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Questions and Answers
What is one key aspect of promoting client safety for individuals experiencing hallucinations or delusions?
What is one key aspect of promoting client safety for individuals experiencing hallucinations or delusions?
Which approach is emphasized for enhancing coping abilities in clients with mental illness?
Which approach is emphasized for enhancing coping abilities in clients with mental illness?
What is an important aspect of client education in a psychiatric rehabilitation strategy?
What is an important aspect of client education in a psychiatric rehabilitation strategy?
How can family support be maximized for individuals with schizophrenia?
How can family support be maximized for individuals with schizophrenia?
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What is a potential benefit of convening support groups for individuals with mental illness?
What is a potential benefit of convening support groups for individuals with mental illness?
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What is a key nursing intervention to promote self-care activities in clients?
What is a key nursing intervention to promote self-care activities in clients?
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Which nursing diagnosis is most commonly associated with negative symptoms in clients?
Which nursing diagnosis is most commonly associated with negative symptoms in clients?
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Which of the following outcomes is NOT expected during the acute, psychotic phase for a client?
Which of the following outcomes is NOT expected during the acute, psychotic phase for a client?
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In managing a client's nutrition and exercise, which outcome should nurses aim to achieve?
In managing a client's nutrition and exercise, which outcome should nurses aim to achieve?
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Which statement best reflects the nursing diagnosis of 'Impaired Verbal Communication'?
Which statement best reflects the nursing diagnosis of 'Impaired Verbal Communication'?
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What characteristic is most commonly associated with 'Deficient Diversional Activity' in clients?
What characteristic is most commonly associated with 'Deficient Diversional Activity' in clients?
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Which outcome indicates successful engagement in medication adherence?
Which outcome indicates successful engagement in medication adherence?
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What is the primary purpose of implementing milieu therapy in psychiatric nursing?
What is the primary purpose of implementing milieu therapy in psychiatric nursing?
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Which of the following is NOT a characteristic of psychiatric rehabilitation strategies?
Which of the following is NOT a characteristic of psychiatric rehabilitation strategies?
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Why is medication adherence emphasized in family interventions for schizophrenia?
Why is medication adherence emphasized in family interventions for schizophrenia?
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What role do senior clients play in the milieu therapy model?
What role do senior clients play in the milieu therapy model?
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In the context of psychiatric nursing, what does 'continuity of care' aim to prevent?
In the context of psychiatric nursing, what does 'continuity of care' aim to prevent?
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Which intervention helps families manage the complexities of having a loved one with mental illness?
Which intervention helps families manage the complexities of having a loved one with mental illness?
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What is the impact of group support on individuals with schizophrenia in rehabilitation?
What is the impact of group support on individuals with schizophrenia in rehabilitation?
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How should nurses approach discharge planning for clients with schizophrenia?
How should nurses approach discharge planning for clients with schizophrenia?
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What is a key factor contributing to the success of long-term treatments for schizophrenia?
What is a key factor contributing to the success of long-term treatments for schizophrenia?
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What is a common outcome of sharing recovery stories in supportive groups?
What is a common outcome of sharing recovery stories in supportive groups?
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Study Notes
Schizophrenia Spectrum - NURS 1028 Chapter 21
- Schizophrenia is a major psychotic disorder affecting thinking, language, emotions, social behavior, and reality perception.
- Individual symptoms and experiences vary significantly between individuals and even within the same person across episodes.
- It frequently emerges during adolescence or early adulthood; symptoms can be confused with teenage anxiety or mood swings.
- Treatable when detected early, but a chronic and potentially disabling mental illness.
Risk Factors
- Rare genetic changes may contribute to the onset.
- Perinatal stressors, such as starvation, poor nutrition, infections, and obstetrical complications, can impact neurodevelopment and increase risk factors.
- Genetic and family predisposition is a considerable risk factor.
- Infants exposed to maternal stressors during pregnancy may experience low birth weight & developmental challenges.
- Poor neuroanatomy and brain changes linked with adverse circumstances can increase the risk.
- Childhood CNS infections are potential risk factors.
- Individuals born in urban settings have a higher risk than rural counterparts.
Risk Factors: Age of Onset, Gender, Ethnic and Cultural Differences, Familial Differences
- Late adolescence to early adulthood (before age 25).
- Evidence of disruption in developmental milestones (e.g., education, employment, relationships)
- Men are often diagnosed earlier (mid-20s) than women (late 20s).
- Lower incidence in Asian populations compared to non-Asian countries.
- First-degree relatives of someone with schizophrenia have a 10x greater risk compared to the general population; this risk is higher for identical twins compared to fraternal ones.
