI -TCA -barbituates -meperidine -morphine

Which modification to a person's personality is most associated with schizophrenia? Change Deterioration Splitting Hypersensitivity

Deterioration

Distractable speech

During the course of a discussion, pt changes subject in response to something unrelated in the environment

Nihilistic delusion

False feeling that self, others or the world is nonexistent or coming to an end

word salad

Incoherent mixture of words, phrases, and sentences

psychomotor agitation

Increased motor activity associated with restlessness, including physical actions (e.g., fidgeting, pacing, feet tapping, handwringing).

Antipsychotic Black Box Warning

Increased risk of death in patients with dementia

What is dystonia?

Involuntary sustained muscle contractions, producing twisting or squeezing movement and abnormal postures -responds to anticholinergics

Which criterion is required for a diagnosis of delusional disorder? Current history of substance abuse Presence of prominent hallucinations No previous diagnosis of schizophrenia Existence of delusions for at least 2 months

No previous diagnosis of schizophrenia

tangentially

Oblique, digressive, or even irrelevant manner of speech in which the central idea is never communicated. (i.e. the patient is asked to explain how she was injured, but loses her train of thought and goes on to other subjects)

A patient experiencing delusions is noted to have more anxiety and difficulty with attention following 2 days on the inpatient unit. Which nursing intervention would be most helpful for the patient? Walking with a group of staff and other patients off the unit Listening to music or reading Discussing treatment goals for the inpatient stay Participating in a noncompetitive creative activity

Participating in a noncompetitive creative activity

In working with a patient experiencing hallucinations, the nurse will direct the unlicensed assistive personnel to engage in what activity? Speak to patients about real people and real events. Listen while patients talk about disordered perceptions. Avoid the use of distraction with patients. Consistently expect bizarre behavior.

Speak to patients about real people and real events.

What aspect of traditional antipsychotic medication therapy is most responsible for a patient's medication nonadherence and resulting rehospitalization? The cost of the medication The need for frequent blood tests The biases against such medications The occurrence of EPSEs.

The occurrence of EPSEs.

delirium is associated with:

UTIs MIs Pneumonia Drugs and meds

An adult male is admitted to the psychiatric unit after being found by the police walking naked down the middle of the street at 3:00 AM. He insists that he is the real Santa Claus. Which nursing intervention should the nurse implement when working with this patient? Consistently use the patient's name. Agree that he is Santa Claus so as not to upset him further. Provide medication as needed (PRN). Point out to the patient why he cannot be Santa Claus.

a

What therapeutic benefit will the nurse include in the patient teaching regarding fluphenazine decanoate? the med is administered weekly not daily. the client will not experience EPSEs the med requires titration only monthly the pt will experience a reduction in both neg and pos symptoms

a

loosening of associations

a speech pattern among some people with schizophrenia in which their thoughts are disorganized or meaningless

A patient diagnosed with chronic schizophrenia is placed on an antipsychotic medication, 20 mg twice a day. At the evening medication time, he expresses that he is not feeling well. The nurse assesses the patient and finds the following symptoms: oral temperature 103 °F (39.4 °C), pulse 110 beats/min, and respirations 24 breaths/min. The patient is diaphoretic and appears rigid. What is the most likely cause of these clinical manifestations? TD NMS pneumonia psuedoparkinsonism

b

A patient is admitted to the psychiatric unit for an acute exacerbation of paranoid schizophrenia after she stopped taking her medications for several months. She tells the nurse that she believes her food is being poisoned, and she refuses to eat. What is the most appropriate intervention by the nurse? Challenge the patient's delusion. Provide canned food while expressing reasonable doubt. Agree with the patient's decision. Dismiss her fears and insecurities.

b

When conducting a health history, the nurse identifies which social risk factors as possible predictors of a diagnosis of schizophrenia. (Select all that apply.) older paternal age ethnic and racial discrimination urban residence impaired physical or mental health 1st degree relative diagnosed w schizo recent immigration

b, c, f

While watching television, a patient appears to be hallucinating. He is swearing loudly at the television and is becoming increasingly agitated. Which nursing interventions would be appropriate in dealing with this patient? (Select all that apply.) In a firm voice, tell the patient to stop this behavior. Reassure the patient that he is not in any danger. Instruct other team members to ignore the patient's behavior. Give simple commands in a calm voice. Acknowledge the presence of the hallucinations.

b, d, e

how does cigarette smoking affect antipsychotics?

breaks down several psychotics

what is psychosis induced polydipsia?

