NUR 361 Psych Test 2 Review PDF

Summary

This document reviews schizophrenia, covering predisposing factors, phases, symptoms, and other related psychiatric disorders. It includes information on various types of disorders, as well as symptoms and interventions.

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NUR 361 Psych Test 2 Review Schizophrenia (17 questions) Predisposing Factors ○ Biological Genetics ○ Biochemical Chemical imbalances ○ Physiological Viral infections Anatomical abnormalities Electrical activity in the brain Physical conditions ○ Psychological Poor parent-child relationships Childho...

NUR 361 Psych Test 2 Review Schizophrenia (17 questions) Predisposing Factors ○ Biological Genetics ○ Biochemical Chemical imbalances ○ Physiological Viral infections Anatomical abnormalities Electrical activity in the brain Physical conditions ○ Psychological Poor parent-child relationships Childhood trauma ○ Environmental Sociocultural factors Stressful life events Cannabis and genetic vulnerability Phases ○ Phase I: The Premorbid Phase- Premorbid signs are those that occur before there is clear evidence of illness and may include distinctive personality traits or behaviors ○ Phase II: The Prodromal Phase- The prodromal phase of schizophrenia begins with a change from premorbid functioning and extends until the onset of frank psychotic symptoms ○ Phase III: Active Psychotic Phase (Acute Schizophrenic Episode)Schizophrenia is a chronic illness that is characterized by acute episodes in which symptoms are more pronounced. During acute episodes, psychotic symptoms are typically prominent. ○ Phase IV: Residual Phase- A residual phase usually follows an active phase of the illness (symptoms described in Phase III). During the residual phase, symptoms of the acute stage are either absent or no longer prominent. Schizophrenia Spectrum and Psychotic Disorders ○ Schizophrenia- Symptoms of delusions, hallucinations, disorganized speech for at least 6 months ○ Delusional Disorder- Characterized by the presence of delusions that have been experienced by the individual for at least 1 month. ○ Brief Psychotic Disorder- Identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month. ○ Substance and Medication Induced Psychotic Disorder- Found to be directly attributable to substance intoxication or withdrawal or after exposure to a medication or toxin. ○ Psychotic Disorder Due To Another Medical Condition- Prominent hallucinations and delusions that can be directly attributed to another medical condition. ○ Catatonic Disorder- Significant motor disturbance that may range from stupor (no motor activity) to excessive motor activity and agitation. Seen in schizophrenia spectrum disorders, MDD, Bipolar Disorder. ○ Schizophreniform Disorder- The essential symptoms are identical to those of schizophrenia, but the duration, including prodromal, active, and residual phases, is at least 1 month but less than 6 months. ○ Schizoaffective Disorder- Manifested by signs and symptoms of schizophrenia, along with a strong element of symptomatology associated with the mood disorders (MDD or Bipolar Disorder). Symptoms ○ Positive symptoms Delusions (Fixed, False Beliefs) Persecutory- belief that one is going to be harmed by other(s) Referential- belief that cues in the environment are specifically referring to them Grandiose- belief that they have exceptional greatness Somatic- beliefs that center on one’s body functioning Bizarre- a delusion that is totally implausible in reality Of reference- Events in the environment are assumed by individuals with delusions of reference to be referring to themselves Of control or influence- Individuals believe that certain objects or persons have control over their behavior Nihilistic- The individual has a false idea that the self, a part of the self, others, or the world is nonexistent Erotomanic- Individuals with erotomanic delusions falsely believe that someone, usually of a higher status, is in love with them Jealous- The content of jealous delusions centers on the idea that the person’s sexual partner is unfaithful Hallucinations (Sensory Perceptions Without External Stimuli) Auditory- false perceptions of sound Visual- false visual perceptions that may consist of formed images, such as of people, or of unformed images, such as flashes of light Tactile- false perceptions of the sense of touch, often of something on or under the skin Olfactory- false perception of taste Gustatory- false perceptions of the sense of smell Disorganized Thinking (Manifested in Speech) Loose associations- characterized by speech in which ideas shift from one unrelated subject to another Neologisms- newly invented words that are meaningless to others but have symbolic meaning to the individual Clang associations- words governed by sounds, often taking the form of rhyming Word salad- a group of words that are put together randomly, without any logical connection Circumstantiality- occurs when the individual delays in reaching the point of a communication because of unnecessary and tedious details Tangentiality- a veering away from the topic of discussion and difficulty maintaining focus and attention Perseveration- occurs when the individual persistently repeats the same word or idea in response to different questions Echolalia- refers to repeating words or phrases spoken by another Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia) Catatonia- ranging from rigid or bizarre posture and decreased responsivity