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SchizophreniaPsychiatric Nursing: Contemporary Practice

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What is the priority of care for a patient during acute times of illness from schizophrenia?
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Treatment with antipsychotic medications.
What are the priorities during the chronic phase of schizophrenia treatment?
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Helping the patient accept their illness, developing expectations that are realistic, helping them avoid social isolation, preventing hopelessness
What should a nurse monitor in order to complete fluid balance assessments in patients with schizophrenia?
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Remain alert for s/s of polydipsia, polyuria. If water imbalance is suspected, institute daily weights, urine specific gavity and serum sodium levels as well as observe for behavioral changes.
How can a nurse promote self-care activities for a patient with schizophrenia?
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Develop a schedule with the patient for various hygiene activities and emphasize their importance.
When should a program to address weight gain be instituted for a patient with schizophrenia?
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At the earliest sign of weight gain between 5-10 lbs. over the desired body weight.
What teaching is important for a client with schizophrenia that has a disordered water balance?
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Self-monitoring skills including how to monitor their own urine specific gravity, what their targeted weight is, how to do daily weights and ensure they know a 5-7 lb. weight gain in 1-3 hours indicates too much fluid.
How are patients with severe water imbalances best managed to restrict their water-seeking behavior?
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One on one observation and management to redirect their behavior
What is the general action of antipsychotic drugs?
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They block the D2 receptors in the brain.
What are the interventions for a patient who has exceeded their target weight established for their chronic water imbalance?
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Prohibit fluid intake, restrict them to their program/residential area, assess their vitals twice every hour and notify the physician if severe symptoms develop.
How long does it take for antipsychotic drugs to begin working, and how long typically until they are considered therapeutic?
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Takes about 1-2 weeks for changes in symptoms and 6-12 weeks to determine their therapeutic effectiveness.
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__________ is an antipsychotic that is typically used only when all other atypical antipsychotics aren't effective.
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Clozapine/Clozaril (because of the risks of agranulocytosis).
Rarely, antipsychotic medications must be stopped. What situations warrant the cessation of a patient's medications?
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They develop neuroleptic malignant syndrome or they develop tardive dyskinesia.
What is the boxed warning for risperidone/Risperdal?
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It is associated with an increased mortality in elderly patients with dementia-related psychosis.
What is the boxed warning for clozapine/Clozaril?
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It can cause agranulocytosis within 4-10 weeks, seizures, myocarditis, or other adverse cardiovascular events.
What is the specific patient requirement/education that should be explained to a patient on clozapine/Clozaril?
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WBC counts must be taken before starting the medication and then done weekly while on the medication for up to 4 weeks after cessation of the drug. Any flu-like symptoms must be reported to the physician.
What is thought to be the underlying cause of extrapyramidal symptoms from antipsychotic medications?
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D2 receptors in the basal ganglia are blocked, increasing acetylcholine and causing the symptoms.
How are extrapyramidal symptoms caused by antipsychotic medications typically managed?
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Reducing the dosage of the medication or adding an anticholinergic drug like benztropine/Cogentin or trihexyphenidyl/Artane
Why might a schizophrenic patient be prescribed benztropine or trihexyphenidyl?
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To reduce extrapyramidal side effects of antipsychotic medications (they are both anticholinergic agents).
What are the withdrawal symptoms that may develop from the abrupt withdrawal of anticholinergic medications?
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Vomiting, excessive sweating, nightmares
What extrapyramidal symptom doesn't respond well to anticholinergic medications?
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Akathisia (restlessness)
What are the common characteristics of people who are more likely to develop dystonic reactions from antipsychotic medications?
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Young men
  
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