compulsive water drinking causes hyponatremia: -lightheadedness -weakness -lethargy -muscle aches -nausea -vomiting -confusion -convulsions -coma

delusions of influence

false beliefs of being controlled by outside forces

grandiose delusions

false, persistent beliefs that one has superior talents and traits

dellusions vs hallucinations

hallucinations: revolve around senses delusions:revolve around beliefs

which antipsychotics cause more EPSEs?

haloperidol and fluphenazine

What is akinesia?

inability to initiate movement -responds to anticholinergics

S/S of NMS

increased T Rigidity tremors impaired ventilations muteness altered consciousness autonomic hyperactivity

What is Pisa syndrome?

leaning to one side

What nutritional education should a nurse provide when managing the care of a patient who has been prescribed a newer antipsychotic medication? Limit protein intake. Increase fluid intake by 200 mL daily. Prepare to cope with a craving for carbohydrates. increase calories to manage an expected weight loss.

prepare to cope with a craving for carbs

The multidisciplinary team discusses the potential side effects of what medication prescribed to treat a patient's negative symptoms of schizophrenia? fluphenazine haloperidol quetiapine chlorpromazine

quetiapine

What is akathisia?

restlessness with inability to sit still -restless leg -jittery feelings -nervous energy

what do antipsychotics treat?

schizophrenia and the manic phase of BPD

how do antipsychotics help alterations of activity?

slow psychomotor activity

What is bradykinesia?

slowness of movement -weakness -fatigue -painful muscles -anergia (lack of energy)

flight of ideas

symptom of mania that involves an abruptly switching in conversation from one topic to another

delusions of reference

the belief that common elements in the environment are directed toward the individual

Religious delusions

the belief that one is an agent of or specially favoured by a greater being

delusions of persecution

the belief that people are out to get you

clang associations

the stringing together of words that rhyme but have no other apparent link

Erotomanic delusions

when an individual believes falsely that another person is in love with him or her

A new RN demonstrates an understanding of clozapine when making what statement? I need to carefully assess each patient for Tardive Dyskinesia, since it is a major risk factor with clozapine." "The team decided to offer clozapine to the patient who was newly admitted and diagnosed with schizophrenia. I will discuss it with his family today." "I gave the first dose of clozapine this morning. He is experiencing no abnormal motor movements so far." "The patient's WBC and ANC meet the criteria to start clozapine."

"The patient's WBC and ANC meet the criteria to start clozapine."

Which statement made by a client demonstrates an understanding of the use of antipsychotic medications during pregnancy? "Their use should be monitored closely by my health care provider." Such medication poses severe risks when used during pregnancy." "Medications like these do not cross the placental barrier." "There is no record of side effects in newborns exposed to such medications."

"Their use should be monitored closely by my health care provider."

nurse-pt relationship with schizo

-be calm -accept pts as they are -do not accept all behaviors -keep promises -be consistent -be honest -do not reinforce hallucinations or delusions -orient pt -do not touch pt without warning them -avoid whispering or laughing when pts are unable to hear all of the conversation -reinforce positive behaviors -avoid competitive activities -allow and encourage verbalization of feelings

anticholinergic side effects of antipsychotics?

-constipation -decreased sweating -dilated pupils -dry mouth -slowed bowels -slowed bladder

how do antipsychotics help alterations of thought?

-improving reasoning -decreased ambivalence -decrease delusions -helps pt be able to communicate

risks for schizophrenia

-inner city residents -people from lower socioeconomic classes -individuals who experience prenatal difficulties -first appears in late adolescents and early adulthood

Risk factors for suicide

-male -white or NA -over 60 -hopelessness -medical illness -severe anhedonia -living alone -prior attempts -unemployed -financial problems

types of hallucinations

-visual -auditory -olfactory :smell -gustatory: taste -tactile: touch -control: tells pt to do something

The mental health nurse notes that a client diagnosed with schizophrenia is exhibiting flat affect. Which situation supports this documentation? 1.During the entire family visit, the client presented with an expressionless, blank look. 2.The client demonstrated minimal response to the news that his discharge had been postponed. 3.The client grimaced during the entire therapy session that focused on finding one's personal joy. 4.During grief therapy, the client was observed laughing while another client described the death of a parent.

1

The nurse is planning relapse prevention information for a client diagnosed with schizophrenia. The nurse understands that it is important to ensure which primary intervention? 1.Including the client's support system in the teaching 2.Facilitating weekly maintenance therapy for the client 3.Having the client restate discharge goals and strategies 4.Stressing the importance of client compliance with the medication plan

1

The nurse should include which information in the medication teaching plan for a client diagnosed with schizophrenia? 1.Coffee, tea, and soda consumption should be limited. 2.If the client is compliant, the relapse of symptoms will never occur. 3.Psychotropic medications may cause mild cardiovascular symptoms. 4.Most schizophrenic clients are able to taper off their medications eventually.

