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PNC 103 lecture > final exam study grid > Flashcards

final exam study grid Flashcards

1
Q

____ is #1 priority

A

safety; especially in psychiatry

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2
Q

hyperopia

A
  • farsightedness
  • caused when the globe or eyeball is too short from the front to the back, causing light rays to focus behind the retina
  • people who are hyperopic see faraway images more clearly than nearby images
  • hyperopia is corrected w/ convex lenses
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3
Q

myopia

A
  • nearsightedness
  • caused by light rays focusing in front of the retina. the eyeball is elongated; the light rays do not reach the retina
  • distance vision is blurred
  • myopia is corrected w/ concave lenses
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4
Q

astigmatism

A
  • results from unequal curvatures in the shape of the cornea
  • when parallel light ray enter the eye, the irregular cornea causes the light rays to be refracted to focus on two different points
  • caused blurred vision w/ distortion
  • caused by injury, inflammation, corneal surgery, or an inherited autosomal, dominant trait
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5
Q

presbyopia

A
  • age related condition in which the eye’s lens gradually loses its elasticity
  • this makes it difficult for the lens to change shape, reducing its ability to focus light onto the retina to see close objects
  • occurs at about age 40
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6
Q

retinopathy

A
  • a disorder in which vascular changes occur in the retinal blood vessels, most commonly w/ diabetes
  • pathological changes in diabetic retinopathy are related to excess glucose, changes in retinal capillary walls, formation of microaneurysms, and constriction of retinal blood vessels
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7
Q

nonproliferative retinopathy

A
  • results from microaneurysms on the retinal capillary walls, occluded vessels, or hard exudates
  • microaneurysms may leak blood into the central retina or macula
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8
Q

proliferative retinopathy

A
  • characterized by the formation of new blood vessels
  • they grow into the retinal and optic disc area to increase the blood supply to the retina
  • the newly formed blood vessels are fragile and abnormal, and they often leak blood into the vitreous and retina
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9
Q

signs and symptoms of proliferative retinopathy

A
  • central and visual acuity or color vision may decrease due to macular edema
  • some patients have no symptoms until vision is lost
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10
Q

treatment for proliferative retinopathy

A
  • treatment of diabetic retinopathy is to stop the leakage of blood and fluid into the vitreous and retina
  • surgical or pharmacological methods
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11
Q

retinal detachment

A
  • a separation of the retina from the choroid layer beneath it
  • allows fluid to enter the space between the layers
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12
Q

3 possible causes of retinal detachment

A
  • a hole or tear in the retina that allows fluid to flow between the two layers
  • fibrous tissue in the vitreous humor that contracts and pulls the retina away from its normal position
  • fluid or exudate accumulation in the subretinal space that separates the retinal layers
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13
Q

signs and symptoms of retinal detachment

A
  • sudden change in vision
  • patient may report seeing flashing lights and then floaters
  • floaters caused by bleeding into the vitreous humor
  • flashing lights caused by vitreous traction on the retina
  • when the retina detaches, patients often describe it as looking through a veil, or “cobwebs”
  • painless
  • loss of visual acuity in affected eye
  • loss of peripheral vision
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14
Q

treatments for retinal detachment

A
  • emergency medical treatments is required to retain vision
  • laser surgery
  • pneumatic retinopexy
  • scleral buckling
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15
Q

laser surgery for retinal detachment

A
  • focuses a laser beam at the torn area of the retina, causing a controlled burn
  • this forms scars around the tear and reattaches the retina to surrounding tissue
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16
Q

cryopexy

A
  • the placement of a supercooled probe on the sclera over the affected area
  • the probe freezes and scars the tear or hole (similar to laser procedures)
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17
Q

pneumatic retinopexy

A
  • it involves injecting air or gas into the eye chamber to hold the retina in place
  • the patient must be extremely compliant w/ the treatment regimen
  • they must recline for about 16 hours before the procedure so the retina can fall back toward the choroid
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18
Q

scleral buckling

A
  • a silicon buckle under a thin band of silicon around the sclera is tightened to create an indentation that brings the choroid in contact w/ the retina
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19
Q

complications w/ retinal detachment

A
  • there is risk of increased intraocular pressure (IOP), retinal tears, and recurrent retinal detachment
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20
Q

glaucoma

A
  • a group of disease that damages the optic nerve
  • the optic nerve transmits visual information from the eye to the brain
  • the damage to this nerve is silent, progressive, and irreversible
  • loss of peripheral vision occurs, followed by reduced central vision and eventually blindness
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21
Q

primary open angle glaucoma (POAG)