to complete lack of verbal or behavioral response to the environment. Waxy flexibility- describes a condition in which the client with schizophrenia allows body parts to be placed in bizarre or uncomfortable positions. This symptom is associated with catatonia. Posturing- is manifested by the voluntary assumption of inappropriate or bizarre postures. Pacing back and forth and body rocking- a slow, rhythmic, backward-and-forward swaying of the trunk from the hips, usually while sitting. Regression- is the retreat to an earlier level of development. Eye movement abnormalities- may manifest in several ways including difficulty maintaining focus on a stationary object and difficulty with smooth pursuit of a moving object. ○ Negative symptoms Disturbances in affect Inappropriate affect- the individual’s emotional tone is incongruent with the circumstances Blunted affect- the emotional tone is very weak Flat affect- appears to be devoid of emotional tone (or overt expression of feelings) Apathy- an indifference to or uninterest in the environment Avolition- the inability to initiate goal-directed activity Lack of interest or skills in interpersonal interaction Anosognosia- lack awareness of there being any illness or disorder even when symptoms appear obvious to others Anergia- deficiency of energy Anhedonia- inability to experience pleasure Lack of abstract thinking ability- concrete thinking, or literal interpretations of the environment, represents a regression to an earlier level of cognitive development ○ Cognitive symptoms Memory issues Inability to process social cues Impaired sensory perception Nursing Interventions ○ Assessment- assess for hallucinations, delusions ○ Therapeutic communication- acceptance, do not reinforce hallucinations ○ Safety promotion- monitor nutritional intake for catatonic patients ○ Patient and family education- medication adherence Medication Management ○ Typical antipsychotics (1st generation) Drugs: Fluphenazine Haloperidol (Haldol) Treats positive symptoms Increased risk of EPS symptoms- acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome Benztropine is given for EPS symptoms Usually not the first line of treatment ○ Atypical antipsychotics (2nd generation) Drugs: Clozapine (Clozaril) Risperidone (Risperdal)- 1st drug tried Treats positive and negative symptoms Increased risk of metabolic symptoms Usually the first line of treatment (EXCEPT clozapine) Clozapine is used for treatment resistance Needs weekly blood tests Monitor for agranulocytosis and flu-like symptoms ○ Long-Acting Injections (LAI) Used to increase medication compliance Given every 2 weeks to every 3 months depending on medication Medications ending with consta, deconoate, sustenna, maintena, etc. indicate it is a LAI Childhood Disorders (8 questions) Assessment data ○ Appearance/behavior ○ Background ○ Social Skills Attention Deficit Hyperactivity Disorder (ADHD) ○ Assessment (signs and symptoms) Inattention- makes careless mistakes, difficulty concentrating on tasks, doesn’t seem to listen, does not follow instructions, difficulty organizing tasks, avoids tasks that require mental effort, easily distracted, forgetful Hyperactivity and Impulsivity- fidgets or squirms, cannot sit still/leaves seat, feeling restless, unable to engage in quiet activities, talks excessively, interrupts others, difficulty waiting ○ Nursing Interventions Provide physical outlets- physical activity, sports Safety promotion- safe environment, adequate supervision Patient and family education- medication adherence, monitor weight if taking medications ○ Medication management CNS stimulants Amphetamines- Dextroamphetamine sulfate (Dexedrine; Dextrostat), Methamphetamine (Desoxyn), Lisdexamfetamine Amphetamine MixturesDextroamphetamine/amphetamine (Adderall; Adderall XR) Methylphenidate- Ritalin; Ritalin-SR; Ritalin LA; Methylin; Methylin ER; Metadate ER; Metadate CD; Concerta; Daytrana Side effects- decreased appetite, weight loss Patient and family education- medication adherence, monitor weight Conduct Disorder (CD) ○ Assessment (signs and symptoms) Aggression to people and animals Destruction of property Deceitfulness or theft Serious violations of rules ○ Nursing Interventions Safety promotion- redirect violent behavior, limit setting Patient and family education- develop trust, safety ○ Treatment Behavior Therapy Classical conditioning- a learning process that occurs when two stimuli are repeatedly paired: a response which is at first elicited by the second stimulus is eventually elicited by the first stimulus alone Operant conditioning- a method of learning that uses rewards and punishment to modify behavior Family Therapy- therapy for children and adolescents must involve the entire family if problems are to be resolved. Group Therapy- provides children and adolescents with the opportunity to interact within an association of their peers. Family Theory (8 questions) Bowen’s Family Systems Theory ○ Assumptions The family is a complex emotional unit. The family is emotionally interconnected. Familial, community, and social relationships are reciprocal. ○ Assessment of a Family Potential strain between the father and mother Communication between mother and child Cultural issues in the family ○ Expected Parts of the Life Cycle of a Family Children leaving for college Families with adolescent children Adult children getting married Having children ○ Interventions Maintain clear boundaries Expressing healthy boundaries. Respecting