Risk Factors: Comorbidities, Substance Abuse
- Co-occurring somatic and psychological disorders frequently accompany schizophrenia (e.g., depression, diabetes, substance use disorders).
- Depression commonly experienced within various stages (acute, stabilization, recovery, relapse).
- Type 2 diabetes is a documented comorbidity; linked to weight gain from antipsychotic medications commonly used in treatment.
- Cannabis use has been associated with an increased risk of psychosis onset; research on the exact nature of the impact of cannabis on mental health is ongoing.
DSM-5 Diagnostic Criteria: Schizophrenia
- Requires two or more presenting symptoms observed for a significant amount of time over a one-month period (or less if successfully treated). At least one symptom must be: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression or avolition).
- There must be a significant decrease in functioning in one or more areas (e.g., work, relationships, self-care) compared to prior performance, or what's expected of someone of that age during adolescence or childhood).
- The symptoms must persist continuously for at least six months, including at least one month of active-phase symptoms.
Positive Symptoms
- Reflect an excess or distortion of normal functions.
- Delusions: fixed false beliefs related to misinterpreting daily experiences. Examples: hearing voices, believing others are plotting against you or thoughts are being read).
- Hallucinations: sensory experiences (see, hear, smell, etc) without external stimulation. Example: hearing voices, seeing things that aren't present.
Negative Symptoms
- Reflect a reduction/loss in normal functions.
- Affective Flattening: reduced expression of feelings/emotions.
- Avolition: decreased motivation (lack of interest/drive)
- Asocial: social withdrawal & reduced ability to maintain & form relationships.
- Apathy: reduced enthusiasm, lack of emotional response or interest.
- Alogia: reduced fluency/productivity in speaking.
- Anergia: lethargy, lack of energy.
- Anhedonia: inability to experience pleasure from activities.
Neurocognitive Impairment
- Short-term (working memory) and long-term memory issues.
- Challenges with sustained attention, verbal fluency.
- Executive functioning problems.
- Impairments can hinder educational and vocational opportunities, among other spheres of life.
- Illusion of objects is categorized separately from hallucinations (when an object exists but perceived differently and/or misidentified).
Family Response
- Initial response is often one of mixed emotions, typically including elements of shock, disbelief, fear, concern, care, hope
- Families may seek reasons for psychotic episodes, attributing problems such as substance use or extraordinary stress to the episode.
- Parents may blame themselves.
- Families may struggle with finding appropriate ways to support those affected and understanding what to expect.
Treatment
- Interdisciplinary approach is essential.
- Involving multiple professionals such as nurses, psychiatrists, psychologists, social workers, occupational therapists, and peer support workers ensures holistic approach and care.
Planning Client Outcomes
- Focuses on the acute phase and includes safety, establishing a connection with reality, interaction with others, expressing feelings in a safe manner, and involvement in therapeutic interventions.
- Long-term outcomes target participation in prescribed treatment plans (including medications), maintaining adequate routines for sleep and nutrition, achieving self-care independence, and effectively communicating with others in the community to support their needs.
Nursing Intervention (Biological Domain)
- Managing fluid balance by conducting daily weights and monitoring urine specific gravity/serum sodium levels.
- Evaluating the efficacy of antipsychotic medications over time; assessing for and taking care of any side effects related to those medications.
- Encouraging self-care activities such as scheduled grooming, dressing, bathing & other daily routine habits.
- Educating clients on the importance of medication adherence to prevent relapse.
- Monitoring & managing weight gain/loss that can occur due to antipsychotic treatments.
- Suggesting activities that help maintain a healthy lifestyle (e.g., diet, exercise) to help manage risk factors.
Nursing Intervention (Psychological Domain)
- Maintaining a consistent, calm, and caring demeanor when interacting with clients and ensuring safety and stability
- Validating the client's experiences, validating their distress and discomfort.
- Employing creative therapeutic strategies that accommodate client preferences
- Engaging clients and families in educational interventions that emphasize managing the illness
- Employing strategies to help increase trust and decrease anxiety; helping them take ownership of their care, needs and concerns.
Nursing Intervention (Social Domain)
- Creating a safe, predictable, secure environment to promote safety & prevent client harm; providing access to support systems, such as family members, support groups
- Implementing interventions to prevent relapse with tools like high risk monitoring, routines, and behavioural interventions.
- Promoting continuity of care (contact with support systems) with care coordination planning to prevent “loss” of support or access to services following discharge.
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Description
This quiz covers essential aspects of schizophrenia, a complex psychotic disorder characterized by diverse symptoms that can emerge during adolescence. Understand the risk factors, which include genetic predisposition and perinatal stressors, and the importance of early detection for effective treatment. Explore how individual experiences can vary and the impact of environmental factors on neurodevelopment.
