Mental Health Nursing Exam 2 Blueprint
Alzheimer’s:
Short-term goals for a pt dx with Alzheimer’s Disease
o Nutritional intake
Alzheimer’s Stages 6 and 7
o Physiological changes
Stage 6 - Moderate to severe cognitive decline
o Disorientation to surroundings is common and may not know the day,
season, or year. The person is also unable to manage AOLs without
assistance. Urinary and fecal incontinence are common.
o Psychomotor symptoms include wandering, agitation, and aggression.
Symptoms seem to worsen in late afternoon and evening (a phenomenon
termed sundowning).
Stage 7 - Severe cognitive decline
o In the end stages, the individual is unable to recognize family members.
He/she most commonly is bedfast and aphasic. Decubiti and contractions
may occur.
Early signs of dementia
= memory impairment (forgetfulness)
Stage 1 - No apparent symptoms
Stage 2 - Forgetfulness
o Losses in short term memory are frequent. The individual begins to lose
things or forget names of people.
Stage 3 - Mild cognitive decline
o In this stage, there is interference with performance, and this becomes
noticeable to others. There is difficulty recalling names or words. A
downturn is noticeable to family and close associates.
Stage 4 - Mild to Moderate cognitive decline
o The individual may forget significant events in history, experience a
declining ability to perform tasks. He/she may deny a problem exists by
covering memory loss with confabulation (creating imaginary events to fill
memory gaps).
Stage 5 - Moderate cognitive decline
o The individual loses the ability to perform some activities of daily living
independently. He/she may forget addresses, phone numbers, and names of
close relatives and friends. Disorientation to time and place becomes more
apparent.
Schizophrenia:
Increased stimulation
= (not good) increase in pacing and hallucinations
Negative symptoms of Schizophrenia
o (Doesn’t mean they’re lazy)
Importance of medical compliance with Schizophrenia
, Schizophreniform vs. Schizophrenia dx
Schizophreniform Disorder- Features are the same as Schizophrenia, but last less than
6 months.
Schizophreniform Disorder = The essential features of this disorder are identical to
those of schizophrenia except that the duration, including prodromal, active, and
residual phases, is at least 1 month but less than 6 months. If the diagnosis is made
while the individual is still symptomatic but has been so for less than 6 months, it is
qualified as “provisional.” The diagnosis is changed to schizophrenia if the clinical
picture persists beyond 6 months. Schizophreniform disorder often has a good
prognosis if the individual’s affect is not blunted or flat, if there is a rapid onset of
psychotic symptoms from the time the unusual behavior is noticed, or if premorbid
social and occupational functioning was satisfactory. Catatonic features may also be
associated with this disorder/
BOX 24–1 DSM-V Criteria for Schizophrenia Diagnosis
A. Two (or more) of the following, each present for a significant portion of time during
a 1-month period (or less if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional expression or avolition)
Symptoms of Schizophrenia
Positive Symptoms
Delusions (Fixed, False Beliefs)
Persecutory—belief that one is going to be harmed by other(s)
Referential—belief that cues in the environment are specifically referring to them
Grandiose—belief that they have exceptional greatness
Somatic—beliefs that center on one’s body functioning
Hallucinations (sensory perceptions without external stimuli)
Auditory (most common in schizophrenia)
Visual
Tactile
Olfactory
Gustatory
(Note: Hallucinations may be a normal part of religious experience in cultural contexts)
Disorganized Thinking (Manifested in Speech)
Loose association
Tangentiality
Circumstantiality
Incoherence (includes word salad)
Neologisms
Clang associations
Echolalia
Alzheimer’s:
Short-term goals for a pt dx with Alzheimer’s Disease
o Nutritional intake
Alzheimer’s Stages 6 and 7
o Physiological changes
Stage 6 - Moderate to severe cognitive decline
o Disorientation to surroundings is common and may not know the day,
season, or year. The person is also unable to manage AOLs without
assistance. Urinary and fecal incontinence are common.
o Psychomotor symptoms include wandering, agitation, and aggression.
Symptoms seem to worsen in late afternoon and evening (a phenomenon
termed sundowning).
Stage 7 - Severe cognitive decline
o In the end stages, the individual is unable to recognize family members.
He/she most commonly is bedfast and aphasic. Decubiti and contractions
may occur.
Early signs of dementia
= memory impairment (forgetfulness)
Stage 1 - No apparent symptoms
Stage 2 - Forgetfulness
o Losses in short term memory are frequent. The individual begins to lose
things or forget names of people.
Stage 3 - Mild cognitive decline
o In this stage, there is interference with performance, and this becomes
noticeable to others. There is difficulty recalling names or words. A
downturn is noticeable to family and close associates.
Stage 4 - Mild to Moderate cognitive decline
o The individual may forget significant events in history, experience a
declining ability to perform tasks. He/she may deny a problem exists by
covering memory loss with confabulation (creating imaginary events to fill
memory gaps).
Stage 5 - Moderate cognitive decline
o The individual loses the ability to perform some activities of daily living
independently. He/she may forget addresses, phone numbers, and names of
close relatives and friends. Disorientation to time and place becomes more
apparent.
Schizophrenia:
Increased stimulation
= (not good) increase in pacing and hallucinations
Negative symptoms of Schizophrenia
o (Doesn’t mean they’re lazy)
Importance of medical compliance with Schizophrenia
, Schizophreniform vs. Schizophrenia dx
Schizophreniform Disorder- Features are the same as Schizophrenia, but last less than
6 months.
Schizophreniform Disorder = The essential features of this disorder are identical to
those of schizophrenia except that the duration, including prodromal, active, and
residual phases, is at least 1 month but less than 6 months. If the diagnosis is made
while the individual is still symptomatic but has been so for less than 6 months, it is
qualified as “provisional.” The diagnosis is changed to schizophrenia if the clinical
picture persists beyond 6 months. Schizophreniform disorder often has a good
prognosis if the individual’s affect is not blunted or flat, if there is a rapid onset of
psychotic symptoms from the time the unusual behavior is noticed, or if premorbid
social and occupational functioning was satisfactory. Catatonic features may also be
associated with this disorder/
BOX 24–1 DSM-V Criteria for Schizophrenia Diagnosis
A. Two (or more) of the following, each present for a significant portion of time during
a 1-month period (or less if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional expression or avolition)
Symptoms of Schizophrenia
Positive Symptoms
Delusions (Fixed, False Beliefs)
Persecutory—belief that one is going to be harmed by other(s)
Referential—belief that cues in the environment are specifically referring to them
Grandiose—belief that they have exceptional greatness
Somatic—beliefs that center on one’s body functioning
Hallucinations (sensory perceptions without external stimuli)
Auditory (most common in schizophrenia)
Visual
Tactile
Olfactory
Gustatory
(Note: Hallucinations may be a normal part of religious experience in cultural contexts)
Disorganized Thinking (Manifested in Speech)
Loose association
Tangentiality
Circumstantiality
Incoherence (includes word salad)
Neologisms
Clang associations
Echolalia
