NR 509 Final Study Guide
Behavior/Mental Health Assessment and Modification _for_ Age
1. Assessment:
a.
b. Many mental health d_is_orders are masked by other clinical conditions;
20% of primary care outpatients have mental d_is_orders(50-70% go
undetected and untreated)
c. Physical symptoms account _for_ approx 50% of office v_is_its
d. ⅓ of physical symptoms are unexplained; in 20-25% those symptoms
become chronic
e. Symptoms and Behaviors:
i. Sorting symptom _is_ a challenge; can be unexplained symptoms
1. Patients who have unexplained symptoms depression and
anxiety exceeds 50%
ii. Physical or “somatic” symptoms account _for_ 50% of U.S. office
v_is_its
1. Pain, fatigue, palpitations, GI symptoms, sexual dysfunction,
dizziness or loss of balance
2. Symptoms that present as clusters are called “functional
syndromes” such as IBS, fibromyalgia, chronic fatigue, TMJ
d_is_order, and multiple chemical sensitivity
3. The presence of symptom overlap _is_ high in the common
functional syndromes such as fatigue, headache, sleep
d_is_turbance, pain, GI upset
iii. Patients with unexplained and somatic symptoms are often frequent
users of the health care system and termed “difficult patients”
iv. Patients with symptoms that last longer than 6 weeks are recognized as
chronic and should be screened _for_ depression and anxiety.
a. A two tiered approach _is_ recommended _for_ screening. A
brief screening with questions that yield high sensitivity then
a more detailed investigation when indicated
V. Patient who warrant a mental health screening include:
1. medically unexplained physical symptoms
2. Multiple physical or somatic symptoms
, 3. High severity of the presenting somatic symptom
4. Chronic pain
5. Symptoms longer than 6 weeks
6. Physician stating “a difficult encounter”
7. Recent stress
8. Low self-rating of overall health
9. Frequent use of health care services
10. Substance abuse
2. Adjustment _for_ age:
A. Elderly:
a. Older adults may complain of memory problems but usually _is_
due to benign _for_getfulness.
b. Older adults retrieve and process data more slowly and take longer
to learn new in_for_mation
c. Older adults may have slower motor responses and their ability to
per_for_m complex task may dimin_is_h
d. It _is_ important to try to d_is_tingu_is_h age-related changes from
manifestations of mental d_is_orders
e. Older patients are more susceptible to delirium which could be the
first sign of infection, problems with medications, or impending
dementia
B. Newborn:
a. Assess mental status of a newborn by observing newborn activities
i. Look at human faces and turn to a parents voice
ii. Ability to shut out repetitive stimuli(such as a vacuum)
iii. Bond with caregiver
iv. self-soothe
b. Assess _for_ mental status during alert periods
· Normal VS. Abnormal Findings and Interpretation
1. Attention:
a. Normal: able to focus and concentrate
b. Abnormal: inattentive and easily d_is_tracted
2. Memory
a. Normal: able to repeat immediate repetition of material given;
b. Abnormal: unable to repeat recent events
3. Orientation:
a. Normal: aware of person, place, and time
, b. Abnormal: unaware of person, place, or time
4. Perception:
a. Normal: Sensory awareness of objects in the environment
b. Abnormal: hallucinations
5. Thought Process:
a. Normal: logic, coherent, and relevant thoughts
b. Abnormal: irrational thought
6. Thought Content:
a. Normal: Has insight and judgement
b. Abnormal: impaired judgement and irrational behaviors
7. Insight
a. Normal: able to d_is_tingu_is_h normal vs. abnormal
b. Abnormal: Unable to d_is_tingu_is_h normal vs. abnormal
8. Judgement
a. Normal: good judgement
b. Abnormal: poor or bad
F· Speech Patterns
1. Note characters of speech
a. Slow speech= depression
b. Accelerated and Loud speech= mania
c. Articulation: are the words clear and d_is_tinct; does the speech have a
nasal quality
i. Dysarthria(defective articulation)
ii. Dysphonia-impaired volume, quality or pitch
iii. Aphasia-d_is_order of speech
d. Fluency: reflects rate, flow and melody of speech and the content and
words used. Abnormalities include
i. Hesitancies and gaps in flow
ii. D_is_turbed inflections such as monotone
iii. Circumlocutions, in which phrases or sentences are substituted
_for_ a word the person cannot think of ie. “what you write with”
instead of “pen”
iv. Paraphrasias, words are mal_for_med(“I write with a den”), wrong (I
write with a bar) or made up (I write with a dar)
v. Fluency abnormalities indicate aphasia from cerebrovascular
infarction.
