Extrapyramidal Side Effects (EPSEs) in Schizophrenia: Causes, Types, and Treatment, Exams of Nursing

Download Extrapyramidal Side Effects (EPSEs) in Schizophrenia: Causes, Types, and Treatment and more Exams Nursing in PDF only on Docsity! RNSG 2213 MH Module 3- Schizophrenia Final Exam Questions with Answers Parkinson's disease - Correct Answers progressive, chronic degenerative disease of unknown cause that involves extrapyramidal system—neurodegeneration of substantial Ingra at beginning of dopamine tracts; characterized by 4 cardinal symptoms—tremors, bradykinesia, rigidity, postural instability. Pathophysiological cause is imbalance of acetylcholine and dopamine (deficiency); treated w/ agents that increase dopamine/dopaminergic levels Extrapyramidal side effects (EPSEs) - Correct Answers caused by blockade of dopamine receptors in the basal ganglia at the end of the dopamine tracts; can mimic symptoms of Parkinson's 7 types of EPSEs - Correct Answers akathisia, akinesia/bradykinesia, dystonias, drug- induced parkinsonism, tardive dyskinesia, neuroleptic malignant syndrome, Pisa syndrome Women; patients with first episode of schizophrenia, older adults, & patients w/ affective symptoms - Correct Answers What populations are at higher risk for developing EPSEs? Akathisia - Correct Answers most common EPSE; subjective feeling of restlessness; elicits restless legs, jittery feelings, nervous injury. Responds poorly to treatment Akinesia - Correct Answers absence of movement; EPSE Bradykinesia - Correct Answers EPSE; slowed movement; includes weakness, fatigue, painful muscles, anergia Dystonias - Correct Answers EPSE; abnormal postures caused by involuntary muscle spasms; manifests as sustained, twisted, & contracted positioning of limbs, trunk, neck, or mouth. Tends to appear in early treatment (w/in 3 days) and responds to anticholinergics, which may have to be given parenteral. Torticollis - Correct Answers type of dystonia; contracted positioning of neck Oculogyric crisis - Correct Answers type of dystonia; contracted positioning of eyes upward Laryngeal-pharyngeal constriction - Correct Answers type of dystonia; potentially life threatening Drug-induced parkinsonism - Correct Answers EPSE; cardinal symptoms of tremor, rigidity, bradykinesia, postural instability Tardive dyskinesia (TD) - Correct Answers EPSE; "late appearing" usually after about 6 months of antipsychotic therapy. Thought to be caused by hypersensitivity of dopamine receptors in basal ganglia r/t chronic use of antipsychotics. Can be bothersome, embarrassing. Typically includes tongue writhing, tongue protrusion, teeth grinding, lip smacking. Often irreversible, but can be averted if caught it time. Prevention is most important approach. Neuroleptic malignant syndrome (NMS) - Correct Answers EPSE; potentially lethal side effect of antipsychotics; cardinal symptoms include hyperthermia (temp of 101- 103), rigidity, autonomic dysfunction, LOC changes, elevated CPK (Creative phosphokinase). Can be treated w/ muscle relaxants (dantrolen/Atrium) & w/ centrally acting dopaminergic (bromocriptine/Paroled). Predisposing factors include youth, male, high potency neuroleptic, and new patient. Pisa syndrome - Correct Answers EPSE; condition marked by pt. leaning to one side; can be acute or tardive. Older adults more vulnerable. Be patient; reassure jittery pt. that you understand the need to move and that appropriate drug interventions can help differentiate akathisia and agitation. B/c akathisia is major cause of noncompliance, switching to different class of antipsychotic may be necessary - Correct Answers What is the nursing intervention for akathisia? May respond to anticholinergics; may want to reduce dose/change antipsychotics - Correct Answers What is the nursing intervention for akinesia/bradykinesia? If severe reaction occurs, give antiparkinsonian drug (i.e. Cogentin/Benadryl) immediately as needed. Offer reassurance. Request order for IM administration immediately, if needed. - Correct Answers What is the nursing intervention for dystonias? Assess for major parkinsonism symptoms (tremors, rigidity, bradykenisia) and report to MD. Antiparkinsonian drugs probably indicated. - Correct Answers What is the nursing intervention for drug-induced parkinsonism? Assess for signs using the abnormal inventory movement scale (AIMS). Drug holidays may help prevent TD. Anticholinergics will worsen TD. - Correct Answers What is the nursing intervention for tardive dyskinesia? Be alert; EPSE is potentially fatal. Routinely take