EXAM 3

Schizophrenia spectrum affects..

Thinking, behavior, emotions, ability to perceive reality

• Genetic, dopamine, nongenetic (injury, virus, nutrition)

• mid teens → 20s; may also occur in different stages

• Prodormal period: (-) symptoms [anergia] or v lv of (+) symptoms

• Relationships, self-care, work abilty → problematic

Psychotic Disorder Types:

Schizophrenia: Psychotic thinking or behaviors >6 months.

• School/work, self-care, relationships impaired

Schizotypical: Personality impairments; not as severe > schizo

Delusional D : Delusional thinking >1month

• self/interpersonal functioning not impaired heavilty

Brief Psychotic D : psychotic s/s 1day-1month

Schizophreniform D : s/s sim to schizo; 1-6 months

• social/work dysfunction may not be visible

Substance/med-induced psychotic D : psychosis from intoxication, withdrawal

• severe

Psychotic/Catatonic D from other medical condition: impaired reality testing, psychotic, catanoic that does not meet criteria of psych D

+ & - findings of Psychotic dissorders: (also cognitive & affective findings too)

+: not normally present; most easity to i/x

• Hallucinations

• Delusions

• Speech alterations

• Bizzare behavior

  • Walking backwards nonstop

-: Absence of things; more difficult to t/x

• Affect → blunted/flat

• Alogia: though/speech poverty

  • may sit w/visitor but yap w/out any sense

• Anergia

• Anhedonia

• Avolition: lack motivation in activities & hygiene

  • doing the bed

Cognitive: issues thinking making it hard to live indepentely

• DIsorderd thinking

  • Impaired abstract thinking

• Unable to decide

• vvv problem solving skills

• issues concetrating on tasks

• short term memoery issue

Affective:

• Hopeless

• Suicidal

• Unstable mood

Alterations in thought (psychotic Disorders)

• Ideas of reference:

• Persecution: feeling singled out for harm by others

  • hunted down by FBI

• Grandeur

• Somatic delusions: believing growing an arm or smth

• Jealousy

• Being controlled

• Thought broadcasting: own thoughts heard by others

• Thought insertion: other's thoughts being inserted to own mind

• Thought withdrawal: thoughts are removed from mind by outside agency

• Religiosity: obsessed w/religion

• Magical thinking

Alterations in speech (psychotic Disorders)

• Associative looseness: Unconscious inability to concentrate on single thought

  • may lead → flight of ideas

  • "I love to eat hot dogs. The sun is very bright today. My feet are cold".

• Neologism: made up words

  • “I tranged/frittled; diddyblud”

• Echolalia: repeats words spoken to them

• Clang association: “oh fox, box, lox”

• Word salad: words jumbled together w/little meaning

• Circumstantiality: multiple/unneeded details during conversation

  • talking ab smth in great details

• Tangentiality: trivial info rather than main topic of convo

  • what they’ll have to eat when talking ab discharge instruction

Alterations in perception (psychotic Disorders)

• Auditory: hearing voices/sounds

  • command: voice tells pt to hurt other/self

• Visual: seeing ppl/things

• Olfactory

• Gustatory

• Tactile

Aka hallucinations

Alterations in boundaries (psychotic Disorders)

disenffranchisement of one’s body/identity/perception

• Depersonalization: nonspecific feeling that pt has lost identity → become different or unreal in own’s view

• Derealization: environment has changed

  • objects are shrinking

• Illusions: misperception/interpretations of a real experience

Alterations in behaviors (psychotic Disorders)

• Extreme agitation: pacing & rocking

• Stereotyped behaviors: motor patterns that had meaning but now are mechanical/lack purpose

  • sweeping the floor before → after

• Automatic obedience: responding in robot-like manner

• Waxy flexibility: maintianing specific position for long period

• Stupor: motionless for long times; coma-like

• Negativitism: opposite of what is requested

• Echopraxia: imitating other’s movements

• Catatonia: v/^ amount of movement

  • muscle rigidity, catalepsy, limb stay stiff & dont move

• Motor retardation

• Impaired impulse control: v ability to resits impulses

• Gesturing/posturing: assuming unusual & illogical expressions

• Boundary inpairment: X ability to see where one body ends → begins

Screening tool for psychotic disorders:

Abnormal Involuntary Movement Scale (AIMS):

• Monitors involuntary movements & tardative dyskinesia when pts take antipsych meds

• Used as a baseline & q3-6 months

Components:

1. Facial and Oral Movements (Items 1-4):

   • Muscles of facial expression (e.g., forehead, brow, cheeks).

