Schizophrenia Overview and Treatments

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a key characteristic of a person exhibiting auditory hallucinations?

Looking around as if searching for someone (correct)

Listening intently without movement

Maintaining consistent eye contact

Speaking loudly without context

Which antipsychotic medication is most suitable for a client with schizophrenia who is overweight and hypertensive?

Aripiprazole (correct)

Clozapine

Ziprasidone

Olanzapine

Why is Clozapine considered a poor first-line agent for schizophrenia treatment?

It is very expensive.

It leads to significant weight gain.

It may produce agranulocytosis. (correct)

It is ineffective for positive symptoms.

What should a nurse say to a client whose speech is disorganized and disconnected?

I don't understand what you're trying to say. Signup and view all the answers

Which adverse effect is associated with Ziprasidone, making it a concern for clients with heart issues?

Prolonged QT interval Signup and view all the answers

Olanzapine is not recommended for clients who are overweight because it is known to cause:

Significant weight gain Signup and view all the answers

What can indicate that a client is experiencing hallucinations?

Turning their head as if listening to someone Signup and view all the answers

What might be an ineffective response by a nurse to a client with schizophrenia who provides disorganized speech?

You need to speak more clearly. Signup and view all the answers

What is the primary purpose of staying with a distraught client who is hearing voices?

To provide reality orientation Signup and view all the answers

Which symptoms indicate that the client is experiencing pseudoparkinsonism?

Shuffling gait and drooling Signup and view all the answers

What does a stiff neck and jaw thrust in a client after receiving haloperidol indicate?

Acute dystonic reaction Signup and view all the answers

Which of the following is NOT a goal of intervention when a client is hearing voices?

To shift intervention responsibility to others Signup and view all the answers

After initiation of antipsychotic medication, how soon may symptoms of pseudoparkinsonism appear?

Within the first month Signup and view all the answers

Which condition is characterized by autonomic instability, and appears after starting antipsychotic medications?

Neuroleptic malignant syndrome Signup and view all the answers

What is a common misconception regarding the assessment of clients who hear voices?

Asking if they hear the voices is crucial Signup and view all the answers

Which of these is a common effect of first-generation antipsychotic medications?

Movement disorders resembling Parkinson's disease Signup and view all the answers

What is the priority nursing consideration for a client exhibiting catatonia?

Meeting physiological needs Signup and view all the answers

What is an appropriate expected outcome for a client with schizophrenia who demonstrates catatonia?

Performs self-care activities with coaching by the end of day 3 Signup and view all the answers

Which of the following is a potential risk when caring for a catatonic client?

Risk of falls and safety concerns Signup and view all the answers

Which nursing intervention is essential for a catatonic client to maintain physiological integrity?

Hand feeding or tube feeding Signup and view all the answers

How should a nurse approach the communication with a client exhibiting catatonia?

Focus on non-verbal communication and reassurance Signup and view all the answers

Which outcome is NOT appropriately related to the self-care deficit observed in a catatonic client?

Demonstrating complete independence in daily tasks Signup and view all the answers

What action should a nurse prioritize when providing care to a client with catatonia?

Assist in maintaining hygiene and nutrition Signup and view all the answers

Which of the following best describes the need for physiological interventions in catatonic clients?

High priority due to the risk of malnutrition Signup and view all the answers

What should the nurse prioritize when a client reports the voice is directing them to do things?

Understanding what the voice is telling the client to do. Signup and view all the answers

Which behavior should a nurse avoid when interacting with a client experiencing depersonalization?

Sitting close to the client. Signup and view all the answers

What signs and symptoms indicate possible neuroleptic malignant syndrome in a client taking risperidone?

Severe muscle stiffness, difficulty swallowing, and diaphoresis. Signup and view all the answers

What is the best action for a nurse when a client shows signs of acute anxiety about merging with the environment?

Maintaining a normal social interaction distance. Signup and view all the answers

How should a nurse respond if a client with schizophrenia states they feel merging into the wall?

Inquire about their visual and sensory experiences. Signup and view all the answers

Which statement regarding command hallucinations is most accurate?

They may pose a risk of harm to the client or others. Signup and view all the answers

If a client on risperidone shows elevated vital signs and severe muscle stiffness, what should be suspected?

Neuroleptic malignant syndrome. Signup and view all the answers

What is the most appropriate first step when a client reports feeling a disconnect with their identity?

Establish a supportive and safe environment without close physical contact. Signup and view all the answers

What are the symptoms that suggest neuroleptic malignant syndrome in a patient taking antipsychotic medication?