temp, encourage adequate water intake for pts on regimen of antipsychotic drugs; routinely assess for rigidity, tremor, similar symptoms. If onset occurs, stop all medications immediately. Administer dantrolene (Dantrium) skeletal muscle relaxant and bromocriptine (Paroled) a dopamine Neurochemical theory of schizophrenia - Correct Answers affords best explanation for effectiveness of antipsychotic meds; states that increased levels of dopamine in limbic area of the brain lead to schizophrenia and psychotic symptoms. Dopamine blocking activity of antipsychotics allows for effectiveness in treatment. Positive symptoms of schizophrenia - Correct Answers arise from too much dopamine in the limbic area (hyperactive mesolimbic tract); include abnormal thoughts, agitation, bizarre behavior, delusions, excitement, feelings of persecution, grandiosity, hallucinations, hostility, illusions, insomnia, suspiciousness. Antipsychotic agents effective in treatment. Negative symptoms of schizophrenia - Correct Answers arise from too little dopamine in the cortex (hypoactive mesocortical tract); include alogia, anergia, asocial behavior, attention deficits, avolition, blunted affect, communication difficulties, difficulty with abstractions, passive social withdrawal, poor grooming/hygiene, poor rapport, poverty of speech. Is the patient actually taking the drug? Has the drug been given a fair trial (usually 3-6 weeks)? - Correct Answers When a pt doesn't respond to antipsychotic drug therapy, the nurse's assessment might be quite helpful to the prescriber. What two considerations should be kept in mind when assessing a patient's response? Constipation, decreased sweating, dilated pupils, dry mouth, slowed bowel & bladder; increased intraocular pressure, intensifies prostatic hypertrophy, can trigger arrhythmias - Correct Answers What are some anticholinergic side effects of antipsychotic drugs? Hypotension; usually occurs in older adults; younger pt can accommodate within a few weeks - Correct Answers what is the major antiadrenergic effect of antipsychotic agents? Lengthening of QT interval (associated w/ torsade de pointes); EKG monitoring important with use - Correct Answers What cardiac effects are of concern with antipsychotic agents? ESPEs - Correct Answers What is the most common reason for noncompliance with antipsychotic medications? Antipsychotic agents - Correct Answers Side effects include anticholinergic, antiadrenergic effects; long QT interval, EPSEs, elevated prolactin (endocrine), metabolic syndrome, sexual side effects, weight gain leading to insulin resistance. chlorpromazine (Thomasine) and thioridazine - Correct Answers What are the low- potency traditional antipsychotics? chlorpromazine (Thomasine) - Correct Answers a low-potency antipsychotic; the first antipsychotic developed. thioridazine - Correct Answers older, low-potency traditional antipsychotic. Maximum upper limit of 800 mg/day b/c of possibility of pigmentary retinopathy. Loraine (Lusitania), molindone (Moan), and perphenazine (Trillion) - Correct Answers moderate-potency traditional antipsychotic medications fluphenazine (Proloxin), haloperidol (Haldol) - Correct Answers high-potency traditional antipsychotics fluphenazine (Proloxin) - Correct Answers high-potency traditional antipsychotic; available in long-acting form. Injectable, beneficial for patients who do not comply with daily PO regimen. Given every 2-3 weeks. haloperidol (Haldol) - Correct Answers high-potency traditional antipsychotic; tends to cause more EPSEs, fewer anticholinergic side effects. Most frequently prescribed traditional drug. Often used as pen chemical restraint. Long acting form can be given to non-compliant patients. Atypical or second Generation Antipsychotics - Correct Answers "Newer" antipsychotic medications that block both dopamine D receptors and serotonin receptors. Have a somewhat better side effect profile and decrease the "positive" and "negative" symptoms. They are very expensive. Depending on drug, may be available in PO form (including sublingual, disintegrating lozenge, liquid), IM, or depot IM form. Includes clozapine (Clairol), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), paliperidone (Invega), aripiprazole (Abilify). clozapine (Clozaril) - Correct Answers Atypical antipsychotic. Prescribed infrequently due to high incidence of agranulocytosis. Decreases negative symptoms of schizo; no Extrapyramidal symptoms (EPS). May decrease symptoms of tardive dyskinesia. Effects both dopamine and serotonin. Side