the hierarchy when communicating. Talk to the family member you are angry with. ○ Eight Concepts Triangles- The triangle is the smallest stable relationship system. It explains the predictable ways in which people relate to each other in an emotional field. Triangles are formed to decrease anxiety. Differentiation of Self- Defines the degree of fusion, or differentiation, between emotional and intellectual functioning within the individual family member and between family members. Nuclear Family Emotional Process- This concept explains the complex ways parents handle emotional processes in a single generation. The four universal patterns include emotional distance, marital conflict, dysfunction in a spouse, and transmission of a problem to the child. Family Projection Process- This concept explains the automatic transmission of problems into future generations, that is, parental problems projected onto a child. Multigenerational Transmission Process- This process describes the patterns of emotional process through multiple generations. Emotional Cutoff- This concept describes the immature separation of people from each other. Emotional cutoff describes people managing their unresolved emotional issues with parents, siblings, and other family members by reducing or totally cutting off emotional contact with them. Relationships may look better if people cut off to manage them, but the problems are not resolved. Sibling Position- The position a child is born into makes his or her development more or less vulnerable to being shaped by parental anxieties. Societal Emotional Process- This concept describes the extension of family emotional process into larger social systems and to the totality of society. Family Violence (9 questions) Abuse- To use wrongfully or in a harmful way. The maltreatment of one person by another. Improper treatment or conduct that may result in injury. The Cycle of Battering ○ Phase I. The Tension-Building Phase- The woman senses that the man’s tolerance for frustration is declining. He becomes angry with little provocation but, after lashing out at her, may be quick to apologize. Minor battering incidents may occur during this phase. May last from a few weeks to many months or even years. ○ Phase II. The Acute Battering Incident (“Crisis Stage”)- This phase is the most violent and the shortest, usually lasting up to 24 hours. ○ Phase III. Honeymoon/Reconciliation Phase- In this phase, the batterer becomes extremely loving, kind, and contrite. He promises that the abuse will never recur and begs her forgiveness. Usually lasts somewhere between the lengths of time associated with phases I and II, it can be so short as to almost pass undetected. In most instances, the cycle soon begins again with renewed tensions and minor battering incidents. ○ Phase IV. Recovery Stage/Calm Phase- Justifications or explanations are made to help both partners excuse the abuse. The abuser may also deny that the abuse occurred or minimize its seriousness. Abuse- domestic, child, or elder ○ Physical Abuse- physical battering. Trauma/pattern of injury inconsistent with event history; delay in presentation. ○ Emotional Abuse- verbal abuse. Adults frequently present with complaints associated with long-term stress and chronic anxiety. Children or adolescents may present with behavioral problems. The elderly may present as withdrawn or fearful of authority. ○ Physical and Emotional Neglect- Lack of attention to person or environment. Examples include Lack of food and water, poor physical hygiene, and unsafe living conditions. ○ Sexual Abuse- rape, molestation, incest, fondling, exploitation. ○ Characteristics of the Abuser Manipulative Aggressive Lack of responsibility Possessive. Isolates her from her family and friends Gives her an allowance too small to pay bills Forces sex Threatens to harm the children ○ Signs/Symptoms of Elder, Domestic, and Child Abuse Bruises of various ages Fractures in different stages of healing Report that does not match injury ○ Nursing Interventions Display sensitivity Provide reassurance Use therapeutic touch Clarify the fact that abuse is abnormal Provide physical and emotional support Provide resources Treat physical wounds Teach caregivers to express frustration verbally rather than physically Provide a support person to stay with the patient who was just abused Provide emergency shelter resources Nurses need to use self-reflection in abuse cases as they could feel anger for the perpetrator Treatment Modalities ○ Trauma-Informed Care- recognizes and responds to the signs, symptoms, and risks of trauma to better support the health needs of patients who have experienced Adverse Childhood Experiences (ACEs) and toxic stress. ○ Crisis Intervention- a short-term management technique designed to reduce potential permanent damage to an individual affected by a crisis. ○ Safe Houses and Shelters- provide a variety of services, and the residents receive emotional support from staff and one another. ○ Family-Based Interventions- develop democratic (respectful, interactive) ways of solving problems. Group (8 questions) Group definition- a collection of individuals whose association is founded on shared interests, values, norms, or purpose. Membership in a group is generally by chance (born into the group), by choice (voluntary affiliation), or by circumstance (the result of life-cycle events over which an individual may or may not have control). Functions of a Group ○ Socialization- provides