NR 509 Final Exam Study Guide Chamberlain College of Nursing
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Course
NR 509
Institution
Chamberlain College Of Nursing
NR 509 Final Exam Study Guide.
Chapter 5
Behavior/Mental Health Assessment and Modification for Age
Unexplained conditions lasting >6weeks should prompt screening for
depression, anxiety, or both
PRIME-MD (Primary Care Evaluation of Mental Disorders). 26 questions and
take 10 minut...
chapter 5 behaviormental health assessment and modification for age
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NR 509 Final Exam Study Guide.
Chapter 5
Behavior/Mental Health Assessment and Modification for Age
Unexplained conditions lasting >6weeks should prompt screening for
depression, anxiety, or both
PRIME-MD (Primary Care Evaluation of Mental Disorders). 26 questions and
take 10 minutes to complete. Used for the 5 most common=anxiety,
depression, alcohol, somatoform, and eating disorders.
Patient indications for Mental Health Screening:
1.Medically unexplained physical symptoms-more than half have depression and
anxiety disorders
2. Multiple physical or somatic symptoms or high symptom count
3.High severity of the presenting somatic symptoms, chronic pain
4.Symptoms for more than 6 weeks
5. Physician rating as a “difficult encounter”
6. Recent stress
7.Low-self rating of overall health
8.Frequent use of health care services
9.Substance abuse.
CAGE=substance-related and addictive disorders
Modification for Age
Elderly:
-Complain of memory problems but usually is due to benign forgetfulness
-Retrieve and process data more slowly and take longer to learn new
information
-Slower motor responses and their ability to perform complex task may
diminish
-Important to distinguish age-related changes from manifestations of mental
disorders
More susceptible to delirium which can be the first sign of infection, problems
with medications, or impending dementia
Infant:
Assess mental status of a newborn=observing newborn activities
1.Look at human faces and turn to parents voice
2.Ability to shout out repetitive stimuli
3. Bond with caregiver
4.Self-soothe
Normal VS. Abnormal Findings and Interpretation
Mood disorders: compulsions, obsessions, phobias, and anxieties
-Lethargic: drowsy, but open their eyes and look at you, respond to questions,
and then fall asleep.
-Obtunded: open their eyes and look at you but respond slowly and are
somewhat confused.
-Agitated depression: crying, pacing, and handwringing
, -Depression: the hopeless slumped posture and slowed movements.
-Grooming and personal hygiene may deteriorate: Depression, schizophrenia,
and dementia
-Manic Episode: the agitated and expansive movement of a manic episode
-Obsessive-Compulsive Disorder: Excessive fastidiousness
-Lesion parietal cortex: one side neglect in the opposite parietal cortex,
usually in the nondominant side
-Parkinsonism: facial immobility
-Paranoia: anger, hostility, suspiciousness, or evasiveness
-Mania: Elation and euphoria
Schizophrenia: flat affect and remoteness
Apathy (dull affect with detachment and indifference): dementia, anxiety, and
depression
Hallucination: schizophrenia, alcohol withdrawal, and systemic toxicity
Amnestic Disorders: impaired memory or new learning ability and reduce
social or occupational functioning but lack the global features of delirium and
or dementia. Anxiety and depression, and intellectual disability may also
cause recent memory impairment.
Calculating ability: poor performance = dementia or aphasia
Variations and abnormalities in thought processes:
1.Circumstantiality: The mildest thought disorder, consisting of speech with
unnecessary detail, indirections, and delay in reaching the point. Some topics may
have a meaningful connection
Occurs in people with obsessions
2. Derailment: Tangential, speech with shifting from topics that are loosely
connected or unrelated. The patient is unaware of the lack of association.
Schizophrenia, manic episodes, and other psychotic disorders
3.Flight of ideas: an almost continuous flow of accelerated speech with abrupt
changes from one topic to the next. Changes are based on understandable
associations, play on words, or distracting stimuli, but ideas are not well connected.
Manic episodes
4.Neologisms: invented or distorted words, or words with new and highly
idiosyncratic meanings
-Schizophrenia: psychotic disorders, and aphasia
5.Incoherence: Speech that is incomprehensible and illogical, with lack of
meaningful connections, abrupt changes in topic, or disordered grammar or word
use. Flight of ideas, when severe, may produce incoherence
-Schizophrenia
6.Blocking: Sudden interruption of speech in mid-sentence or before the idea is
completed “losing the thought”
-Schizophrenia
7.Confabulation: Fabrication of facts or events, to fill in the gaps from impaired
memory
-Korsakoff syndrome from alcoholism
8.Perseveration: persistent repetition of words or ideas
-Schizophrenia or other psychotic disorders
9. Echolalia: Repetition of the words and phrases of others
-Manic episodes or Schizo
,10.Clanging: Speech with choice of words based on sound, rather than meaning, as
in rhyming and punning. Example: “look at my eyes and nose, wise eyes and rosy
nose. To to one, the ayes have it!”
