Elevated CPKElevated TemperatureHypertensionDiaphoresisMuscle RigidityStop Medication and Treat Symptoms
Neuroleptic Malignant Syndrome
Schizophrenia Nursing Interventions
Distract Patient from hallucinationsUse validation to facilitate communicationProvide safe, structured environment and titrate stimuli in environment to patient
Schizophrenia Nursing Interventions
Protect patient from harming self/othersDo not challenge delusional thinkingProvide reality based activities to help patient understand what is real/notMonitor medications
Etiology of Delirium
EncephalopathiesSepsis and Toxic metabolic eventsExposure to heavy metals, toxins, intoxicants, inhalants, and volatile solventsOverdose and SE of medsMalabsorption and dietary probsSeizures
Dementia Criterion
Multiple Cognitive deficits such as memory impairment, aphasia, apraxia, agnosia, executive functioningSignificant ImpairmentGradual onset and progressive declineNot exclusively during delirium
Delirium Criterion
Acute Onset/SuddenFluctuating ImpairmentDisorientationVisual or tactile hallucinationsUsually reversible with treatment
Delirium Criterion Continued
Disturbances of consciousnessChange in cognitionDisturbance develops over short timeDirect physiological consequence of general medical condition
Delirium Assessment
Alertness--alert, vigilant, lethargic, stupor, comaAttention--follow conversationOrientation--Person, place, timeMemory--recent and remote events, Thinking, PerceptionsPsychomotor behavior--hypo/hyperkinetic, unusual or inappropriate (undressing)
Dementia Criterion
Chronic Onset, slow/progressive course, progressive disorientation, progressive cognitive impairmentProblems naming objectsProgressive apraxia and agnosia
Mental Status Exam
Orientation: person, place, timeEvaluate mood and affectEvaluate speech and languageCognitive Testing: General Information, recall, recent and remote memory, attention, reading and simple calculations, visual-spatial ability Presence/absence of hallucinationsSuicidal/homicidal ideation and intentInsight and Judgement
Depression with Cognitive Disorders
Chronic OnsetInconsistent ImpairmentOrientation IntactPatchy Cognitive Impairment Language IntactCan have auditory hallucinations usually mood congruentnormal CT and EEG
Amnestic Disorders
due to a general medical condition--specified as transient or chronic--memory disturbance that does not occur during the course of a delirium or dementia
Transient global amnesia
Typically associated with cerebrovascular disease
Anterograde amnesia
problems learning new things
Retrograde Amnesia
Problem recalling previously learned material
Korsokoff's Syndrome (Amnesia)
Associated with prolonged ETOH intake
Dementia/Delirium/Amnesia (Cognitive Disorder Interventions)
Reorient the patientRestructure the environmentRestore normal functioning and health Re-motivate and involve patientReminiscenceRegulate dysfunctional psychiatric symptoms
Dissociative Disorders
Disruption in the usually integrated functions of consciousness, memory, identity, or perceptions of the environment(amnesia is the most common symptom) ex. DID, depersonalization symptoms, somatoform disorders
Somatization Disorder
ChronicAnxiety, depression, suicidal ideations are frequently manifestedDrug abuse/dependence is common Personality Traits (heightened emotionality, strong dependency, preoccupation withself/symptoms)
Pain Disorder Primary/Secondary/Teritiary Gains
Primary Gains: Symptoms allow avoidance of unpleasant activitySecondary Gains: Symptom promotes emotional support/attention Tertiary Gains: In dysfunctional family the symptom might distract from a real issue that is unresolved
Conversion Disorder
A loss of or change in body function resulting from a psychological conflict, the physical symptoms cannot be explained by any pathophysiology/medical disorderMost obvious symptoms suggest a neurological disease and occur following a situation that produces extreme psychological stress Client may express a lack of concern of impairment (clue problem is psychological)
Body dysmorphic disorder
exaggerated belief that the body is deformed/defective in some specific waysymptoms of depression and traits associated with o-c-d personality are common
Dissociative Amnesia
inability to recall important personal data that is too extensive to be explained by ordinary forgetfulnessnot due to substance/medical conditionfollow psychological stress
Depersonalization Disorder
Depersonalization is a disturbance is the perception of oneselfDerealization is an alteration in the perception of the external enviornment