1

Which situation will present the most prominent problem when attempting to manage the outpatient care of a client diagnosed with schizophrenia? 1.The client's noncompliance with medication therapy 2.The community's opposition to outpatient mental health clinics 3.The associated increased risk that the client may become homeless 4.The family's negative reaction to transferring the client to community-based care

1

The nurse recognizes which assessment and diagnostic data as being associated with a newly diagnosed schizophrenic client? Select all that apply. 1.A birthday of March 30 2.A loss of interest in hobbies 3.A suicide attempt 6 months ago 4.Adopted by family at age 14 months 5.Brain scan shows increased blood flow to the frontal lobes 6.Magnetic resonance imaging shows temporal lobe atrophy

1,2,3,6

Which client behavior is indicative of negative symptoms associated with schizophrenia? Select all that apply. 1.Verbal communication is almost nonexistent. 2.Gross motor skills are impacted by involuntary body movements. 3.The client needs frequent redirection because of short attention span. 4.Interpersonal relationships are negatively impacted because of delusional thoughts. 5.Conversations are difficult to follow because of demonstration of loose associations of thought.

1,3

During the admission assessment process, the nurse observes that a client diagnosed with paranoid schizophrenia has multiple dental caries and mouth ulcers. The client denies oral pain or difficulty eating and does not present any concern over the nurse's finding. The nurse recognizes the client's response as most likely the result of which client factor? 1.Apathy 2.Impaired pain perception 3.Distrust of authority figures 4.Poor verbal communication skills

2

The nurse caring for a client diagnosed with schizophrenia should include which interventions in the plan of care to assist in managing the client's concrete thinking? 1.Provide the client with written instructions regarding the routine of the unit. 2.Present verbal instructions regarding expectations in single, simple commands. 3.Assess the client's understanding of instructions by requiring restatement of expectations. 4.Incorporate family members in determining the emotional and physical needs of the client.

2

The nurse is monitoring a client diagnosed with schizophrenia who demonstrates a dysfunctional affect. Which situation is congruent with inappropriate affect? 1.When told that a beloved pet has died, the client responds, "OK." 2.The client giggled while describing being physically abused as a child. 3.The client's facial expressions are unchanged during the entire admission process. 4.When staff members attempt to engage the client in conversation, the client only mumbles.

2

The nurse notes that a client with schizophrenia who is receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? 1.Parkinsonism 2.Tardive dyskinesia 3.Hypertensive crisis 4.Neuroleptic malignant syndrome

2

The nurse taking a medication history for a client who has been admitted to the nursing unit notes that the client is receiving olanzapine. The nurse interprets that this client most likely has a history of which disorder? 1.Hypertension 2.Schizophrenia 3.Diabetes mellitus 4.Diabetes insipidus

2

Which behavior in a client with schizophrenia demonstrates the client's cognitive inability to appropriately process data from external stimuli? 1.The client remains in the same physical position for hours. 2.The client is convinced that the curtains are actually ghosts. 3.The client looks for a cat when someone says, "It's raining cats and dogs." 4.The client repeatedly asks, "Can you see my dead sister over by the door?"

2

A client diagnosed with schizophrenia has been prescribed clozapine. The nurse should monitor the client for which side/adverse effects of this medication? Select all that apply. 1.Diarrhea 2.Sedation 3.Dry mouth 4.Weight loss 5.Orthostatic hypotension 6.Presence of a fixed stare

2,3,5,6

A client is being seen at his primary health care provider (PHCP) office. The client has a history of schizophrenia and has been taking a new psychotropic medication for 3 weeks. Which finding(s) indicate a need for follow-up? Select all that apply. 1.The client has reported sleeping less. 2.The client's cholesterol level is elevated. 3.The client reports a decrease in appetite. 4.The client gained 8 pounds since the last visit. 5.The client's blood pressure is increased from baseline.

2,4,5

A client diagnosed with schizophrenia has a new prescription for risperidone. Which baseline laboratory result should the nurse review before administering the first dose of this medication? 1.Platelet count 2.Blood clotting tests 3.Liver function studies 4.Complete blood count

3

A client diagnosed with schizophrenia says to the nurse, "Will you protect me from the Grand Duchess?" and points to an older client who is sitting reading a book. Which statement is the therapeutic response by the nurse? 1."Where is she? I'll talk to her." 2."I can see no Grand Duchess. You will need to trust me on that." 3."You will be safe here. Your thinking will be clearer after your medication starts to work." 4."The Grand Duchess, huh? Well, I'm the Queen, and I will order her to stay away from you."