Severe muscle stiffness and difficulty swallowing Signup and view all the answers

Which option best represents concrete thinking in response to the proverb about judging a book?

The table of contents tells what a book is about. Signup and view all the answers

For a group of adults with schizophrenia, which goal should the nurse prioritize in psychoeducational sessions?

Demonstrate improved social skills. Signup and view all the answers

Which of the following best describes the typical cognitive process in clients with schizophrenia?

Impaired ability to grasp abstract concepts Signup and view all the answers

What is a characteristic of neuroleptic malignant syndrome that necessitates urgent medical attention?

Severe muscle stiffness and hyperpyrexia Signup and view all the answers

What is a common misconception regarding the mental state of clients with schizophrenia when discussing recovery?

They do not require social skills for recovery. Signup and view all the answers

Which behavior would indicate a departure from abstract thinking in a patient with schizophrenia?

Questioning the relevance of discussing literary concepts. Signup and view all the answers

Which symptom is not typically associated with neuroleptic malignant syndrome?

Euphoria and elevated mood Signup and view all the answers

Which two topics take priority for persons newly diagnosed with schizophrenia? (Select all that apply)

The importance of taking your medication correctly Signup and view all the answers

Which nursing diagnoses relate to a client diagnosed with schizophrenia who feels threatened? (Select all that apply)

Risk for other-directed violence Signup and view all the answers

What is echolalia?

A Signup and view all the answers

What is 'word salad'?

A jumble of words that is meaningless to the listener and possibly to the speaker. Signup and view all the answers

What medication should be administered immediately for the treatment of dystonias?

Diphenhydramine Signup and view all the answers

Which problem would a nurse suspect in a client with grimacing and lip-smacking after receiving fluphenazine decanoate?

Tardive dyskinesia Signup and view all the answers

What is the nurse's most therapeutic response to a client with schizophrenia who starts laughing uncontrollably?

You're laughing. Tell me what's happening. Signup and view all the answers

What would the nurse identify as a negative symptom of schizophrenia?

Poor personal hygiene Signup and view all the answers

Which assessment findings mark the prodromal stage of schizophrenia?

Withdrawal, misinterpreting, poor concentration, and preoccupation with religion Signup and view all the answers

What type of problem is indicated by a client's statement about bacteria locking them up with other infected people?

Paranoia Signup and view all the answers

Which intervention has the highest priority for a client beginning a new prescription for ziprasidone?

Weight management strategies Signup and view all the answers

What type of verbalization is evident with the statement: 'It's beat. Time to eat. No room for the cat.'?

Associative looseness Signup and view all the answers

Which medication change would be expected for a client whose conventionally prescribed antipsychotic is less effective?

Olanzapine Signup and view all the answers

Which type of therapy should the nurse recommend for a family unfamiliar with schizophrenia?

Psychoeducational Signup and view all the answers

What does the nurse assess when a client says, 'My computer is sending out infected radiation beams.'?

Relapse. Signup and view all the answers

How should the nurse document the client's phrase 'Red chair out town board'?

Word salad Signup and view all the answers

Tardive dyskinesia is a reversible condition associated with long-term antipsychotic medication use.

False Signup and view all the answers

A client with schizophrenia may experience both positive and negative symptoms.

True Signup and view all the answers

What is the primary purpose of psychoeducational therapy for families of clients with schizophrenia?

To provide knowledge and strategies for managing the disorder. Signup and view all the answers

What is a common first-generation antipsychotic medication?

Haloperidol Signup and view all the answers

What is the nurse's most therapeutic response to a client who shouts about others plotting to destroy them?

Feeling that people want to destroy you must be very frightening. Signup and view all the answers

How would the nurse correctly assess a newly admitted client diagnosed with schizophrenia who is hypervigilant and thinks doctors are plotting to kill them?

Paranoia Signup and view all the answers

How does the client diagnosed with schizophrenia perceive the environment when they say their co-workers are out to get them?

Dangerous Signup and view all the answers

What common side effects should the nurse validate with a client who stopped taking haloperidol because it made them feel like a robot?

Sedation and muscle stiffness Signup and view all the answers

Which hallucination expressed by a client necessitates the nurse to implement safety measures?

The voices say everyone is trying to kill me. Signup and view all the answers

What assessment findings suggest a client may be hallucinating?

Darting eyes, tilted head, mumbling to self Signup and view all the answers

Which antipsychotic medication should the nurse advocate for a client with schizophrenia who has auditory hallucinations and is overweight?

