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Psychiatric Individuals (NURS 3481) Study Guide Exam 2

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The University of Texas at Arlington

Psychiatric-Mental Health Nursing of Individuals (NURS 3481)

N3481 Psychiatric Mental Health Study Guide Exam 2

N3481 Psychiatric Mental Health Study Guide Exam 2
 Compare and contrast objectives with chapter content. Safety is always the first priority.
 Compare, contrast, define and give examples of positive and negative symptoms of schizophrenia and
identify specific medications for each.
o Positive symptoms (Hyperactive mesolimbic pathway)
 Hallucinations
 Delusions
 Disorganized Speech (Associative Looseness)
 Bizarre Behavior
o Negative symptoms (Hypofunction of mesocortical pathway)
 Blunted affect
 Poverty of Thought
 Loss of motivation
 Inability to experience pleasure of joy (anhedonia)
 Compare, contrast the typical and atypical antipsychotics discussing specific common side and adverse
effects as well as most appropriate patients for these meds.
o Typical (First Generation) (Dopamine Antagonists)
 Reduce dopaminergic transmission in the four dopamine pathways
 Mesocortical pathway impairment resulting in cognitive, emotional, and
affective impairments
 Mesolimbic pathway impairment resulting in positive effects
 Nigrostriatal pathway impairment resulting in Extrapyramidal Symptoms
 Tuberinfundibular pathway impairment results in Hyperprolactinemia
 Treat positive symptoms of schizophrenia
 Much less expensive than atypical antipsychotics
 Do not treat the source of the disease
 May cause EPS
 May cause anticholinergic side effects
 May cause sedation, orthostatic hypotension
 They may lower the seizure threshold
 Limited effect on negative symptoms
o Atypical (Second Generation) (Serotonin-dopamine antagonists)
 Diminishes negative as well as positive symptoms
 Less side effects encourages medication compliance
 Decreases paranoid thoughts and behavior
 Disadvantages
 Weight gain
 Metabolic abnormalities
 Increased risk of agranulocytosis, prolongation of QT interval, neuroleptic
malignant syndrome
 Compare, contrast, define and give examples of characteristics associated with schizophrenia such as
thought blocking, poverty of thought, neologisms, word salad, thought insertion/deletion, ideas of
reference, echolalia and give examples of each.
o Thought Blocking
 A reduction of stoppage of thought. Interruption of thought by hallucinations can cause
this
o Poverty of Thought
 Global reduction in quantity of thought. Also seen in depression
o Neologisms
 Words that have meaning for the patient but a different or nonexistent meaning to others.
o Word Salad
 Most extreme form of associative looseness, a jumble of words that is meaningless to the
listener.
o Thought insertion/deletion
1
 The uncomfortable belief that someone else has inserted thoughts into the brain
(INSERTION)
 A belief that thoughts have been take or are missing (DELETION)
o Ideas of reference
 Beliefs or perceptions that irrelevant, unrelated, or innocuous things are referencing them
directly or have special personal significance
o Echolalia
 Pathological repeating of another’s words, occurring perhaps because of the patient’s
thought processes being so impaired that he is unable to generate speech of his own.
 Compare, contrast, define and give examples of extrapyramidal side effects (EPS) pseudoparkinsonism,
dystonia, akathisia, tardive dyskinesia, and describe assessment tools, nursing interventions and medication
protocols for each.
o Acute dystonia
 Sudden, sustained contraction of one or more or several muscle groups, usually of the
head and neck. May be frightening or painful but unless they effect muscle groups of the
airway they are not dangerous. They cause significant anxiety and require prompt
treatment
o Akathisia
 Pacing, repetitive movements, inability to stay still. Can be mistaken for anxiety or
agitation
o Pseudoparkinsonism
 A temporary group of symptoms that look like Parkinson’s disease: tremor: reduced
accessory movement, reduced facial expression, shuffling gait, slowing of motor
behavior (bradykinesia)
o Tardive Dyskinesia
 Persistent EPS, can be permanent
 Involuntary rhythmic movement
 Usually begins in oral and facial muscles and progresses to include the fingers, toes,
neck, trunk, or pelvis. More common in women.
o Assessment Tools, Interventions, & Nursing Interventions
 Diphenhydramine (Benadryl) and Benztropine (Cogentin)
 Abnormal Involuntary Movement Scale (AIMS)
 Ingrezza (Valbenazine capsules)
 Treatment of tardive dyskinesia
 Compare, contrast, define and give examples of Neuroleptic Malignant Syndrome & Agranulocytosis;
identify specific medications that may cause, describe and discuss symptoms of each and best practice
interventions and treatments.
o Neuroleptic Malignant Syndrome
 Reduced consciousness and responsiveness
 Increased muscular rigidity
 Autonomic dysfunction
 Less likely with SGA’s, more common with FGA’s
 Caused by EXCESSIVE dopamine blockade
 Mortality rate of 10%
o Agranulocytosis
 Most closely associated with clozapine
– Compare, contrast phases of schizophrenia: prodromal, acute or active, and residual and identify what
occurs in each.
o Prodromal
 Mild changes in thinking, reality resting, and mood, insufficient to meet the diagnostic
criteria for schizophrenia.
 Appear one month to a year before full blown episode
 Anxiety, obsessive thoughts, and compulsive behaviors may be present
 Deterioration in school/job performance and social functioning
 Person may feel they are “not right” or “something strange” is happening

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Psychiatric Individuals (NURS 3481) Study Guide Exam 2

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