-Schizo and manic episodes
Abnormalities of Perception
1. Illusions: misinterpretations of real external stimuli, such as mistaking rustling
leaves for the sounds of voices
-Grief, delirium, PTSD, Schizo
2.Hallucinations: Perception-like experiences that seem real but, unlike illusions,
lack actual external stimulation. The person may or may not recognize the
experiences as false. May be auditory, visual, olfactory, gustatory, tactile, or
somatic.
-PTSD, Schizo, delirium, dementia, alcoholism
Abnormalities of Thought Content
1.Compulsions
-repetitive behaviors feel driven to perform in response to an obsession
(anxiety disorders)
2.Obessions
-Recurrent persistent thoughts, images, or urges
3.Phobias
-Persistent irrational thoughts, compelling desire to avoid provoking stimulus
4. Anxieties
5. Feelings of unreality
6.Feelings of Depersonalization
7.Delusions
Erotomanic: the belief that another person is in love with the individual
Somatic: involves body functions
Unspecified: includes delusions of reference without a prominent
persecutory or grandiose component
Speech Patterns
-Slow speech: depression
-Accelerated speech: mania
-Articulation: are the words clear and distinct: does the speech have a nasal
quality
-Dysarthria: defective articulation “slurred speech”
-Dysphonia: results from impaired volume, quality, or pitch of voice.
Difficulty speaking due to a physical disorder of the mouth, tongue, throat, or
vocal cords.
-Aphasia: the loss of ability to understand (receptive/Wernicke) or express
speech (expressive/Broco aphasia)
-Brocas aphasia: patients articulate very slowly and with a great deal of
effort. Nouns, verbs, important adjectives are usually present and only small
grammatical words are dropped from speech "Well…..cat and…..up……..um,
well, um…forget it"
-Wernicke's aphasia the patient can speak effortlessly and fluently, but his
words often make no sense “the coffee cat looks crazy still”
-Cerebrovascular infarction
, -Fluency: fluency reflects the rate, flow, and melody of speech and the content and
use of words. Abnormalities
-Hesitancies and gaps in the flow and rhythm of words
-Disturbed inflections, such as monotone
-Circumlocutions: phrases or sentences are substituted for a word the person
cannot think of. Example “what you write with for “pen”
-Paraphasia: malformed, wrong, or invented
Testing for Aphasia
-Word comprehension: ask the patient to follow one-stage commands such
as “Point to your nose”
-Repetition
-Naming
-Reading comprehension
-Writing
Mental Status Examination
Brief test used to screen for cognitive dysfunction or dementia and follow the
patients course over time.
Orientation
Short-term memory-retention/recall
Language
Attention
Calculation
Constructive Praxis
Example of findings that suggest dementia: “The patient appears sad
and fatigued; clothes are wrinkled. Speech is slow and words are mumbled.
Thought processes are coherent, but insight into current life reverses is
limited. The patient is oriented to person, place, and time. Digit span, serial
7s, and calculations accurate, but responses delayed. Clock drawing is good.
Screening for Depression
High Yield Screening Questions for office practice: 1. over the past 2 weeks,
have you felt down, depressed, or hopeless? 2. Over the past 2 weeks, have you felt
little interest or pleasure in doing things (anhedonia)?
Symptoms of depression: low self-esteem, loss of pleasure (anhedonia), sleep
disorder, difficulty concentrating. Depression tends to be long-lasting and can recur.
Suicide is the second leading cause of death among 15-24-year-old. Suicide rate are
the highest among those ages 45 to 54, followed by elderly adults 85 years old or
older. 90 % of suicide is non-Hispanic whites.
Other symptoms of depression: headaches, muscle aches, fatigue
Generalized Anxiety Disorder
-Most common mental disorder in primary care
-High Yield Screening Questions for office practice:
1. Over the past 2 weeks, have you been feeling nervous, anxious, on edge, unable
to stop or control worrying?
2. Over the past 4 weeks, have you had an anxiety attack-suddenly feeling fear or
panic?
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