Schizophrenia Management PDF

11/27/23, 3:47 AM Realizeit for Student Summary Schizophrenia is a chronic illness requiring long-term management strategies and coping skills. It is a disease of the brain; a clinical syndrome characterized a person’s thoughts, perceptions, emotions, movements, and behaviors. The nurse may care f...

11/27/23, 3:47 AM Realizeit for Student Summary Schizophrenia is a chronic illness requiring long-term management strategies and coping skills. It is a disease of the brain; a clinical syndrome characterized a person’s thoughts, perceptions, emotions, movements, and behaviors. The nurse may care for a client in an acute inpatient setting. The client may appear frightened, hear voices (hallucinate), make no eye contact, and mumble constantly. The nurse would deal with the positive, or psychotic, signs of the disease. Another nurse may encounter a client with schizophrenia in a community setting who is not experiencing psychotic symptoms; rather, this client lacks energy for daily tasks and has feelings of loneliness and isolation (negative signs of schizophrenia). Although both clients have the same medical diagnosis, the approach and interventions that each nurse takes would be different. One primary intervention for managing auditory hallucinations includes dismissal intervention (e.g., telling the voices to go away). Teaching a client to talk back to the voices forcefully may help him or her manage auditory hallucinations; this should be done in private rather than publicly. The nurse may also be genuinely frightened or threatened if the client’s behavior is hostile or aggressive. The nurse must acknowledge these feelings and take measures to ensure his or her safety. This may involve talking to the client in an open area rather than in a more isolated location or having an additional staff person present rather than being alone with the client. If the nurse pretends to be unafraid, the client may sense the fear anyway and feel less secure, leading to a greater potential for the client to lose personal control. As with many chronic illnesses, the nurse may become frustrated if the client does not follow the medication regimen, fails to keep needed appointments, or experiences repeated relapses. The nurse may feel as though a great deal of hard work has been wasted or that the situation is futile or hopeless. Schizophrenia is a chronic illness, and clients may suffer numerous relapses and hospital admissions. The nurse must not take responsibility for the success or failure of treatment efforts or view the client’s status as a personal success or failure. Nurses should look to their colleagues for helpful support and discussion of these self-awareness issues. The effects of schizophrenia on the client may be profound, including all aspects of the client’s life: social interactions, emotional health, and ability to work and function in the community. Schizophrenia is conceptualized in terms of positive signs such as delusions, hallucinations, and disordered thought processes as well as negative signs such as social isolation, apathy, anhedonia, and lack of motivation and volition. The clinical picture, prognosis, and outcomes for clients with schizophrenia vary widely. Therefore, it is important that each client is carefully and individually assessed with appropriate needs and interventions determined. Careful assessment of each client as an individual is essential to planning an effective plan of care. Families of clients with schizophrenia may experience fear, embarrassment, and guilt in response to their family member’s illness. Families must be educated about the disorder, the course of the disorder, and how it can be controlled. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVD5YOX6GjyN8BXsE5kBD64UN3Harx67qLkpTVXS1upt… 1/3 11/27/23, 3:47 AM Realizeit for Student Failure to comply with treatment and the medication regimen and the use of alcohol and other drugs are associated with poorer outcomes in the treatment of schizophrenia. For clients with psychotic symptoms, key nursing interventions include helping to protect the client’s safety and right to privacy and dignity, dealing with socially inappropriate behaviors in a nonjudgmental and matter-of-fact manner, helping present and maintain reality for the client by frequent contact and communication, and ensuring appropriate medication administration. For the client whose condition is stabilized with medication, key nursing interventions include continuing to offer a supportive, nonconfrontational approach, maintaining the therapeutic relationship by establishing trust and trying to clarify the client’s feelings and statements when speech and thoughts are disorganized or confused, helping to develop social skills by modeling and practicing, and helping to educate the client and family about schizophrenia and the importance of maintaining a therapeutic regimen and other self-care habits. Self-awareness issues for the nurse working with clients with schizophrenia include dealing with psychotic symptoms, fear for personal safety, and frustration as a result of relapses and repeated hospital admissions. Schizophrenia is the principal indication for antipsychotic drugs, although many are also used for bipolar disorder. The antipsychotic drugs fall into two major groups: first-generation antipsychotics, also known as conventional antipsychotics, and second-generation atypical antipsychotics, also known as antipsychotics. Drugs in