Author Question: You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B., who ... (Read 98 times)

Arii_bell · **on:** Jun 25, 2018

You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B., who has just been admitted. He has a diagnosis of schizophrenia, paranoid type

He is 22 years old and has been attending the local university and living at home with his parents. He has always been a good student
and has been active socially. Last semester his grades began declining and he became very withdrawn.
He spends most of his time alone in his room. His grooming has deteriorated; he can go days without
bathing. For several weeks before admission, he insisted on keeping all of the blinds and curtains in the
house closed. He refuses to join family gatherings and games. For the past 2 days he has refused to eat,
saying, they have contaminated the food. as you approach R.B., you note that he appears to be carrying
on a conversation with someone, but there is no one there. When you talk to him, he looks around and
answers in a whisper but gives you little information. He states, they are watching me and told me not
to cooperate.

Explain what a negative symptom of schizophrenia is, and identify at least three negative
symptoms of schizophrenia that R.B. might be experiencing.

Explain what a positive symptom of schizophrenia is, and identify at least two positive
symptoms of schizophrenia that R.B. might be experiencing.

Give the definition of each of the following types of delusional thinking:
a. Thought broadcasting
b. Thought insertion
c. Grandeur
d. Ideas of reference
e. Persecution
f. Somatic delusions

What symptoms indicate that R.B. has paranoid schizophrenia?

Why is it important to know R.B.'s history before he is diagnosed with schizophrenia?

What diagnostic screenings are important in evaluating R.B.?

What are the most important initial interventions in treating R.B.?

Question 2

Lithium (eskalith) is commonly used to treat bipolar disorder. s.t. has been taking lithium for several years

When S.T. first started taking lithium, she would have been cautioned to report side effects.
Which are common side effects of lithium? Select all that apply.
a. Thirst
b. Nausea
c. Constipation
d. Tremor
e. Dizziness

Lithium toxicity can occur in patients taking lithium. What are the symptoms of early
lithium toxicity? Select all that apply.
a. Vomiting
b. Insomnia
c. Dyspnea
d. Diarrhea
e. Lethargy

S.T.'s maintenance lithium level results are reported as 1.0 mEq/L. Interpret these results

What other laboratory examinations should be routinely performed while S.T. is taking
lithium?

What instructions should have been given to S.T. when she began lithium therapy?

Aside from lithium, what other medications are used to treat bipolar disorder?

Even though she has been taking lithium for a year, you review some teaching about drug
herapy with S.T. Which statement by S.T. reveals a need for further education?
a. I will call my doctor if I have severe vomiting or diarrhea.
b. I need to be careful because lithium is addictive.
c. I take the lithium tablets with meals.
d. I will keep my appointments to have my drug levels checked.

Given her history of bipolar disorder, what should you teach S.T. to minimize mood swings?

kescobar@64 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

A negative symptom of schizophrenia is the absence of something that should be present in a
person but is not present. Negative symptoms might include:
Flat or blunted affect
Poverty of thought
Lack of motivation
Social withdrawal
Poor grooming
Anhedonia (inability to experience pleasure)

A positive symptom of schizophrenia is the presence of something that is not normally present,
such as:
Hallucinations
Delusions
Disorganized speech (associative looseness)
Bizarre behavior

a. Thought broadcasting:Belief that thoughts can be heard by others
b. Thought insertion:Belief that others' thoughts are being inserted or substituted into one's brain or
conversation
c. Grandeur:Belief about grand or exaggerated accomplishments; belief that one is very important
or has great power
d. Ideas of reference:Belief that events are related to one when they are not; giving great personal
significance to a trivial event
e. Persecution:Belief that one is being singled out by others for harmful reasons
f. Somatic delusions:Belief that one's body is changing in an unusual way

Preoccupation with one or more delusions: He is being persecuted, They have contaminated my
food, They are watching me.
Frequent auditory hallucinations: They told me not to cooperate.

Other factors or conditions can cause psychotic symptoms that are common with schizophrenia.
Drug use, certain medical or neurologic conditions, and alcohol withdrawal may cause psychosis.
It is common for people with schizophrenia to experience deterioration in their level of functioning
for up to a year before developing frank psychotic symptoms.

Family history: medical, neurologic, psychiatric
Mental status examination
Physical examination
Blood and urine drug screen; blood alcohol level
Complete blood count
Complete metabolic panel
Urinalysis

Protect him from harm to self and others; create a supportive, structured environment
Engage in supportive and directive communications
Establish a relationship with the patient in which he feels safe
Perform acute symptom stabilizationpsycho pharmacologic treatment

Answer to Question 2

Answers: a, b, d
Side effects are dose-related and are seldom noted if lithium levels are within normal limits.

Answers: a, d, e
Symptoms of early lithium toxicity include vomiting, diarrhea, lethargy, slurred speech, muscle
weakness, and fine hand tremor. As lithium levels rise above 2.0 mEq/L, coarse hand tremor,
persistent gastrointestinal upset, mental confusion, incoordination, and sedation may occur. Acute
toxicity may result in seizures, circulatory failure, pulmonary complications, and death

Maintenance blood levels for lithium should range from 0.4 to 1.3 mEq/L. Her level is within normal limits.

Thyroid function testsHypothyroidism is a risk of long-term lithium therapy.
Creatinine and blood urea nitrogen (BUN)Impairment of renal function is a risk of long-term
lithium therapy.
Sodium levelsDehydration can contribute to lithium toxicity.

Maintain adequate hydration at all times, but especially when perspiring heavily or losing fluids as
a result of vomiting or diarrhea.
Know the symptoms of toxicity. Hold the next dose of lithium, and notify your physician
immediately if symptoms of toxicity occur.

Certain antiseizure medications are often used to treat bipolar disorder. These include valproate
(Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Both valproate and
carbamazepine require blood level monitoring. Valproate requires monitoring of liver function and
platelet levels. Carbamazepine requires routine monitoring of the complete blood count, platelets,
and liver function study results.
Two of the atypical antipsychotics, risperidone (Risperdal) and olanzapine (Zyprexa), have been
used to treat bipolar disorder.

Answer: b

Avoid stressful situations.
Maintain a regular schedule for sleep and exercise.
Eat a healthy diet.
Avoid intake of caffeine, alcohol, drugs of abuse, and over-the-counter drugs; these might cause a
relapse, even in small amounts.
Take medications consistently, the same time every day.
Keep the appointments for group or individual psychotherapy support sessions.