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Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
Thought Disorders
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Thought Disorders

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Thought Disorders and Medications - Schizophrenia in Focus

Thought Disorders and Medications - Schizophrenia in Focus

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  • helpful website that help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools . Hope they help


    http://www.rnpedia.com/
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  • This is an excellent slide show! Recommend it to anyone who is lokking for Schiz info.
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  • http://NurseReview.org & http://BookOfTips.BlogSpot.com are sites that i highly recommend you visit if you like this slides!
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  • #1 Nursing Site http://NurseReview.org !
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  • 1. Unit 4: Thought Disorders and Medications Schizophrenia in Focus
  • 2. Schizophrenia: Bleuler’s 4-A’s
    • AFFECT: flat, blunted, inappropriate or bizarre affect
    • AMBIVALENCE: holding opposing opinions or attitudes at the same time
    • ASSOCIATIVE LOOSENESS: Jumbled, illogical thinking
    • AUTISM: living in one’s own fantasy world—turned in to the self
  • 3. Classifying Symptoms: Positive Symptoms
    • “What’s there that shouldn’t be there”
    • Hallucinations
    • Delusions
    • Bizarre Behavior
    • Disorganized speech, word salad, echolalia
  • 4. Thought Alterations
    • Ideas of reference
    • Persecutory, grandiose, somatic delusions
    • Thought blocking, insertion, withdrawl, broadcasting
    • Command/control hallucinations
  • 5. Classifying Symptoms: Negative Symptoms
    • “ What’s not there that should be there”
    • Lack of Feeling and affect including positive emotion (anhedonia)
    • Poverty of thought (alogia)
    • Loss of motivation (avolition)
  • 6. Classifying Symptoms:Cognitive Symptoms
    • Thinking and Decision-making
    • Impaired memory
    • Poor problem solving and poor judgment
    • Illogical thinking
    • Inattention, distractability
  • 7. Phases of Schizophrenia
    • Prodromal: isolation, behavior change, often in adolescence or y. adult
    • Acute/Active Phase: Evident psychosis. Periods of fluctuation, but symptoms are evident
    • Chronic/Residual: Long term outcome is that the intensity of the psychosis may diminish, leaving more of the negative symptoms
  • 8. Theories of Causation
    • Many of the psychological theories are now doubted as evidence of a brain disease is more clear.
    • Genetic transmission is evident
    • Dopamine theory—excess dopamine (does not explain all)
    • Glucomate theory—regulation of glucomate (NMDA) receptor in brain r/t PCP psychosis
  • 9. Neuroanatomical Changes
    • Enlarged lateral cerebral ventricles
    • Cortical and cerebellum atrophy
    • Third ventricle dilation and asymmetry
    • Changes in blood flow and glucose metabolism patterns
  • 10. Mechanism of Action of Antipsychotics
    • Phenothiazines: block post-synaptic dopamine receptors giving a decreased dopamine response. Works on + symptoms only
    • Atypical antipsychotics: Antagonizes both serotonin and dopamine receptors giving a decreased dopamine and serotonin response. Works on + and – symptoms both
    • See supplemental info on Oncourse
  • 11. Side effects of antipsychotics
    • Extrapyramidal (see H/O in syllabus)
    • Tardive dyskinesia: can be permanent,
    • See AIMS test, don’t raise dose of med
    • Anticholinergic side effects (go over)
    • Blood dyscrasias
    • Photosensitivity, excess prolactin
  • 12. Neuroleptic Malignant Syndrome
    • Life threatening: increased temp, decreased consciousness, severely increased muscle tonicity, HTN, tachycardia, drooling sweating
    • Stop the antipsychotic, treat symptoms in a monitored setting (ICU), fluids, cooling blanket, dantrolene, parlodel (a dopamine agonist)
  • 13. Nursing Diagnosis: Non compliance
    • Not taking meds or attending therapy is a big factor leading to rehospitalization
    • Why? Denial, hate being in sick role, lack of judgment, side effects of meds
  • 14. Nursing Diagnosis: Potential for violence
    • Usually related to paranoia/perceived threat
  • 15. Nursing Diagnosis: Impaired social interaction
    • Related to negative symptoms, hard to change!
  • 16. Nursing Diagnosis: self care deficit
    • No motivation to bathe, lack of recognition of problem, paranoia
  • 17. Nursing Diagnosis: altered nutrition/FVE
    • Paranoia about eating and drinking
    • Excess fluid intake
  • 18. Nursing diagnosis: risk for suicide
    • About 10% schizophrenics commit suicide
  • 19. Paranoid Schizophrenia
    • Intense, strongly defended irrational suspicions
    • Ideas of reference
    • Behaving with anger, sarcasm, hostility
    • Projection of feelings
    • Often paranoid ideas are intricate and complex
  • 20. Nursing Tactics with Paranoia
    • Calm, matter of fact approach—don’t smother or hover
    • Respect personal territory
    • Verbal indication of nursing measures before intervention
    • Be honest, trustworthy, consistent
    • Don’t feed delusions or challenge directly—cast reasonable doubt and focus on reality
    • Look at underlying themes in delusions
  • 21. More nursing interventions in Paranoia
    • Help client manage anger and fear through consistent limits, appropriate diversion, and not taking bx personally
    • “ When in doubt, check it out” strategy
    • Talk about dealing with food and med. paranoia
  • 22. Disorganized Schizophrenia
    • Regression, increased social impairment, bizarre affect/behavior, incoherent speech
    • Nursing measures: help with grooming, eating. Routine, consistent and structured. Understanding milieu. Plus all the general nsg measures.
  • 23. Catatonia: abnormal motor behavior
    • Withdrawn: posturing, waxy flexibility, stupor, mute, unaware of environment
    • Nsg care in Withdrawn state: complete hygiene, nutrition, mobility, bathroom assist
    • Excited: Gross hyperactivity-running striking out
    • Nsg with Excited: preserve milieu, keep client safe
  • 24. Other categories of Schizophrenia
    • Undifferentiated – means doesn’t fit a specific othre group
    • Residual—means most of the active symptoms are gone (mostly negative symptoms remaining)

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