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RNSG 2213 MH Module 3.
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RNSG 2213 MH Module 3: Schizophrenia.progressive, chronic degenerative disease of unknown cause that involves
extrapyramidal system—neurodegeneration of substantia nigra at
beginning of dopamine tracts; characterized by 4 cardinal symptoms—
tremors, bradykinesia, rigidity, postural instability. Pathophysiological cause
is imbalance of acetylcholine and dopamine (deficiency); treated w/ agents
that increase dopamine/dopaminergic levels - Correct Answers
Parkinson's disease
caused by blockade of dopamine receptors in the basal ganglia at the end
of the dopamine tracts; can mimic symptoms of Parkinson's - Correct
Answers Extrapyramidal side effects (EPSEs)
akathisia, akinesia/bradykinesia, dystonias, drug-induced parkinsonism,
tardive dyskinesia, neuroleptic malignant syndrome, Pisa syndrome -
Correct Answers 7 types of EPSEs
What populations are at higher risk for developing EPSEs? - Correct
Answers Women; patients with first episode of schizophrenia, older adults,
& patients w/ affective symptoms
most common EPSE; subjective feeling of restlessness; elicits restless
legs, jittery feelings, nervous injury. Responds poorly to treatment - Correct
Answers Akathisia
absence of movement; EPSE - Correct Answers Akinesia
EPSE; slowed movement; includes weakness, fatigue, painful muscles,
anergia - Correct Answers Bradykinesia
EPSE; abnormal postures caused by involuntary muscle spasms;
manifests as sustained, twisted, & contracted positioning of limbs, trunk,
neck, or mouth. Tends to appear in early treatment (w/in 3 days) and
responds to anticholinergics, which may have to be given parenterally. -
Correct Answers Dystonias
, type of dystonia; contracted positioning of neck - Correct Answers
Torticollis
type of dystonia; contracted positioning of eyes upward - Correct Answers
Oculogyric crisis
type of dystonia; potentially life threatening - Correct Answers Laryngeal-
pharyngeal constriction
EPSE; cardinal symptoms of tremor, rigidity, bradykinesia, postural
instability - Correct Answers Drug-induced parkinsonism
EPSE; "late appearing" usually after about 6 months of antipsychotic
therapy. Thought to be caused by hypersensitivity of dopamine receptors in
basal ganglia r/t chronic use of antipsychotics. Can be bothersome,
embarrassing. Typically includes tongue writhing, tongue protrusion, teeth
grinding, lip smacking. Often irreversible, but can be averted if caught it
time. Prevention is most important approach. - Correct Answers Tardive
dyskinesia (TD)
EPSE; potentially lethal side effect of antipsychotics; cardinal symptoms
include hyperthermia (temp of 101-103), rigidity, autonomic dysfunction,
LOC changes, elevated CPK (Creatine phosphokinase). Can be treated w/
muscle relaxants (dantrolen/Dantrium) & w/ centrally acting dopaminergic
(bromocriptine/Parlodel). Predisposing factors include youth, male, high
potency neuroleptic, new patient. - Correct Answers Neuroleptic
malignant syndrome (NMS)
EPSE; condition marked by pt leaning to one side; can be acute or tardive.
Older adults more vulnerable. - Correct Answers Pisa syndrome
What is the nursing intervention for akathisia? - Correct Answers Be
patient, reassure jittery pt that you understand the need to move and that
appropriate drug interventions can help differentiate akathisia and agitation.
B/c akathisia is major cause of noncompliance, switching to different class
of antipsychotic may be necessary
What is the nursing intervention for akinesia/bradykinesia? - Correct
Answers May respond to anticholinergics; may want to reduce
dose/change antipsychotics
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