vi. Aphasia may be receptive(impaired comprehension with fluent
speech) OR expressive(with preserved comprehension and slow
nonfluent speech)
, vii. A person who can write a correct sentence does NOT have aphasia
e. Testing _for_ Aphasia
i. Word Comprehension: Ask the patient to follow one-stage
commands such as “Point to your nose”
ii. Repetition: Ask the patient to repeat a phrase of one-syllable words
“ No ifs, ands, or buts”
iii. Naming: Ask the patient to name the parts of a watch
iv. Reading Comprehension: Ask the patient to read a paragraph aloud
v. Writing: Ask the patient to write a sentence
· Mental Status Examination
1. Five components of the mental status examination
a. Appearance and Behavior
i. Note level of consciousness: _is_ the patient awake and alert, does
the patient understand your questions and respond appropriately
1. If the patient does not respond then speak to the patient by
name in a loud voice
2. Lethargic patients are drowsy but open their eyes and look
at you, respond to questions, then fall back asleep
3. Obtunded patients open their eyes and look at you but
respond slowly and are somewhat confused
ii. Note posture and motor behavior:does the patient sit or lie quietly
or prefer to walk around; note the pace, range, and type of
movement
1. Look _for_ tense posture, restlessness, and anxious
fidgeting; the crying, pacing, and hand wringing of agitated
depression
2. The hopeless slumped posture and slowed movement of
depression
3. The agitated and expansive movements of manic
ep_is_odes
iii. Note Dress, Grooming, and Personal hygiene: how _is_ the patient
dressed, clean and presentable?, how _is_ grooming compared to
those of similar age, compare one side to the other
1. May deteriorate in depression, schizophrenia, and dementia
2. Excessive fastidiousness may be seen OCD
3. One-sided negligence may result from a lesion in the
opposite parietal cortex; usually the non-dominant side
Behavior/Mental Health Assessment and Modification _for_ Age
1. Assessment:
a.
b. Many mental health d_is_orders are masked by other clinical conditions;
20% of primary care outpatients have mental d_is_orders(50-70% go
undetected and untreated)
c. Physical symptoms account _for_ approx 50% of office v_is_its
d. ⅓ of physical symptoms are unexplained; in 20-25% those symptoms
become chronic
e. Symptoms and Behaviors:
i. Sorting symptom _is_ a challenge; can be unexplained symptoms
1. Patients who have unexplained symptoms depression and
anxiety exceeds 50%
ii. Physical or “somatic” symptoms account _for_ 50% of U.S. office
v_is_its
1. Pain, fatigue, palpitations, GI symptoms, sexual dysfunction,
dizziness or loss of balance
2. Symptoms that present as clusters are called “functional
syndromes” such as IBS, fibromyalgia, chronic fatigue, TMJ
d_is_order, and multiple chemical sensitivity
3. The presence of symptom overlap _is_ high in the common
functional syndromes such as fatigue, headache, sleep
d_is_turbance, pain, GI upset
iii. Patients with unexplained and somatic symptoms are often frequent
users of the health care system and termed “difficult patients”
iv. Patients with symptoms that last longer than 6 weeks are recognized as
chronic and should be screened _for_ depression and anxiety.
a. A two tiered approach _is_ recommended _for_ screening. A
brief screening with questions that yield high sensitivity then
a more detailed investigation when indicated
V. Patient who warrant a mental health screening include:
1. medically unexplained physical symptoms
2. Multiple physical or somatic symptoms
, 3. High severity of the presenting somatic symptom
4. Chronic pain
5. Symptoms longer than 6 weeks
6. Physician stating “a difficult encounter”
7. Recent stress
8. Low self-rating of overall health
9. Frequent use of health care services
10. Substance abuse
2. Adjustment _for_ age:
A. Elderly:
a. Older adults may complain of memory problems but usually _is_
due to benign _for_getfulness.