   • Lips and perioral area (e.g., puckering, pouting).

   • Jaw (e.g., biting, clenching, chewing).

   • Tongue (e.g., protrusion, tremor).

2. Extremity Movements (Items 5-6):

   • Upper extremities (arms, wrists, hands, fingers).

   • Lower extremities (legs, knees, ankles, toes).

3. Trunk Movements (Item 7):

   • Neck, shoulders, and hips (e.g., rocking, twisting).

4. Global Judgments (Items 8-10):

   • Severity of abnormal movements (overall).

   • Incapacitation due to movements.

   • Patient's awareness of movements.

5. Dental Status (Items 11-12 - Yes/No):

   • Presence of teeth problems.

   • Usage of dentures

Appropriate communication & nursing care for Psychotic Disorders:

Milleu environment → v anxiety & stop pts from thinking ab hallucinations

ACT: intensive management to help pts w/community-living needs

Therapeutic comm → v anxiety, defensive patterns

Appropriate communication:

• Ask directly ab hallucinations

  • dont argue/disagree

• Focus on pt’s feelings & offer reasonable explanations

• Monitor paranoid delusions (^ r/x of hurting others)

• If command hallucinations → ^ safety to v self-harm

• Focus converstations on reality-based subjects

• I/x s/s triggers & situations

  • loud noises

• Genuine & empathetic

Other nursing care for Psychotic Disorders:

• I/x ADL ability

• Model & ^ self-care abilty in pts

• Relate wellness to elements of s/s managements

• Collab w/pt to make coping techs when dealing w/ A/D

• Manifestation management techniques:

  • music → distract from voices

  • going for walk

  • talking w/someone regarding hallucination

  • interacting; go away hallucinations

• Provide med teaching

• Incorporate family AS much as possible

Edu:

• ^ social skills & friendships

• Group work/psychoedu

• Med compliance

When dopamine & glutamate dysregulated

* v cycle between episodes

*shorter time span between episodes

Antipsychotics: aims to prevent psychotic breakdown that may lead to v cycle time spans

• Also used to t/x (+) & (-) s/s

1st gen antipsychotics:

Mostly used to control positive s/s of disorder from dopa blockage in brain

Mainly given to pts that can tolerate A/E or concerned ab costs of 2nd gens

• Haloperidol, Fluphenazine → high potency

• -zine

1st gen antipsychotics Complications:

• Agranulocytosis:

  • Obtain CBC if infection

    • stop meds if <3000 WBC

  • Fever, sore throat → P

• Anticholinergic:

  • Dry mouth, blurry, photophobia, hesitancy/retention, constipation, tachycardic

  • Sugarless, sip, x hazard activitises, sunglasses, ^ fiber & H2O, exercise, void before meds

• EPS: Acute dystonia

  • Severe tongue, neck, face, back spasms

  • Crisis → ER

  • Monitor after 1-5 days of giving med

  • T/x w/antiparkinsons (BENZTROPINE)

  • Stay w//clients 5-14 mins for any aiway isssues/spasms

• Pseduparkinsons:

  • Bradykinesia, (+) s/s,

  • Rigidity, shuffling

  • Drooling, pill-rolling

  • Mask-like facies

  • Observe for s/s 5-30 days after first dose

  • T/x w/anti parchinsons → Benzotropine

  • v fall r/x

• Akathisia: unable to sit/stand still → pacing & agitated

  • 5-60 days monitor

  • Antiparkinzons, BB, lorazepam/diazepam

  • Monitor suicid r/x for severe cases

• Tardive Dyskinesia:

  • late EPS; req time to develop

  • Involuntary tongue/face/arms/legs/trunk movements

    • lip smacking/tongue fasciculations

  • Monitor after 12 months; switch to 2nd gen or v dose

  • Once TD occurs → usually does not v even w/stop of meds

  • Purposeful movements help control it

• Neuroendocrine:

  • Gynecomastia, Weight ^, menstruaal issues, galactorrhea

  • monitor weight

• NMS:

  • Sudden high fever

  • Labile BP

  • Diaphoresis, Tachycardia, Muscle rigidity, v LOC, Coma

  • ER occuring in 1st week of t/x

    • Stop med

    • Monitor VS, cooling blankets w/antipyretics, ^ fluids

  • DANTROLE/BROMOCRIPTNE → relaxes muscles

  • Meds for arrhythmias

  • Aid w/ICU transfer

  • Wait 2 weeks before contiinuing therapy; consider atypical agent

• Ortho Hypo:

  • Tolerance develops w/in 2-3 months

  • Monitor BP & HR

  • Hold meds till P notified if vvv in BP or ^^^ in HR

  • ^ fluid

  • tell them to stil, lie down

• Sedation:

  • Should stop in few weeks

  • Meds taken at bedtime to v daytime sleepiness

  • Do not drive unless subside

• Seizures:

  • ^ r/x on ppl w/seizure r/x → P

• Severe Dysrhythmias

  • Baseline ECG & K lvs BEFORE t/x

  • Avoid use w/meds that prolongue QT

• Sexual Dysfunction

  • All genders

  • v dosage or switch to high-potency agent

• Skin effects:

  • Photosensitivty → severe sunburn

    • Avoid sun exposure, sunscreen, protective clothing

  • Contact dermatitis from touching meds

    • Avoid direct med contact duh

• Liver impairment:

  • Baseline liver function

  • Anorexia, N/V, fatigue, Abd pain, jaundice → P

1st gen antipsychotics Administration & Education:

• Use AIMS to check EPS

• Use anticholinergic, BB, BZD to control early EPS → later → 2nd gen

• Depot preparationed (IM 2-4x/week) for pts who having issues adhering to meds

  • edu pt that v doses may be taken → v A/E & TD r/x

Edu:

• It is rare for these meds to have dependance issues

• Takes meds on regular schedule

• most take 2-4 weeks or w/in few days (or even months)

2nd gen Antipsychotics:

1st line for schizo; works more on serotonin blocking

• Work on both ± s/s

• Psychosis from levodopa therapy

• Bipolar D relief

• Impulse Control Disorders

• ROQA, clozapine

• Risperidone causes stroke & CVA issues

Advantages:

• v affective findings

• ^ poor memory t/x

• v EPS due to less dopa blockade

• v anticholinergic effects EXPECT clozapine

• less relapse

2nd gen Antipsychotics Complications:

• Agranulocytosis: check for infection signs

  • CBC; gradual & happpens first 6 months of t/x

  • may happen w/conjuct therapy of chlorpromazine

• DM: new onset & X glucose control

  • Obtain fasting BG & monitor periodically

  • Report s/s (^ thirst, urination, appetite)

• Weight gain:

  • Follow health, low-calorie diet

  • Exercise

  • Monitor weight gain

• Hypercholesterolemia: w/HTN & CV disease r/x involved

  • Monitor chole, triglycerides, & BG if weight & is >14 kg/30lbs

• Ortho Hypo:

  • Monitor BP w/first dose

  • Change position slowly

• Anticholinergic effects: Retention, hesitancy, dry mouth

  • Monitor A/E → P

  • Sip fluids throughout the day to relieve dry mouth

• Agitation, dizzy, sedated, sleep issues

  • Monitor A/E → P

  • Alternative med if necessary

• Mild EPS: tremors

  • Monitor & teach pt to recognize

  • Use AIMS to check

• ^ Prolactin lvs:

  • Obtain lvs PRN

  • Monitor for:

    • Galactorrhea, gynecomastia, amenorrhea → P

• Sexual Dysfunction:

  • Anorgasmia, impotence, v libido

  • Provider (P) if intolerable

  • Adjunct meds to ^ function (sildenafil)

Clozapine:

1st 2nd gen med made; no longer 1stline for szhizo due to its A/E

• Low EPS risk

• HIGH ^ weight, DM, & dyslipidemia r/x

• Fatal arganulocytosis r/x during first 6 months

  • Monitor WBC regularly

  • If infection s/s occurs → P

    • fever, sore throat, mouth leasions

• Other A/E:

  • Sedation, Ortho hypo, ^ salivation, anticholinergic effects

Specific Traumatic Disorders:

Acute Stress Disorder (ASD): Exposure to traumatic event → anxiety, detached for >3days but no longer than 1month

PTSD: Traumatic events → anxiety, detachment ab event >1month

• s/s may last years

Adjustment Disorder: Stressor triggering reaction that changes mood or issues w/ADLs.

• Less severe than ASD & PTSD

Dissociative Disorders:

Depresonalization/Derealization Disorder: Temporary changes in awareness showcasing depersonalization/derealization/both.

• C/x: stress

• Derealization: feeling that outside events are a dream/unreal; objects appear larger/smaller than they should

• Depersonalization: observing own self from distance

Dissociative Amnesia (DA): unable to recall personal info ab traumatic events

• May be from a certain time period or very specific deats

Dissociative Fugue: DA type; unable to know identity & part of one’s past when traveling to a new area

• weeks → months followed by traumatic event

Dissociative Identity Disorder: Pt displaying 1+ personality

• stressful event converts one personality to another

Pediatric Disorder:

Reactive Attachment DIsorder (RAD): child does not turn to parents for comfort or socializing

• Child withdrawn from adults or other caregivers

• D/x: <5 age; after 9 months of age

Disinhibited Social Engagement Disorder (DSED): Overly familiar to strangers w/out regarding social boundaries

• from poor caregiving when growing up

• D/x: >9 months

Meds For trauma disorders:

Antidepressants:

• SSRI, SNRI, TCA, MAOI, NaSSA (Mirtazapine)

BB: v VS & anxiety, panic, hypervigilance, insomnia

Peripherally acting Antiadrenergics (Prazosin): v hypervigilance + insomnia

Centrally Acting Adrgenergics (Clonidine)

ADJUSTMENT D & DD:

• no meds unless specific A/D findings need t/x

ASD & PTSD Expected findings:

• Intrusive findings: recur involuntary → distress

  • Memories

  • flashbacks

    • harmless loud noise, triggers reliving situation in veterans

• Night-time dreams related to event

  • insomnia

• Avoiding ppl, place, event, situations that remind of event

• Avoiding thinking of event

Mood/Cognitive Changes:

• Anxiety/Depressive D

• Anger, irritable

• v interest in activities

• Guilt, (-) self-beliefs, cognitive disortions (I am to blame for everything)

• Detached from others

• Unable to love or tender (+ experiences)

• Dissociative s/s:

  • amnesia, derealization, depersonalization

Behavioral s/s:

• Hypervigilance; startled

• X focus & concentrate

• Destructive behaviors

  • thoughts on suicide/harming others

D/x for Dissociative Disorders:

• Physical a/x, EEG, xray → rules out physical trauma

  • Brain injury, epilepsy

• Substance use Screening to rule it out

• MSE & nursing h/x

Nursing Actions:

• a/x recent & remote memory for any gaps

• Family/work issues

• Ask ab occurence of events

• A/x A/D & mood shifts

EMDR for Traumatic Disorders:

• rapid eye movements w/desensitization techs

  • Multi-phase procedure done by therapist

  • replaces negative memories w/positive ones

• Contraindications:

  • Suicidal

  • Detached retina/glaucoma

  • Unstable SUD

• Teach relaxation techs in between

SUD:

repeated use of ETOH, caffeine, cannabis, halucinogens, inhalants, opioids, sedatives, stimulants, tobacco for 12 month period

• Non-substance: gambling, gooning, shopping, social media, gaming

• Loss of control from substance/behavior → participation continuing despite a/x problems,

  • Tendency to relapse back

Defense: denial

• “I can quit whenever I want”

SUD r/x & Sociocultural:

