NUR 414A Psychosis
what is disorganized motor behavior
abnormal behavior ranging from agitation to catatonia
what are negative symptoms
alogia, affective blunting, associality, anhedonia, avolition
what is psychosis
dysregulation of dopamine transport systems b/w the limbic system and prefrontal cortex; syndrome of neurocognitive s/s that impair cognitive capacity, leading to deficits of perception, functioning, and social relatedness
what are delusions
fixed beliefs that are not amenable to change in light of conflicting evidence
why are 2nd generation antipsychotics preferred over 1st gen?
lower risk for extrapyramidal side effects there is an increased risk for metabolic disorders tho like weight gain, diabetes, etc
what is disorganized thought
most commonly inferred from speech, defined by derailment, loose associations, tangentially, incoherence
what are hallucinations
perception like experiences that occur w/o external stimulus
primary and secondary prevention of psychosis
primary - understand psychosis is genomic and environmental; pregnancy genetic counseling; determine risk factors secondary - screening with family hx and monitoring for subclinical s/s
1st generation antipsychotics mechanism of action
reduce transmission of dopamine at D2 receptor site of 4 key dopaminergic pathways in the brain; significant side effects; high risk for extrapyramidal side effects
2nd generation antipsychotics mechanism of actions
same as 1st gen, also targets negative s/s with 5-HT-2a antagonism and 5-HT-1a agonism
what drugs are known to induce psychosis
synthetic cannabis (spice or marijuana), cathinones (bath salts), alcohol, cocaine, methamphetamine, psychotomimetic (LSD), anabolic steroids
why does dementia occur twice as often in schizophrenics
untreated psychosis is a persistent neurotoxic state and can degrade neural pathways over time
when are anticholinergic agents given
when a patient is experiencing extrapyramidal side effects from antipsychotics -cogentin -parlodel -artane -benadryl
dx tests
-CBC -chemistry panel (Chem18) -thyroid function test -rapid plasma reagin -dexamethasone suppression test -HIV test -heavy metals panel -UA -urine drug screen -urine C&S -CT/MRI
what is toxic psychosis
-aka delirium -occurs from untreated condition, rapid onset with dramatic fluctuations in mental status
what toxins are known to induce psychosis
-carbon monoxide -organophosphates -heavy metals (arsenic, magnesium, mercury, thallium)
2nd generation antipsychotics drugs
-clozapine -olanzapine -risperidone -quetiapine -aripiprazole -paliperidone -ziprasidone -asenapine
what are the 5 different symptomatic abnormalities in psychosis
-delusions -hallucinations -disorganized thought -disorganized motor behavior -negative sypmtoms
risk factors of psychosis
-family hx -previous psychotic episode -substance abuse -stress intolerance -ineffective coping -pre-existing psychiatric illness -children with pre-morbid IQ in learning disability range -temperament -environmental (birth process, child abuse, social adversity) -genetics (chromosomes 1, 6, 8, 12, 13, 22) -decreased cortical gray matter
1st generation antipsychotic drugs
-haloperidol -fluphenazine -thiothixene -trifluoperazine -perphenazine -chlorpromazine -thioridazine -loxapine
what is secondary psychosis
-organic etiology (substance abuse, delirium, dementia) -
what is primary psychosis
-psychiatric etiology (schizophrenia) -all other possible medical explanations must be ruled out first
assessment of hx
-risk factors -PMH -mental health hx -substance use -perinatal trauma -developmental hx -family hx -trauma exposure -culture and beliefs
social complications of psychosis
-shunned by society -employment issues -housing issues -unable to attend to basic needs
non-pharmacologic treatment for psychosis
-social skills training -family focused therapy -CBT -cognitive enhancement therapy -electroconvulsive therapy
physical exam
-vital signs -cranial nerve assessment -mental status exam
A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? 1.Using open-ended questions and silence 2.Sharing personal preference regarding food choices 3.Documenting reasons why the client does not want to eat 4.Offering opinions about the necessity of adequate nutrition
1
The registered nurse is teaching a nursing student regarding education a client who is on treatment with monoamine oxidase inhibitors (MAOIs). Which statement made by the nursing student indicates further teaching? 1. i should encourage the client to take food high in tyramine 2. i should encourage the client to wear a medical alert bracelet 3. i should advise the client to report any problem in vision 4. i should advise the client to report any symptoms of seizures
1