3

The history assessment of a client diagnosed with schizophrenia confirms a routine that includes smoking 2 packs of cigarettes and drinking 10 cups of coffee daily. Considering the assessment data, the nurse recognizes which as placing the client at most risk for injury? 1.Developing lung cancer and/or other respiratory disorders 2.Withdrawal symptoms triggering a stress-induced relapse 3.Diminishing the effectiveness of psychotropic medication 4.Developing gastrointestinal disorders, including bleeding ulcers

3

The nurse caring for a client with a diagnosis of acute schizophrenia should use which approach when planning care? 1.Allow the client to set the goals for the plan of care. 2.Let the client act out initially, and use the quiet room and restraints as needed. 3.Provide assistance with grooming and nutrition until the client's thinking has cleared. 4.Repeatedly point out inconsistencies in the client's communication during initial treatment.

3

The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention? 1.Ask direct questions to encourage talking. 2.Leave the client alone so as to minimize external stimuli. 3.Sit beside the client in silence with simple open-ended questions. 4.Take the client into the dayroom with other clients to provide stimulation.

3

The nurse is preparing a client with schizophrenia a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? 1."My medications will help my anxious feelings." 2."I'll go to support group and talk about what I am feeling." 3."When I have command hallucinations, I'll call a friend for help." 4."I need to get enough sleep and eat well to help prevent feeling anxious."

3

A client diagnosed with schizophrenia is taking haloperidol. The nurse understands that this medication will exert its therapeutic effect through which mechanism? 1.Blocking serotonin reuptake 2.Inhibiting the breakdown of released acetylcholine 3.Blocking the uptake of norepinephrine and serotonin 4.Blocking dopamine from binding to postsynaptic receptors in the brain

4

A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? 1.Platelet count 2.Blood glucose level 3.Liver function studies 4.White blood cell count

4

The nurse is administering risperidone to a client with schizophrenia who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? 1.Get adequate sunlight. 2.Continue driving as usual. 3.Avoid foods rich in potassium. 4.Get up slowly when changing positions.

4

The nurse is caring for a client diagnosed with schizophrenia who states, "I decided not to take my medication because I realize that it really can't help me. Only I can help me." Which question asked by the nurse has the best therapeutic value? 1."Why do you think this is a wise decision?" 2."I don't understand. Only you can help you?" 3."You've decided not to take your medication. Is that right?" 4."Do you recall what it was like before you started your medication?

4

The nurse reviewing a client's diagnostic results recognizes that which is a possible positive indication for a diagnosis of schizophrenia? 1.Abnormally high blood flow to the frontal lobes 2.Atrophy of both the limbic structures and cerebellum 3.Abnormally small fissures on the surface of the brain 4.Atrophy of the lateral and/or third ventricles of the brain

4

What information regarding possible prognosis will the nurse provide to the parents of a 15-year-old newly diagnosed with schizophrenia? 1.Their child will very likely experience difficulty in school. 2.The prognosis for their child is good because he is so young. 3.With medication, their child is not likely to experience relapses. 4.Their child will be treated for an imbalance of the chemical dopamine.

4

Knowing that a patient is demonstrating positive symptoms of schizophrenia has a role in predicting what possibility for a patient? Risk for relapse. Response to prescribed medication. Return to precrisis function. Reluctance to adhere to the treatment plan.

Response to prescribed medication.

psychomotor retardation

Visible generalized slowing of movements and speech. -slow speech -increased pauses -soft speech -tired -muteness -slowing of body movements

somatic delusions

believes that his body is changing in an unusual way, such as growing a third arm

When an older adult is prescribed an antipsychotic medication, which intervention has priority regarding the patient's safety? Wearing sunglasses when outdoors Changing from a sitting to standing position slowly Being frequently monitored for suicidal ideations avoiding foods with high fat content

changing from sitting to standing position slowly

A client's risk for the development of blurred vision is high when prescribed which antipsychotic medication? Ziprasidone Risperidone Haloperidol Clozapine

clozapine

what is NMS (neuroleptic malignant syndrome)

rare but serious reaction to antipscyhotic medications. More common with high potency FGAs. Elevated temperature>38C or 100.4F Unstable blood pressure Profuse sweating Dyspnea Muscle rigidity="Lead Pipe" Incontinence (similar to MH) *Treatment of NMS:* Stop/Hold Antipsychotic, Cool patient with blanket, fluids,and antipyretics (ASA, Acetaminophen, Ibuprofen), Administer Dantrolene or Bromocriptine (Muscle Relaxants), Maintain hydration with fluids.

do antipsychotics affect BP?

yes- cause orthostatic hypotension give cautiously to those with severe hypotension, heart failure, or a history of arrhythmias