b. Older adults retrieve and process data more slowly and take longer
to learn new in_for_mation
c. Older adults may have slower motor responses and their ability to
per_for_m complex task may dimin_is_h
d. It _is_ important to try to d_is_tingu_is_h age-related changes from
manifestations of mental d_is_orders
e. Older patients are more susceptible to delirium which could be the
first sign of infection, problems with medications, or impending
dementia
B. Newborn:
a. Assess mental status of a newborn by observing newborn activities
i. Look at human faces and turn to a parents voice
ii. Ability to shut out repetitive stimuli(such as a vacuum)
iii. Bond with caregiver
iv. self-soothe
b. Assess _for_ mental status during alert periods
· Normal VS. Abnormal Findings and Interpretation
1. Attention:
a. Normal: able to focus and concentrate
b. Abnormal: inattentive and easily d_is_tracted
2. Memory
a. Normal: able to repeat immediate repetition of material given;
b. Abnormal: unable to repeat recent events
3. Orientation:
a. Normal: aware of person, place, and time
, b. Abnormal: unaware of person, place, or time
4. Perception:
a. Normal: Sensory awareness of objects in the environment
b. Abnormal: hallucinations
5. Thought Process:
a. Normal: logic, coherent, and relevant thoughts
b. Abnormal: irrational thought
6. Thought Content:
a. Normal: Has insight and judgement
b. Abnormal: impaired judgement and irrational behaviors
7. Insight
a. Normal: able to d_is_tingu_is_h normal vs. abnormal
b. Abnormal: Unable to d_is_tingu_is_h normal vs. abnormal
8. Judgement
a. Normal: good judgement
b. Abnormal: poor or bad
F· Speech Patterns
1. Note characters of speech
a. Slow speech= depression
b. Accelerated and Loud speech= mania
c. Articulation: are the words clear and d_is_tinct; does the speech have a
nasal quality
i. Dysarthria(defective articulation)
ii. Dysphonia-impaired volume, quality or pitch
iii. Aphasia-d_is_order of speech
d. Fluency: reflects rate, flow and melody of speech and the content and
words used. Abnormalities include
i. Hesitancies and gaps in flow
ii. D_is_turbed inflections such as monotone
iii. Circumlocutions, in which phrases or sentences are substituted
_for_ a word the person cannot think of ie. “what you write with”
instead of “pen”
iv. Paraphrasias, words are mal_for_med(“I write with a den”), wrong (I
write with a bar) or made up (I write with a dar)
v. Fluency abnormalities indicate aphasia from cerebrovascular
infarction.
vi. Aphasia may be receptive(impaired comprehension with fluent
speech) OR expressive(with preserved comprehension and slow
nonfluent speech)
, vii. A person who can write a correct sentence does NOT have aphasia
e. Testing _for_ Aphasia
i. Word Comprehension: Ask the patient to follow one-stage
commands such as “Point to your nose”
ii. Repetition: Ask the patient to repeat a phrase of one-syllable words
“ No ifs, ands, or buts”
iii. Naming: Ask the patient to name the parts of a watch
iv. Reading Comprehension: Ask the patient to read a paragraph aloud
v. Writing: Ask the patient to write a sentence
· Mental Status Examination
1. Five components of the mental status examination
a. Appearance and Behavior
i. Note level of consciousness: _is_ the patient awake and alert, does
the patient understand your questions and respond appropriately
1. If the patient does not respond then speak to the patient by
name in a loud voice
2. Lethargic patients are drowsy but open their eyes and look
at you, respond to questions, then fall back asleep
3. Obtunded patients open their eyes and look at you but
respond slowly and are somewhat confused
ii. Note posture and motor behavior:does the patient sit or lie quietly
or prefer to walk around; note the pace, range, and type of
movement
1. Look _for_ tense posture, restlessness, and anxious
fidgeting; the crying, pacing, and hand wringing of agitated
depression
2. The hopeless slumped posture and slowed movement of
depression
3. The agitated and expansive movements of manic
ep_is_odes
iii. Note Dress, Grooming, and Personal hygiene: how _is_ the patient
dressed, clean and presentable?, how _is_ grooming compared to
those of similar age, compare one side to the other
1. May deteriorate in depression, schizophrenia, and dementia
2. Excessive fastidiousness may be seen OCD
3. One-sided negligence may result from a lesion in the
opposite parietal cortex; usually the non-dominant side