a hyperactive client with bipolar I disorder becomes loud and insulting and says to a staff member "get lost, you old buzzard!" how can the nurse best handle this situation? 1. asking the client to come along on a walk 2. asking the client to explain the anger 3. pointing out that the staff member is neither old nor a buzzard 4. telling the client that if the rude behavior does not change there will be consequences
1
while caring for a client on antidepressant therapy, the nurse observes hyperthermia and seizures. upon a further assessment, the nurse finds that the client's heart rate is 200 beats per minute. which medication might be responsible for the condition? 1. sertraline 2. asenapine 3. risperidone 4. fluphenazine
1
A client is diagnosed with neuroleptic malignant syndrome (NMS) as a side effect of high-potency antipsychotic use. The registered nurse trains the nursing student about how to provide supportive care. Which actions made by the nursing student indicates effective education? Select all that apply. 1. providing the clients with cooling blankets 2. administering lorazepam to the client 3. increasing the client's fluid intake 4. withdrawing the neuroleptic drug immediately 5. switching to another first generation antipsychotic
1, 2, 4
A male client diagnosed with bipolar disorder is prescribed medication that has caused a decreased libido. Which drugs would be appropriate to be prescribed by the primary healthcare provider to treat this condition? Select all that apply. 1. asenapine 2. quetiapine 3. haloperidol 4. aripiprazole 5. chlorpromazine
1, 2, 4
A registered nurse provides dietary instructions to a client who is prescribed isocarboxazid for depression. Which statements made by the client indicates a need for further education? Select all that apply. 1. i will limit my intake of coffee 2. i will my intake of yogurt 3. i will include bananas in my diet 4. i will limit my intake of red wine 5. i will add dark chocolate to my diet
1, 2, 4
A delusional client has refused to eat for the past 24 hours, saying "the food is poisoned." How should the nurse respond? 1. why do you think that the food is poisoned 2. you feel worried that someone wants to poison you 3. this feeling is a symptom of your illness. its not real 4. you'll be safe with me. i won't let anyone poison you
2
The nurse notes that a client with schizophrenia and 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
what is the 1st line choice for treating psychosis
2nd generation antipsychotics
A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which mental health condition? 1.Psychosis 2.Repression 3.Conversion disorder 4.Dissociative disorder
3
A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern? 1."I don't believe this is true." 2."The guards are not out to kill you." 3."Do you feel afraid that people are trying to hurt you?" 4."What makes you think the guards were sent to hurt you?"
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
which client statement supports the diagnosis of somatic delusions? 1. i wear this coat all the time to keep them from x-raying my organs 2. the president of france and i will be announcing our engagement soon 3. my heart stopped beating three days ago, and now my lungs are rotting away 4. the government has assigned a team of assassins to kill me because i know too much
3
A client with paranoid schizophrenia wraps the legs in toilet paper, believing that this will provide protection from deadly germs contaminating the floor. What is the best nursing intervention? 1. limiting the client's access to toilet paper 2. providing the client with antimicrobial soap 3. explaining to the client why this action is ineffective 4. talking with the client about anxiety and focuses on health
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 registered nurse is teaching the nursing student about the interventions to be followed while caring for a client undergoing treatment with anxiolytic drugs. Which statement made by the nursing student indicates the need for further teaching? 1. i should monitor vital signs of the client 2. i should check the client's oral cavities for cheeking of drugs 3. i should encourage the client to use compression stockings 4. i should encourage the client to change positions quickly
4
a client paces back and forth across the floor, speaks incoherently, and continually talks to and verbally fights with people who are not present. what is the nurse's initial therapeutic intervention? 1. setting limits on the client's verbal aggression 2. isolating the client to decrease the aggressive behavior 3. establishing a relationship to reduce the client's loneliness 4. providing emotional support while demonstrating acceptance of the client
4
