115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy Series)-Lippincott-16083_p462

438 Schizophrenic & delusional disorders

Dissociation (separation of things from their emotional significance) Echolalia (repetition of anothers words) Echopraxia (involuntary imitation of another persons movements and gestures) Episodes of impulsiveness Fantasy Inability to trust Little reaction to environment Mutism Neologism Projection Purposeless overactivity or underactivity Ritualistic mannerisms Social isolation Speech resembling a word salad (string of words that arent connected in any way)

DIAGNOSTIC TEST RESULTS Magnetic resonance imaging (MRI) shows possible enlargement of lateral ventricles, an enlarged third ventricle, enlarged sulci, cor-tical atrophy, and decreased cerebral blood flow. Clients show impaired performance on neuropsychological and cognitive tests.

NURSING DIAGNOSES Risk for impaired skin integrity Imbalanced nutrition: Less than body requirements Ineffective coping Dressing self-care deficit

TREATMENT Electroconvulsive therapy (if client isnt responsive to medication) Family therapy Milieu therapy Outpatient group therapy Psychoeducational programs Social skills training Stress management Supportive psychotherapy

Drug therapy Antiparkinsonian agents: benztro-pine (Cogentin) for adverse effects of antipsychotics

behavior involves remaining completely motionless or continuously repeating one motion. This behavior can last for hours at a time. Catatonic schizophrenia is the least common type of schizophrenia.

CONTRIBUTING FACTORS A fragile ego that cant withstand the demands of reality Brain abnormalities Developmental abnormalities Genetic factors Hyperactivity of the neurotransmitter dopamine An infectious agent or autoimmune response (unproven cause) Social or environmental stress, interacting with the persons inherited biological makeup

ASSESSMENT FINDINGS Agitation that may be unexpected and dan-gerous Bizarre postures, waxy flexibility (posture held in odd or unusual fixed positions for extended periods), and resistance to being moved Excessive motor activity Extreme negativism (resistance to instruction or movement) Childlike, regressed behavior Clang association Displacement (switching emotions from their original object to a more acceptable sub-stitute)

Heres a major difficulty in treating

schizophrenia: After clients more

troubling symptoms recede, they believe

they can discontinue therapy and medication.

Yet, when treatment stops, the symptoms inevitably

recur in full force.

313419NCLEX-RN_Chap17.indd 438313419NCLEX-RN_Chap17.indd 438 4/8/2010 10:20:45 AM4/8/2010 10:20:45 AM

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115-NCLEX-RN Review Made Incredibly Easy, Fifth Edition (Incredibly Easy Series)-Lippincott-16083_p462