A
  • most common type
  • when the drainage system of the eye, the trabecular meshwork and scleral venous sinus, degenerates and blocks the flow of aqueous humor and/or there is increased aqueous production
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22
Q

signs and symptoms of POAG

A
  • develops bilaterally
  • onset is gradual and painless
  • peripheral vision gradually decreases
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23
Q

treatments for POAG

A
  • focuses on decreasing IOP by opening the aqueous flow
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24
Q

medications for POAG

A
  • cholinergic agents (miotics)
  • beta blockers
  • laser trabeculoplasty
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25
Q

cholinergic agents (miotics)

A
  • physostigmine
  • pilocarpine
  • constricts the pupil which pulls the iris away from the drainage canal
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26
Q

betablockers

A
  • timolol
  • betaxolol
  • helps decreases IOP
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27
Q

laser trabeculoplasty

A
  • a narrow laser beam opens drainage in the trabecular meshwork to allow aqueous humor to flow freely
  • selective laser trabeculoplasty uses low level laser that affects selected pigmented tissue in the eye to improve drainage of aqueous humor through the trabecular meshwork
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28
Q

angle closure glaucoma (ACG)

A
  • also known as narrow angle glaucoma
  • occurs in people who have an anatomically narrowed angle at the junction where the iris meets the cornea
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29
Q

signs and symptoms of angle closure glaucoma

A
  • unilateral, rapid onset
  • severe pain over the affected eye
  • decreased vision
  • halos around lights
  • headache
  • nausea and vomiting
  • when nearby eye structures such as the iris protrude nto the anterior chamber, the angle is occluded, blocking the flow of aqueous fluid
  • medical emergency and results in partial or total bindness
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30
Q

many categories of medications are contraindicated with POAG and ACG regardless of route and can cause blockage of the eye’s drainage system. they include…

A
  • glucocorticoids (topical, ocular, oral, or inhaled)
  • systematic sympathomimetics (ephedrine, pseudophedrine-containing medications, decongestants, tricyclic antidepressants, antipsychotics, and selective serotonin uptake inhibitors)
  • anticholinergics
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31
Q

cataracts

A
  • an opacity in the lens of the eye that may cause a loss of visual acuity
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32
Q

signs and symptoms of cataracts

A
  • loss of vision
  • difficulty w/ night vision, reading fine print or seeing in bright light
  • increased sensitivity to glare such as driving at night
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33
Q

myopic shift

A

increase in nearsightedness

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34
Q

surgical management for cataracts

A
  • when cataracts begin to interfere w/ daily living and quality of life, intraocular lens implant surgery is recomended
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35
Q

macular degeneration

A

dry (atrophic)
wet (exudative)

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36
Q

dry (atrophic) macular degeneration

A
  • accounts for 70% to 90% of cases
  • photoreceptors in the macula fail and are not replaced because of age
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37
Q

wet (exudative) macular degeneration

A
  • retinal tissue degenerates, allowing vitreous fluid or blood into the subretinal space
  • new fragile blood vessels from (angiogenesis)
  • this compromises the macuar tissue, causing subretinal edema. eventually, fibrous scar tissue forms, severely limiting central vision
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38
Q

signs and symptoms of dry macular degeneration

A
  • slow, progressive loss of central and near vision
  • usually bilaterally in varying degrees
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39
Q

signs and symptoms of wet macular degeneration

A
  • sudden onset
  • loss of central and near vision
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40
Q

treatments for dry macular degeneration

A
  • no treatments for dry AMD
  • most patients with dry AMD do not lose peripheral vision or become totally blind and instead are legally blind
  • low vision telescopic glasses can enhance remaining vision
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41
Q

treatments for wet macular degeneration

A
  • treated w/ intermittent injection into the eye of an anti angiogenesis medication (eg ranibizumab [lucentis] or aflibercept [eylea])
  • medications that are antiangiogenetic prvent formation of fragile blood vessels that can leak and bleed
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42
Q

common warning signs of abuse

A
  • delay in seeking treatment for injuries, minimizing injuries
  • history of being “accident prone”
  • pattern of injuries not accidental looking; for example, identical burns on bottom of feet, identical injuries on both sides of head
  • multiple injuries in varying stages of healing
  • conflicting stories from victim and abuser about cause of injury
  • inconsistency between history and injury
  • unusual, even bizarre, explanation for injuries
  • repeated visits to EDs or clinics
  • previous reports of abuse
  • patient reporting abuse
  • patient fearful of caregiver or partner
  • visits to a variety of doctors, emergency rooms for treatment to avoid a record of treatment
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43
Q

