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4.

Help client with problem solving and Services


decision making as indicated v. negative attitude toward treatment -
5. Encourage the client and/or significant encourage expression
others to ventilate b. express genuine concern for client
6. Utilize therapeutic touch as appropriate c. discuss imporvement potential
7. Assist in discussions of future plans as 2. Schizophrenia
appropriate G. Definition: a multifaceted psychosis with
19. Stress Management early onset; criteria from DSM IV as follows:
o Stress: a universal phenomenon, stress 1. When disease is in active phase, client
requires change or adaptation so that the shows psychotic behaviors. (Psychosis is
person can maintain equilibrium severe ego dysfunction. Psychosis is also
o Stress can be internal or external part of other DSM-IV diagnoses of
o Nature of stressor involves: dysfunctions of thought and sensorium.)
1. Intensity 2. Findings involve many psychological
2. Scope processes
3. Duration 3. Previously, client had functioned at a
4. Other stressors: their number and nature higher level
o Categories of stressors - and examples 4. Schizophrenia normally sets in before 30
1. Physical - drugs or alcohol years of age
2. Psychological - such as adolescent 5. Findings last six months or more
emotional upheaval, or unexpressed anger 6. Not caused by affective or organic mental
3. Social - isolation, interpersonal loss disorder
4. Cultural - ideal body image 7. Involves hallucinations and/or delusions
5. Microbiologic - infection H. General characteristics of schizophrenia -
o The greater the stressor as preceived by six losses: S-S-O-B-E-R
the client, the greater the stress response 1. Self-care often fails
o Stress response involves both localized 2. Social adjustment is impaired
and general adaptation 3. Orientation to the environment is lost
G. Factors affecting stress response 4. Boundaries between self/others dissolve
1. Personal: heredity, gender, race, age 5. External/internal stimuli are confused
personality, cognitive ability (delusions/hallucinations)
2. Sociocultural: finances, support systems 6. Reality testing fails
3. Interpersonal: self-esteem, prior coping I. Etiologies of Schizophrenia
mechanisms 1. Biogenetic (possible hereditary factor)
4. Spiritual: belief system 2. Biochemical
5. Environmental: crowding, pollution, b. dopamine hydrochloride - too much
climate neurotransmitter for neural activity
6. Occupational: work overload, conflict, c. research has suggested abnormalities of
risk neurotransmitters norepinephrine,
H. Physiologic indicators of stress serotonin, acetylcholine and GABA (gamma
I. Emotional/behavioral indicators of stress aminobutyric acid).
J. Stress can cause a variety of emotional 3. Contributing factors
and physical disorders a. poor relationships with primary caretaker
K. Stress management strategies b. dysfunctional family systems
L. The non-compliant client does not c. double-bind communication
cooperate with the treatment plan d. stressful life events
1. Behavior characteristics e. decreased socio-economic status (SES)
a. does not take prescrived medication D. Findings of schizophrenia
b. continues activities restricted by provider 3. Positive findings
of care, such as smoking a. hallucinations
c. does not follow prescribed activities, such b. delusions
as exercise c. looseness of associations
2. Nursing interventions d. agitated or bizarre behaviors
a. explore the reasons for non-compliance 4. Negative findings
i. lack of understanding - reinforce teaching a. apathy
ii. lack of family support - involve family and b. poverty of speech or content of speech
support groups c. poor social functioning
iii. side effects - refer to provider of care d. anhedonia
iv. finances and access - refer to Social e. Social withdrawal
E. Positive findings
3. Acute onset
4. Normal premorbid functioning
5. Normal social functioning during
remission
6. Normal CT scan
7. Normal neuropsychological test results
8. Favorable response to antipsychotic meds
9. Appear early in illness
10. Often precipitate hospitalization
11. Alterations in thinking, perceiving and
behavior
F. Negative findings
3. Insidious onset
4. Premorbid history of emotional problems
5. Chronic deterioration
6. Demonstration of atrophy on CT scan
7. Abnormalities on neuro-psychological
testing
8. Poor response to antipsychotic meds
9. Interferes with person's ability to:
a. initiate and maintain relationships
b. initiate and maintain conversations
c. hold a job
d. make decisions
e. maintain adequate hygiene and grooming
G. Alterations in thinking
3. Types of delusions
a. ideas of reference
b. persecution
c. grandeur
d. somatic delusions
e. jealousy
f. control/being controlled
g. thought-broadcasting
h. thought insertion
i. thought withdrawal
4. Associative looseness
5. Neologisms