Genetics

• Family h/x

Teens

• Issues w/decision making

Chronic stress

• Socioeconomic status

Trauma h/x

• Abuse, combat exp

v self-esteem

v tolerance for pain/frustration

v relationships

v life successes

R/x taking behavior

Sociocultural:

• Alaska & Native → ^ r/x

• Asians → v r/x

• 18-25 → ^ r/x

• Pregnant w/SUD → premature, v birth-weight, neonatal abstinence syndrome

SUD protective factors:

• family support, relationships, ^ self-esteem

• Caregiver involved

• Community resources/programs

• Employment

CIWA

10 withdrawal s/s tool a/x

• agitation, A, auditory issues, tactile issues, vision issues, clouding of sensorium, headache, N/V, sweat, tremors → total score

• <8: no meds are needed

• higher score → BZD

Table:

Severity Category	Associated CIWA-AR Range	Symptom Description
Mild	CIWA-AR < 10	Mild or moderate anxiety, sweating, and insomnia, but no tremor
Moderate	CIWA-AR 10 to 18	Moderate anxiety, sweating, insomnia, and mild tremor
Severe	CIWA-AR ≥ 19	Severe anxiety and moderate to severe tremor, but not confusion, hallucination, or seizure
Complicated	CIWA-AR ≥ 19	Seizure or signs and symptoms indicative of delirium (e.g., inability to fully comprehend instructions, confusion, or new onset hallucinations)

CAGE:

Evaluates SUD

• C: Cutting down

• A: annoyance by criticism

• G: guilty feeling

• E: Eye opener

• Answered via Y/N

  • >2 = issue; >1 = needs further evaluation

Questions:

• Have you ever felt you should cut down on your drinking?

• Have people annoyed you by criticizing your drinking?

• Have you ever felt bad or guilty about your drinking?

• Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover

Opioid Agonists:

Attach to CNS → alters perception of pain → CNS depression

• Schedule II

• Heroin, morphine, hydromorphone

  • Injected, smoked, swallowed

  • Misuse has ^ throughout years

• Not life threatening but suicdal r/x ^

Effects: rush of euphoria, pain relief

Intoxication:

• Slurred speech, X memory, pupil changes

• v RR & LOC → death

• Maladaptive behavior → X judgement & social functioning

Withdrawal:

• Sweating, Rhinorrhea, piloerection/gooselesh, termors, irritable

• Later → severe weakness, diarrhea, fever, insomnia, dilation, N/V, muscle/bone pain, spasms

Antidote: Naloxone IV

SUD Withdrawals:

For abstinence syndrome; may develop tolerance & withdrawal

• Withdrawal ^ syndrome r/x

  • Alcohol

    • S/s:

      • start w/in 4-12 hrs since last ETOH → lasts 5-7 days

      • N/V, tremors, restless, X sleep, depressed/irritable, ^ HR, ^BP, ^RR, ^Temp, sweating, tonic-clonic

    • Delirum may happen 2-3 days after → ER

      • Severe disorientation, hallu/illusions, severe HTN, dysrhythmias → death

  • Opiods:

    • hours → several days

      • May lead to suicidal ideation

    • Sweating, Rhinorrhea, piloerection/gooselesh, termors, irritable, agitation, insomnia, yawn, diarhea

  • Tobacco:

    • Irritable, nervous, restless, insomnia, v concentrating

  • Cannabis, hallucionges, inhalants, sedative/hypnotics, stimulants

Alcohol

• 0.08% mg/dL → legally intoxicated when driving

• death may occur >0.4%

• Fetal ETOH syndrome:

  • Microcephaly, craniofacial malfomations, limb/heart defects, developmental problems

• Intended effects:

  • Relaxed, v anxiety, v stress

  • Intoxication:

    • Slurred speech, nystagmus, memory X & judgmenet, v motor skills, v LOC → stupor/coma, resp arretst, peripheral collapse, DEATH

    • Chronic use: CV change, liver dmg → fatty liver, cirrhosis, GI bleeding, acute pancreatitis, S3x X

• Withdrawal:

  • N/V, tremors, restless, X sleep, depressed/irritable, ^ HR, ^BP, ^RR, ^Temp, sweating, tonic-clonic, abd cramping, ANXIETY

