Chamberlain College of Nursing NR 509 ADV ASSESSMENT FINAL

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NR 509 Final Study Guide Behavior/Mental Health Assessment and Modification for Age 1. Assessment: a. b. Many mental health disorders are masked by other clinical conditions; 20% of primary care ... outpatients have mental disorders(50-70% go undetected and untreated) c. Physical symptoms account for approx 50% of office visits 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 visits 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 disorder, and multiple chemical sensitivity 3. The presence of symptom overlap is high in the common functional syndromes such as fatigue, headache, sleep disturbance, 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 stress8. 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 forgetfulness. b. Older adults retrieve and process data more slowly and take longer to learn new information c. Older adults may have slower motor responses and their ability to perform complex task may diminish d. It is important to try to distinguish age-related changes from manifestations of mental disorders 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 distracted 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. Insighta. Normal: able to distinguish normal vs. abnormal b. Abnormal: Unable to distinguish 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 distinct; does the speech have a nasal quality i. Dysarthria(defective articulation) ii. Dysphonia-impaired volume, quality or pitch iii. Aphasia-disorder 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. Disturbed 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 malformed(“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 [Show More]

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