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Assessment 3 N450- Scizophrenia (1).
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Assessment 3 N450- Scizophrenia (1).
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Assessment 3 N450- ScizophreniaSchizophrenia is - ANS-Marked by profound withdrawal from interpersonal relationships and
cognitive/perceptual disturbances that make dealing with reality difficult
Cause: Excess of dopamine dependent neuronal activity in the brain. Antipsychotics
(Chlorpromazine or haloperidol) lower brain levels of dopamine by blocking dopamine receptors
thus reducing schizophrenic symptoms.
Regression in schizophrenic client - ANS-Falling back to earlier behavioral levels: fetal position,
eating with hands etc.
Schizophrenia is diagnosed when - ANS-Client experiences 2+ symptoms during a 1 month
period and at least 1 symptom must be a core positive symptom (delusions, hallucinations,
disorganized speech)
Positive symptoms (hallucination, delusions, speech impairment) - ANS-Positive symptoms tend
to reflect an alteration or distortion of normal mental fx. Psychotic NEW symptoms!
-Normal scans and testing
-Respond well to meds
Delusions
-Control
-Reference
Hallucinations
-Sensations that are not there (voices)
Disorganized speech
-Word salad = mixture of meaningless phrases "go great the fate bowl"
-Clanging- use of rhyming words "be glad, you're sad, i'm bad"
Disorganized/ Catatonic behavior
-Not moving, stupor
Catatonic behavior - ANS-1. Stupor- decrease in reaction to the environment
2. Rigidity- Maintenance of a posture against efforts to be moved
3. Posturing (waxy flexibility)
4. Negativism- resistance to instructions
5. Excitement- Severely agitated; out of control
6. Potential for violence to self or others during stupor or excitement
,Negative symptoms (apathy, poverty of thought, anhedonia, impaired decision making) -
ANS-Removal of normal processes- decrease in emotions or loss of interest
*FLAT AFFECT* where they don't respond to emotion that would seem appropriate
Alogia- lack of speech
Example: Nurse asks, do you have any children? Client will just say "Yes."
Anhedonia- inability to feel pleasure
Apathy- lack of interest
Thought blocking- stops talking in the middle of sentence and remains silent
Avolitition- lack of motivation
Anergia- lack of energy
-Abnormal scans and testing
-More difficult to treat than positive but atypical anti psychotics (new gen meds) show better
response
Assessment: 4 As of schizophrenic client - ANS-1. Affect
2. Associative looseness
3. Autism
4. Ambivalence
4 As- Affect - ANS--Flat
-Blunt
-Inappropriate
-Bizarre
Affects
4 As- Associative looseness - ANS-Confused thinking with illogical speech and reasoning
4 As- Autism - ANS-Not in reality; delusions, hallucinations, neologisms, preoccupied with self
4 As- Ambivalence - ANS-Holds opposing emotions, attitudes, ideas at the same time, difficulty,
making decisions
What interventions are focused on with schizophrenic clients? - ANS-Interventions that
decrease stress; since stress exacerbates symptoms
, General side effects of antipsychotics - ANS--Extrapyramidal side effects (tremors, muscle
spasms, rigidity, slow movements, restlessness)
-Orthostatic hypotension
-Tardive dyskinesia (lip smacking, tongue movement)
-*Neuroleptic malignant syndrome- FATAL!*
Nurse Dorothy is evaluating care of a client with schizophrenia, the nurse should keep which
point in mind?
A
Frequent reassessment is needed and is based on the client's response to treatment.
B
The family does not need to be included in the care because the client is an adult.
C
The client is too ill to learn about his illness.
D
Relapse is not an issue for a client with schizophrenia. - ANS-A
Frequent reassessment is needed and is based on the client's response to treatment.
Because client respond to treatment in different ways, the nurse must constantly evaluate the
client and his potential. Premorbid adjustment must also be considered. Most clients with such
condition go home, so the family should be involved. The client can learn about the illness if
information is provided gradually. Relapse is common in schizophrenia.
Gio told his nurse that the FBI is monitoring and recording his every movement and that
microphones have been plated in the unit walls. Which action would be the most therapeutic
response?
a. Confront the delusional material directly by telling Gio that this simply is not so.
b.Tell Gio that this must seem frightening to him but that you believe he is safe here.
c.Tell Gio to wait and talk about these beliefs in his one-on-one counselling sessions.
d. Isolate Gio when he begins to talk about these beliefs. - ANS-b.Tell Gio that this must seem
frightening to him but that you believe he is safe here.
he nurse must realize that these perceptions are very real to the client. Acknowledging the
client's feelings provides support; explaining how the nurse sees the situation in a different way
provides reality orientation. Confronting the delusional material directly will not work with this
client and may diminish trust. Telling the client to wait and talk about these beliefs in his
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