Aripiprazole Signup and view all the answers

What is the nurse's most therapeutic response to a client whose thoughts are disorganized?

I am having difficulty understanding what you are saying. Signup and view all the answers

For a client diagnosed with schizophrenia and exhibiting catatonia, which client needs are of priority importance?

Physiological Signup and view all the answers

What is an appropriate outcome for a client diagnosed with schizophrenia and severe self-care activity compromise?

Performs self-care activities with coaching by the end of day 3. Signup and view all the answers

What is the name of the phenomenon when a catatonic client holds a distorted posture for an extended period?

Catatonia Signup and view all the answers

Which potential side effect of first-generation antipsychotics may cause concerns regarding body image in clients?

Gynecomastia Signup and view all the answers

Which teaching strategy is likely to be most effective in a problem-solving group for clients diagnosed with schizophrenia?

Invite participants to come up with solutions to getting incorrect change for a purchase. Signup and view all the answers

Which comment by a client indicates effective teaching about the antipsychotic medication regime?

Taking this medication regularly will reduce the severity of my symptoms. Signup and view all the answers

What is the nurse’s most helpful reply to a client disturbed by voices telling them they are bad?

I'll stay with you. Focus on what we are talking about, not the voices. Signup and view all the answers

What term applies to symptoms like shuffling gait, mask-like face, and drooling in a client taking fluphenazine?

Pseudoparkinsonism Signup and view all the answers

What problem is most likely for a client showing immobile posture and drooling after haloperidol treatment?

An acute dystonic reaction Signup and view all the answers

What intervention is indicated for a client with severe acute dystonia after receiving haloperidol?

Administer diphenhydramine 50 mg IM from the prn medication administration record. Signup and view all the answers

Study Notes

Schizophrenia

Euphoric mood, hyperactivity, and distractibility are symptoms of mania, not schizophrenia.
Aripiprazole is a third-generation atypical antipsychotic medication effective against both positive and negative symptoms of schizophrenia.
Aripiprazole is a preferred choice for clients with obesity or heart disease as it causes little to no weight gain, and does not increase glucose, high- or low-density lipoprotein cholesterol, or triglycerides.
Clozapine can cause agranulocytosis making it a poor choice as a first-line medication.
Ziprasidone is not recommended for clients with cardiac disease, as it may prolong the QT interval
Olanzapine is associated with weight gain.
Loosely associated, confused, and disorganized speech is a hallmark characteristic of schizophrenia; the nurse should state that they are having difficulty in understanding what the patient is saying.
Physiological Needs are the highest priority in caring for clients with catatonia.
Self-care deficits in catatonic clients need to be addressed; a suitable client outcome would be performing self-care activities with coaching by the end of day 3.
Command hallucinations are concerning as they can lead to harm; the nurse should prioritize asking the client what the voice is telling them to do.
Neuroleptic malignant syndrome (NMS) is a medical emergency that can be triggered by antipsychotic medication, such as risperidone. Look for symptoms like severe muscle stiffness, difficulty swallowing, hyperpyrexia, autonomic symptoms (pulse elevation), and diaphoresis.
Concrete thinking is a hallmark of schizophrenia, characterized by an impaired ability to think abstractly.
Clients with schizophrenia benefit from improved social skills to engage in relationships and manage their condition.
Clients with schizophrenia often have delusional thinking.
Facebook has a new tracking capacity, this is not a relevant statement to study notes on schizophrenia.