interaction with peers ○ Support- develops security from other members of the group ○ Task Completion- provide assistance in endeavors that are beyond the capacity of one individual alone or when results can be achieved more effectively as a team ○ Camaraderie- members of a group provide the joy and pleasure that individuals seek from interactions with significant others ○ Information sharing- knowledge is gained when individual members learn how others in the group have resolved situations similar to those with which they are currently struggling ○ Normative influence- group members interact and influence each other regarding the expected norms for communication and behavior ○ Empowerment- bring about improvement in existing conditions by providing support to individual members who seek to bring about change ○ Governance- may provide oversight functions and direction of activities Types of Groups ○ Task- the function of a task group is to accomplish a specific outcome or task ○ Teaching- exist to convey knowledge and information to a number of individuals ○ Supportive/Therapeutic- primarily concerned with participants sharing thoughts, feelings, events, and coping strategies to help them learn effective ways to deal with emotional stress arising from situational or developmental crises ○ Self-Help- allow clients to talk about their fears and relieve feelings of isolation while receiving comfort and advice from others undergoing similar experiences Physical Conditions that Influence Group Dynamics ○ Seating- no barriers between members ○ Size- no more than 15 people ○ Membership- open or closed ended Therapeutic Factors ○ Instillation of hope- by observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved ○ Universality- individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing ○ Imparting of information- sharing of advice and suggestions among group members ○ Altruism- mutual sharing and concern for each other ○ Corrective recapitulation of the primary family group- members are able to re-experience early family conflicts that remain unresolved ○ Development of socializing techniques- interaction with and feedback from other members of the group ○ Imitative behavior- members who have mastered particular psychosocial skills or developmental tasks can be valuable role models for others ○ Interpersonal learning- group offers many and varied opportunities for interacting with other people ○ Group cohesiveness- members develop a sense of belonging that separates the individual from the group ○ Catharsis- members are able to express both positive and negative feelings ○ Existential factors- the group is able to help individual members take direction of their own lives and to accept responsibility for the quality of their existence Phases of Group Development ○ Phase I. Initial or Orientation Phase- establish/clarify rules and goals ○ Phase II. Middle or Working Phase- work towards completion of the task,sSupport the group to express their feelings about any conflict. ○ Phase III. Final or Termination Phase- review the goals and outcomes, members will feel safe to practice new interpersonal behaviors ○ Example of Timeline of a Group Establish a need based on the unit population Plan the goal(s) of the group Promote an atmosphere of respect and safety Members are focusing on problem solving Members will reflect on their progress in the group Leadership Styles ○ Autocratic-the focus in this style of leadership is on the leader ○ Democratic- leaders focus on the members of the group ○ Laissez-Faire- allows people to do as they please Member Roles ○ Task Roles Coordinator- brings relationships together to pursue common goals Evaluator- examines group plans and performance Elaborator- explains and expands upon group plans and ideas Energizer- encourages and motivates group to perform at its maximum potential Initiator- outlines the task at hand for the group and proposes methods for solution Orienter- maintains direction within the group ○ Maintenance Roles Compromiser- relieves conflict within the group by assisting members to reach a compromise agreeable to all Encourager- offers recognition and acceptance of others’ ideas and contributions Follower- listens attentively to group interaction; is a passive participant Gatekeeper- encourages acceptance of and participation by all members of the group Harmonizer- minimizes tension within the group by intervening when disagreements produce conflict ○ Individual Roles Aggressor- expresses negativism and hostility toward other members Blocker- resists group efforts Dominator- manipulates others to gain control Help-seeker- uses the group to gain sympathy from others Monopolizer- maintains control of the group by dominating the conversation Mute or silent member- does not participate verbally; remains silent Recognition seeker- talks about personal accomplishments in an effort to gain attention for self Seducer- shares intimate details about self with group ○ Role of the Nurse Can lead a variety of groups such as self-help, teaching, and supportive. CANNOT lead psychotherapy groups. Clarify the rules and goals of the group. Enhance therapeutic factors in the group by using interpersonal learning, universality, and instillation of hope. If a member is silent/doesn’t participate you can ask a question and come back later for the answer. Encourage the members to share their feelings about the patient's monopolizing.

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