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UNIT 3 ■ Care of Patients With Psychiatric Disorders
catatonic disorder associated with another medical condition, schizophreniform disorder, schizoaffec- tive disorder, and schizophrenia. ■■ Nursing care of the patient with schizophrenia is accomplished using the six steps of the nursing process. ■■ Nursing assessment is based on knowledge of symptomatology related to thought content and processes, perception, affect, volition, interper- sonal functioning and relationship to the external world, and psychomotor behavior. ■■ Symptoms of schizophrenia are categorized as positive (an excess or distortion of normal func- tions) or negative (a diminution or loss of normal functions). ■■ Antipsychotic medications remain the mainstay of pharmacological treatment for psychotic dis- orders. Atypical antipsychotics have become the first line of therapy. They have a more favorable side effect profile than the conventional (typical) antipsychotics. ■■ Individuals with schizophrenia require long-term integrated treatment with pharmacological and other interventions. Some of these include indi- vidual psychotherapy, group therapy, behavior
therapy, social skills training, milieu therapy, fam- ily therapy, and assertive community treatment. For the majority of clients, the most effective treat- ment appears to be a combination of psychotropic medication and psychosocial therapy. ■■ Some clinicians are choosing a course of therapy based on a model of recovery, somewhat like that which has been used for many years with prob- lems of addiction. The basic premise of a recovery model is empowerment of the patient. The recov- ery model is designed to allow consumers primary control over decisions about their own care and to enable persons with mental health problems to live a meaningful life in a community of their choice while striving to achieve their full potential. ■■ Families generally require support and education about psychotic illnesses. The focus is on coping with the diagnosis, understanding the illness and its course, teaching about medication, and learn- ing ways to manage symptoms. ■■ The most current, evidence-based approach to treatment, RAISE (Recovery After an Initial Schizophrenia Episode), demonstrates that early intervention at the first episode of psychosis can significantly improve outcomes.
Review Questions
Select the answer that is most appropriate for each of the following questions: 1. Recent research on the RAISE approach to treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply.) a. Early intervention at the first episode of psychosis b. Support for employment and/or educational pursuits c. Rapid, high-dose loading with antipsychotic medication d. Court-ordered sanctions for treatment e. Recovery-focused psychotherapy 2. Which of the following is the primary goal in working with an actively psychotic, suspicious client? a. Promote interaction with others. b. Decrease the client’s anxiety and increase trust. c. Improve the client’s relationship with their parents. d. Encourage participation in therapy activities. 3. A client with schizophrenia has physician’s orders for haloperidol (Haldol) 5 mg. IM STAT and then 3 mg PO tid; 2 mg benztropine PO bid prn. Why is benztropine ordered? a. To treat extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep
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