Schizophrenia Spectrum Disorders

A client with schizophrenia may experience paranoia, which is an irrational fear. The client might believe that others are plotting to harm them.
Clients diagnosed with schizophrenia may perceive their environment as hostile and dangerous.
The most common side effects of first-generation antipsychotics are sedation and extrapyramidal side effects, which could include stiffness, gait disturbance, and feelings of being robotic.
Hallucinations that express paranoia can necessitate safety measures.
Examples of signs that a client may be hallucinating: Darting eyes, tilted head, and mumbling to oneself.
Aripiprazole is a third-generation atypical antipsychotic that tends to cause less weight gain than first-generation antipsychotics.
Tips for communicating with a client with schizophrenia:
- If a client is using disorganized or confused speech, let them know you are having a hard time understanding them.
- Use concrete examples to explain things.
Clients with catatonia are at risk of dehydration and other physiological problems because they are unable to care for themselves.
A client with catatonia may exhibit waxy flexibility, which involves holding distorted postures for extended periods of time.
First-generation antipsychotics can cause gynecomastia, which can negatively impact the client's body image.
Clients diagnosed with schizophrenia may benefit from a psychoeducational group that helps them to develop problem-solving skills.
Important information to teach clients about their antipsychotic medications:
- Taking their medication regularly will reduce the severity of their symptoms.
- If a client continues to experience auditory hallucinations, you can reduce the client's anxiety by staying with them and encouraging the client to focus on the conversation.
Symptoms of pseudoparkinsonism:
- Shuffling, propulsive gait
- Mask-like face
- Drooling
Symptoms of Akathisia:
- Internal and external restlessness
- Pacing
- Fidgeting
Signs of an acute dystonic reaction:
- Painful contractions of the tongue, face, neck, and back.
- Opisthotonos (arching of the back)
- Oculogyric crisis (eyes roll back in the head)
Treatment for acute dystonic reaction:
- Diphenhydramine (Benadryl)
- Trihexyphenidyl (Artane)
- Benztropine (Cogentin)
Symptoms of tardive dyskinesia:
- Involuntary spasmodic muscular contractions, especially of the face, tongue, and extremities
- May be caused by long-term use of first-generation antipsychotics
- May not be reversible, even after the medication is discontinued

Nursing Process

Assessment:
- Monitor the client's perception of the environment
- Observe for symptoms of paranoia, hallucinations, catatonia, or tardive dyskinesia
Planning:
- Develop a care plan that addresses the client's physiological and psychosocial needs
- Set realistic outcomes for the client based on their abilities.
Implementation:
- Maintain a therapeutic relationship with the client
- Administer medications and monitor for side effects.
- Provide psychoeducation and support groups.
Evaluation:
- Assess the client's progress in achieving their goals
- Adjust the care plan as needed.

Anticholinergic Effects

Common anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes.

Assessing Schizophrenia

Negative symptoms: Apathy, anhedonia, poor social functioning, and poverty of thought (e.g., poor personal hygiene).
Positive symptoms: Auditory hallucinations, delusions of grandeur, psychomotor agitation.
Prodromal Stage: Characterized by withdrawal, misinterpreting information, poor concentration and religious preoccupations.
Acute Stage: Marked by positive symptoms like auditory hallucinations, ideas of reference, thought insertion, and broadcasting.
Paranoia is evident in delusional and unrealistic fears of harm.
Neologisms: Invented words unique to the individual.
Concrete thinking: Literal interpretation of language, unable to grasp abstract concepts.
Poverty of content is a limited or inadequate amount of information.
Looseness of association: Jumbled and incoherent thoughts expressed to the listener.
Command hallucinations: Auditory hallucinations that instruct the individual to perform actions.

Second-generation Antipsychotics

Second-generation antipsychotics (e.g., ziprasidone) are associated with a higher risk of weight gain, diabetes, and high cholesterol.

Schizophrenia Treatment & Management

Psychoeducational therapy helps families understand the condition, manage medication, and provide support.
Relapse: Signs include tension, poor sleep, difficulty concentrating, increased withdrawal, and bizarre thoughts.
Medication nonadherence can be a cause for relapse.
Word salad: Meaningless jumbled words that may be incomprehensible to both the speaker and the listener.
**Command hallucinations can be terrifying and pose a psychiatric emergency. ** It is important to assess what the hallucinations are instructing the individual to do to ensure safety.

Nursing Interventions

When working with clients experiencing auditory hallucinations, it is important to maintain a safe distance.
Neuroleptic malignant syndrome (NMS) is a potentially fatal reaction to antipsychotic medications. It is characterized by severe muscle stiffness, difficulty swallowing, hyperpyrexia, and autonomic instability. This condition requires immediate medical intervention.
Concrete thinking: Assessed by understanding the client's interpretation of proverbs.

Teaching and Education

Psychoeducational groups are a valuable resource for clients with schizophrenia, helping improve social skills and coping strategies.

Key Considerations

Paranoid delusions can lead to fear and anxiety. It is important to reassure the client of their safety.
Positive symptoms include hallucinations and delusions.
Negative symptoms can include apathy, social withdrawal, and a lack of motivation.
Medication adherence is crucial for managing schizophrenia.
Family support is essential for the recovery process.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores key aspects of schizophrenia, including symptoms, treatment options, and medication side effects. It also highlights the importance of addressing physiological needs in patients. Test your knowledge on this serious mental health disorder and its management.