  • ETOH delirium → 2-3 days after cessation → ER

    • Severe disorientation, hallucinations, severe HTN, dysrhythmias → Death

Other CNS depressants: (Just to know)

• Sedatives/Anxiolitics

  • BZD:

    • Intended: v anxiety, sedation

    • Intoxication:

      • ^ drowsy & sedation, agitated, slurred speech, bad motor actiity, nystagmus, disoriented, N/V

      • Resp depression & v LOC → ER

    • Antidote: flumanezil IV

      • No antidote for barbiturate toxicity tho…

    • Withdrawal:

      • A, insomnia, sweat, HTN, psychosis, hand tremors, N/V, hallu/illu, psychomotor agitation, ^ seizure r/x

• Cannabis: Marijuana, Hashish

  • Intended:

    • Euphoria, sedated, hallu, v N/V from chemo, chronic pain management

  • Intoxciated:

    • Chronic → ^ lung cancer, v ADLs

    • High doses: paranoia (delu/hallu)

    • appetite, dry mouth, ^ HR

    • v Motor skills for 8-12 hrs → X driving & heavy machines

    • Syntehtics (K2,SPice) → more potent

  • Withdrawal:

    • Irritable, Aggression, A, X sleep, X appetite, restless, depressed, abd pain, tremors, sweat, fever, headahce

• CNS stimulants

  • Cocaine: Injected, smoked, snorted

    • Effects: euphoria rush, pleasure, ^ energy

    • Intoxication:

      • Mild: dizzy, irritable, tremor, blurry

      • Seveere Hallucinations, seizures, extreme fever, ^ HR, HTN, chest pain, CV collapse → death

    • Withdrawal:

      • D, fatigue, craving ^^^ sleep/vvv sleep, unpleasants dreams, psychomotor vvv, agitation

      • Suicideal ideation

• Amphetamines/Metha

  • Intended: ^ energy & euphoria like cocaine

  • Toxicity:

    • X judgment, agitation, hypervigilance, irritable

    • Acute CV → ^ HR, ^ BP, → death

  • Withdrawal:

    • Craving, Depression, fatigue, sleep

    • NOT life threatening

• Inhalants: Amyl nitrate, nitrous oxide, solvevents by jits

  • Intended: Euphoria

  • Toxicity:

    • Dizzy, nystagmus, X gait, drowsy, slurred speech, drowsy, v reflex, muscle weak, diplopia, stupor/coma, resp depression, death r/x

  • Withdrawal

    • N/A

• Hallucinogens: LSD, peyote, PCP → Injected, smoked

  • Intended: ^ sense of self & alt perception → colors more vivid

  • Withdrawal:

    • Persiting perception disorder: visual issues/flashbacks of hallucinations

      • Intermittent for years

• Caffeine: cola, coffe, tea, choco, energy drinks

  • Intended: ^ alter & v fatigue

  • Intoxication: >250mg

    • ^ HR, arryhtmia, flushed face, muscle twitching, restless, diuresis, GI issues, A, insomnia

  • Withdrawal: 24 hrs after last drank

    • H, N/V, muscle pain, irritable, X focus, drowsy

• Other:

  • Tobacco/Nicotine: Cigarretes/cigars, vapes

    • Intended effects: relax, v A

    • Toxicity: highly toxic in children or ppl exposed to pesticides w/nicotine

      • Long-term effects:

        • CVD → HTN, stroke, Resp Depression → emphysema, lung cancer

        • Smokeless tobacco → oral irritation mucous membrane & cancer

    • Withdrawal:

      • Abstinence syndrom → irritable, craving, nervous, restless, A, insomina, ^ appetite, X concentrating, anger, depressed

12 step program:

AA, Al-Anon, Ala-Tee

• Focus on:

  • Abstinence necessary for recovery

  • Higher power needed to aid in recovery

  • Pt not responsible for their disease BUT responsible for recovery

  • Other ppl CANNOT be blamed for addiction; must acknowledge their feelings & problems

    • Pt’s parents’ divorce is not reason to be on fent

Teach regcognizing relapse & factors that contrubute

• Regular attendance of this program implies med effectiveness

• Also used in adjunct w/Methadone substitutions

DIsulfiram (Antaabuse)