both generations increase the risk of mortality in older adult patients with dementia-related psychosis. Therapeutic responses to antipsychotic drugs develop slowly, often taking several months to exert maximal effects. First-generation antipsychotics are thought to relieve symptoms of schizophrenia by causing strong blockade of D2 receptors. Secondgeneration antipsychotics are thought to relieve symptoms of schizophrenia by causing moderate blockade of D2 receptors and strong blockade of 5-HT2 receptors. The major concern with FGAs is production of EPS, which can occur early in treatment (acute dystonia, parkinsonism, and akathisia) or late in treatment (tardive dyskinesia). EPS are movement disorders resulting from effects of antipsychotic drugs on the extrapyramidal motor system. The extrapyramidal system is the same neuronal network whose malfunction is responsible for the movement disorders of Parkinson disease (PD). Although the exact cause of EPS is unclear, blockade of D2 receptors is strongly suspected. Four types of EPS occur. They differ with respect to time of onset and management. Three of these reactions—acute dystonia, parkinsonism, and akathisia—occur early in therapy and can be managed with a variety of drugs. The fourth reaction—tardive dyskinesia—occurs late in therapy and has no satisfactory treatment. Acute dystonia and parkinsonism respond to anticholinergic drugs (e.g., benztropine). Akathisia is harder to treat but may respond to anticholinergic drugs, benzodiazepines, or beta blockers. Patient and family involvement and education on treatment regimen and side effects are essential for adherence to medications. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVD5YOX6GjyN8BXsE5kBD64UN3Harx67qLkpTVXS1upt… 2/3 11/27/23, 3:47 AM Realizeit for Student Review Antipsychotic drugs are indicated to treat psychosis, including disorders such as schizophrenia and the manic phase of bipolar disorder. First-generation antipsychotics, or “typical antipsychotics,” include the phenothiazines and older nonphenothiazines such as haloperidol and thiothixene. The mechanism of action of first-generation antipsychotic drugs is blockade of D2 receptors. All first-generation antipsychotics are considered equal in terms of their ability to relieve symptoms of psychosis; however, they differ in potency and side effects. The FDA has issued a BLACK BOX WARNING ♦ for haloperidol regarding extrapyramidal and withdrawal symptoms in newborns exposed to the drug during the third trimester of the pregnancy. The FDA has issued a BLACK BOX WARNING ♦ stating that older patients who suffer from dementia and dementia-related psychosis treated with haloperidol have an increased risk of death. Second-generation antipsychotics, or “atypical antipsychotics,” include newer nonphenothiazine drugs. They are also considered first-choice therapy for schizophrenia because they have a more favorable adverse effect profile, producing fewer extrapyramidal movement disorders. The mechanism of action of second-generation antipsychotics is blockade of dopamine and serotonin receptors. The FDA has issued a BLACK BOX WARNING ♦ related to the administration of clozapine (SECOND-GENERATION “ATYPICAL” ANTIPSYCHOTICS) to elderly patients with dementia. These patients are at risk for death. The FDA has issued a BLACK BOX WARNING ♦ regarding the risk of fatal agranulocytosis with clozapine. The FDA has issued a BLACK BOX WARNING ♦ for clozapine regarding the risk of hyperglycemia. The FDA has issued a BLACK BOX WARNING ♦ stating that use of clozapine increases the risk of seizure activity as the dose increases. Positive symptoms of schizophrenia respond to drug therapy more readily than negative symptoms. The second-generation “atypical” nonphenothiazine drugs may be slightly more effective in treating negative symptoms of schizophrenia. Therapeutic effects to antipsychotics may take several weeks to achieve maximum therapeutic effect. Adverse effects occurring more frequently in low-potency drugs as compared with high-potency drugs include anticholinergic effects, antiadrenergic effects (orthostatic hypotension), and CNS depression (sedation). Adverse effects more common to high-potency drugs as compared with low-potency drugs include early extrapyramidal effects (acute dystonia, akathisia, parkinsonism). Early extrapyramidal effects are treated by reducing dosage, changing to a second-generation antipsychotic, or use of anticholinergic medications. Akathisia may also be treated with benzodiazepines and beta-adrenergic blockers to reduce the urge to move. Tardive dyskinesia, a late extrapyramidal effect, may occur with all phenothiazine and typical nonphenothiazine drugs and is generally considered to be irreversible. Prevention through early detection is key. Neuroleptic malignant syndrome is a potentially fatal adverse effect characterized by rigidity, severe hyperthermia, agitation, confusion, delirium, dyspnea, tachycardia, respiratory failure, and acute renal failure. Encourage family members to oversee medication for outpatients. Provide patients with written and verbal instructions on dosage size and timing, and encourage them to take their medicine as prescribed. Inform patients and their families that antipsychotic drugs must be taken on a regular schedule. Inform patients about side effects and teach them how to minimize undesired responses. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVD5YOX6GjyN8BXsE5kBD64UN3Harx67qLkpTVXS1upt… 3/3