effects— agranulocytosis (requires weekly blood draws), Sedation, excessive salivation, dizziness, seizures, Hyperglycemia/Wt. Gain, Type 2 DM, myocarditis. Very costly $9,000 per year. Use with cigarette smoking can cause a decreased absorption. risperidone (Risperdal); palperidone (Invega) is in same family and ER capability - Correct Answers Atypical antipsychotic; most frequently prescribed antipsychotic. Affects both positive & negative schizo symptoms. Well-tolerated w/ few side effects. Can cause EPS, but lower incidence. Side effects include CNS, drowsiness (most common, given at night), insomnia agitation, headache, anxiety, orthostatic hypotension, hyperglycemia. Available in long-acting IM form taken q 2 weeks. olanzapine (Zyprexa) - Correct Answers atypical antipsychotic med; affect positive & negative symptoms b/c affects both serotonin & dopamine. High potency—10-20 mg/day. Side effects—drowsiness, constipation, dry mouth, headache, rare EPS, NMS, significant weight gain. Available in short-acting IM form. quetiapine (Seroquel) - Correct Answers Atypical antipsychotic, low potency. Effective in positive and negative symptoms. Appears to improve elements of cognitive function. No increase in prolactin levels. No sexual dysfunction problems. Side effects— somnolence, sedation/anxiolytic effect, hypotension. Dose effective at 150 mg to 750 mg per day. Must be titrated slowly over 4-5 day period. Available in IM injection. ziprasidone (Geodon) - Correct Answers atypical antipsychotic med; effective for positive & negative schizo. Causes less weight gain than other meds. Linked to cardiac problems & QT interval lengthening. Low EPS, no increase in prolactin levels. Side effects-somnolence in short term and insomnia in long term use. Patient cannot have any cardiac or electrolyte imbalance. Monitor serum potassium and magnesium. Starting dose of 80 mg per day in 2 doses; can go to 160 mg. Available in short acting IM form. aripiprazole (Abilify) - Correct Answers Atypical antipsychotic, "dopamine system stabilizer" affects both dopamine and serotonin, antagonizing some receptors and serving as a partial agonist for others. Decrease in the EPS side effects and minimal Wt. Gain, minimal sedation, no problems with QT interval. Side effects—headache, Anxiety, Insomnia, somnolence, occasional stomach upset, akathisia. Dosage 10 to 15 mg daily; can go up to 30. A. does not have to remember to take medication daily. Correct Characteristic of the depot (deaconate) preparation - Correct Answers A therapeutic benefit of Prolix in Deaconate (fluphenazine deaconate) is that the individual: A. does not have to remember to take medication daily. B. will not experience EPSEs. C. may have daily doses titrated up or down. D. will experience a reduction in both negative and positive symptoms. D. CBC. Correct Related to the risk for agranulocytosis from bone marrow suppression. Will facilitate monitoring of the WBC count by the prescriber, nurse, and/or pharmacist - Correct Answers Prior to administering Clozaril (clozapine), the nurse will evaluate the patient's: A. EEG. B. ECG. C. lipids. D. CBC. C. Seroquel (quetiapine) Correct This atypical second-generation antipsychotic drug targets both the positive and negative symptoms of schizophrenia. - Correct Answers The multidisciplinary team discusses the patient's negative symptoms of schizophrenia. The nurse expects which medication to be ordered? A. Prolix in (fluphenazine) Biological (medical illness), psychological (loss of relationship), sociocultural (homeless), emotional (persistent criticism) - Correct Answers What are stressors that can lead to relapse of schizophrenia symptoms or noncompliance with med regimen? Substance abuse - Correct Answers what is the most common psychiatric co-morbidity associated with schizophrenia? Psychosis induced polydipsia - Correct Answers Compulsive water drinking (6% to 20%); thirst and Osmotic deregulation. Can lead to hypernatremia (s/s confusion, convulsions, coma, lightheadedness, nausea and vomiting, weakness, muscle Cramps). Treatment—weigh, restrict fluid, sodium replacement, constant supervision Do not argue. Do not belittle. Show acceptance and empathy and speak to them ("That must be difficult to believe that."). Delusions of Grandeur-may be a defense against low self-esteem. Do not patronize. Can reassure-"You are safe here." Orient patient to what is happening - Correct Answers what are nursing interventions for delusions? Set limits on disruptive behavior. Assess agitated clients frequently for