Intended Effects:

• Daily Oral meds that act like aversion/behavioral therapy

• If used w/ETOH → acetaldehyde syndrome

  • N/V, weakness, sweat, palpitation, hypotension

  • may worsen → resp depression, CV suppression, seizures, death

• Monitor liver function → hepatotoxic

• Edu:

  • X ETOH

  • X contact w/etoh products

    • Cough syrup, aftershave lotion, mouthwash, hand santitizer

  • Wear med alert bracelet

  • Self-help programs

  • Meds effects:

    • Persist for 2 weeks even after disulfiram discontinuation

Naloxone:

Opioid antagonist that reverses resp depression, coma, & other opioid toxicity effects

• short-acting

• Give naltrexone for maintenance

Nicotine Replacement Therapy

Gum, patches, nasal spray, lozenges, inhalers

• Substitutes for cigarettes/chewing tobacco

• Rate of cessation 2x w/this method

• Inhalers: simulate smoking mechanism

  • Taper 2-3 months → discontinue

Nursing Actions:

• Nasal spray → ^ rapidly nicotine blood lv → pleasurable ffects

  • spraying in each nostril = same # in a cigarrette

• Contraindicated in pt’s who have a chronic upper resp issues

  • Sinus problems, allergies, asthma

• Contains menthol → similar sensation in back of throat compared to smoking

Edu:

• Nicotine Gum

  • Chew slowly & intermittently for 30mins

  • X eating/drinking 15 min before/during chewing

  • Do NOT use for > 6 months

• Nicotine Patch:

  • Apply to area of clean/dry skin per day

  • Applied morning & removed 16 hrs after at bedtime

    • folllow dosage times

    • If taken at night → ^ nightmare/sleep issues r/x

  • Do not use other nicotine products with patch

  • If local skin reaction → Report to Provider

  • Remove Nicotine patch before MRI

Prazosin:

Peripherally acting antiadrenergics; may lower hypervigilance & insomnia s/s in traumatic disorders

• off-label use to v nightmares

  • Not 100% based on evidence

• Also a an antiHTN drug

Illness Anxiety Disorder

Misinterprets physical s/s as evidence of a serious disease

• “hypochodriasis”

• Leads to obsessive thoughts/fears regarding illness

  • Obsessively researching & continuosly self-examining

    • Examining throat in mirror

  • Seek numerous medical opinions OR avoid healthcare to not ^ anxiety

• They are overaly aware of bodily sensations & correlate them to a serious illness

• Physical s/s may be minimal/absent, but pt is preoccupied w/having undiagnosed illness

  • Continuous anxiety despite negative results or reassurance from provider

CT/MRI done to rule out pathology

Illness Anxiety Disorder R/x:

• 1st degree relatives w/illness anxiety D

• Previous loss/disappointments → anger, guilt, hostile

• Childhood trauma/maltreatment/neglect

• Depressive/Anxiety Disorder

• Major life stressor

• v Self-esteem

Illness Anxiety Disorder Expected Findings:

Excessive anxiety over “illness” or acquiring it

• >6 months

• Pt may switch from one illness to another

Preoccupied w/peformance of health-related behaviors

• Breast self-examination

Health-seeking type: frequently seeking medical care or diagnostic results

Care-avoidant type: avoiding all contacts w/P due to ^ anxiety lvs

Factitious disorder and its types:

Conscious decision of pt to report physical/psychological s/s that are falsificated

• “Munchausen syndrome”

• It IS a mental illness

• Not for personal gain but to “seek” attention

  • May even self-harm

• Average/abover average IQ

• Dramatic when describing illness, they use medical terminology, hesitant for provider to speak w/family or previous provider

  • Often report new s/s when d/x comes in (-)

Types:

• Facitious Disorder imposed on another; injury to others

  • “proxy”

  • Pt causes injury/illness to a vulnerable person

  • Due to need for emotional attention OR relief from responsibility

• Malingering: consciously motivated and for personal gain

  • NOT a mental illness

  • Disability benefits, avoiding military service

Report to health care team on their disorder to v medical costs & excessive surgeries