escalation. Assess ability to participate in activities; choose activities at client's level of ability. May need 1:1 rather than group activities at first. Decrease environmental stimuli pen. Supervise meals, hygiene, grooming - Correct Answers What are nursing interventions for milieu management for schizophrenia? Schizoaffective disorder - Correct Answers psychosis characterized by both affective (mood disorder) and schizophrenic (thought disorder) symptoms, with substantial loss of occupational and social functioning. Schizo symptoms dominant but accompanied by major depressive or manic symptoms. Delusional disorder - Correct Answers symptoms displayed are similar to schizophrenia, but with delusions w/ basis in reality. Behavior relatively normal except in relation to delusions. Symptoms are not result of substance-induced or medical condition. Brief psychotic disorder - Correct Answers includes all psychotic disturbances that last less than 1 month and are not related to a mood disorder, general medical condition, or substance induced disorder. Must have at least one of the following—delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. Schizophreniform disorder - Correct Answers displays symptoms typical of schizophrenia and last at least 1 month but no longer than 6 months. Ds spares individual the lifelong dx of schizophrenia until professionals are absolutely sure of dx. A. speak to patients about real people and real events. Correct Providing reality (real people talking about real events in real time), emotional support, and the presence of caring staff are important in working with the patient experiencing hallucinations. - Correct Answers In working with a patient experiencing hallucinations, the nurse will direct the unlicensed assistive personnel (UAP) to: A. speak to patients about real people and real events. B. listen while patients talk about disordered perceptions. C. avoid the use of distraction with patients. D. consistently expect bizarre behavior. D. Participating in a noncompetitive creative activity Correct Facilitates engagement with a lower-stress, creative, and hopefully distracting (from the delusions) activity - Correct Answers A patient experiencing delusions is noted to have more anxiety and difficulty with attention following 2 days on the inpatient unit. Which nursing intervention would be most helpful for the patient? A. Walking with a group of staff and other patients off the unit B. Listening to music or reading C. Discussing treatment goals for the inpatient stay D. Participating in a noncompetitive creative activity C. sit with the patient, allow silence, and state when the nurse will return to see the patient. Correct Most therapeutic; offering self, making no verbal demands, and acknowledging when the nurse will return - Correct Answers To establish a therapeutic relationship with a severely socially withdrawn patient with a diagnosis of schizophrenia, the nurse should: A. observe the patient for changes, limit all contact and interactions, and encourage the patient to spend time alone. B. play soft and soothing music, ask about feelings, and read the daily newspaper to the patient. C. sit with the patient, allow silence, and state when the nurse will return to see the patient. D. reorient the patient frequently, provide preferred food and fluids, and remain for at least 1 hour per visit. D. recognizes the voices as a part of the disease and demonstrates the ability to validate what is real in the environment. Correct Appropriate patient outcome in distinguishing what is the disease process and likewise what is environmental reality - Correct Answers The nurse would evaluate improvement in a patient who experiences auditory command hallucinations when the patient: A. follows the commands of the hallucinations. B. is able to ignore the commands though they are still present. C. reports that the hallucinations have ceased because of the ability to tell them to stop. D. recognizes the voices as a part of the disease and demonstrates the ability to validate what is real in the environment. C. "Pick up your shirt and put it on, please." Correct Specific, directed, and concrete in verbal intervention - Correct Answers A young adult experiencing schizophrenia is found seated on his bed unclothed with today's clothes lying beside him. He is dazed, mumbling, and staring out the window. The nurse will state: A. "It is time to get dressed now." B. "Why are you staring out the window?" C. "Pick up your shirt and put it on, please." D. "Breakfast is ready!"