common characteristics of victims in elder abuse

A
  • evidence of malnutrition, dehydration, poor hygiene, pressure injuries, not receiving needed medical care
  • unusual injuries such as twisting fractures, cigarette burns on face or back, perforated eardrums from being slapped
  • evidence of sexually transmitted infections, unusual genital injuries
  • deterioration in mental status including confusion and depression
  • sudden lack of funds in person who previous had resources
  • frail, dependent, possible mental impairment requiring care from family member or hired help
  • extreme dependency, attachment to new caregiver
  • evidence of inappropriate use of restraints
  • abandonment of elder in emergency room, nursing home
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44
Q

common characteristics of abusers in elder abuse

A
  • often living w/ victim, lacks resources to live elsewhere
  • refuses to allow diagnostic tests, hospitalization
  • often much younger than patient
  • chases victim’s social security or pension check
  • sudden, intense involvement with patient with little input from other family members
  • discourages patient from contacting others
  • evidence of drug or alcohol abuse or mental illness
  • expects dependent elder to meet caregiver’s needs
  • caregiver overwhelming w/ patient’s care needs, demonstrates frustration and resentment, isolated w/ limited assistance
  • elderly spouse w/ dementia who has challenges in managing stress
  • coerces senior to change will to caregiver’s benefit
  • shows no guilt or rationalizes actions
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45
Q

specific examples of elder abuse can include

A
  • hitting
  • shoving
  • social isolation
  • leaving the victim in soiled linens
  • withholding food and/or water
  • using inappropriate restraints
  • making threats
  • forcing the victim to sign over financial affairs or change a will
  • sexually molesting the victim
  • insulting the victim
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46
Q

abusers may present with some of the following traits

A
  • inconsistent explanation of injuries of the victim
  • failure to show empathy for the victim
  • demanding to take victim home and refuse of hospitalization for the injured victim
  • speaking for the victim
  • criticizing the victim
  • abusing family pets
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47
Q

characteristics for child victims of all ages; w/ greatest risk < age 3 (including infants)

A
  • blamed for family conflict
  • low self esteem
  • fear of parent or caretaker
  • cheating, lying, low achievement in school
  • signs of depression, helplessness
  • one child sometimes singled out in family due to being labeled as “difficult”; child may be the product of unwanted pregnancy, remind the parents of someone they dislike or even themselves, may hve been born premature, or may hve a chronic illness/disability
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48
Q

characteristics of victims of domestic/spouse/intimate partner

A
  • low self esteem
  • self blame for partner’s actions
  • sense of helplessness to escape abuse
  • isolation from family and friends
  • views self as subservient to partner
  • economic dependence on abuser
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49
Q

characteristics of victims of elder abuse

A
  • older than 75
  • mentally or physically impaired
  • isolated from others
  • female
  • increased risk for exacerbation of pre existing conditions or of premature death
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50
Q

broad range of traits of victims of abuse, two most common

A

low self esteem
reliance on the abuser

51
Q

low self esteem and abuse

A
  • people who have not learned to be assertive and to say what they think and feel or to speak out for what they need and want may not be able to call up the strength they need to ward off an attack.
  • they may be easily manipulated by the abuser into believing either that they deserved the attack or that the abuser is truly repentant and will not abuse them again
  • they will begin to make up reasons to rexcuse the abuser’s behavior and may accept responsibility for the abuser’s actions
52
Q

reliance on the abuser

A
  • people who are reliant on the abuser for financial support as well as emotional and physical support are vulnerable to attacks from the abuser
  • this holds true for all age groups of people who are abused
53
Q

indications of sexual abuse

A
  • violent r nonviolent sexual contact or activity that is not wanted by the receiver
    that could include foreplay, touching, kissing, and mutual masturbation, as well as oral sex and vaginal or anal intercourse
  • frequent bladder or vaginal infections
  • bloody underwear
  • evidence of incest: sexual intercourse between persons so closely related that marriage is illegal
  • evidence of rape: forcible, degrading, nonconsensual sexual intercourse accompanied by violence and intimidation
  • “date rape” - seen frequently in high school and college students (belief surrounding date rape is that the person who pays for the date is entitled to sex from the other person
54
Q

nursing indications for suspected sexual abuse

A
  • carefully use rape kit and preserve evidence
  • provide safety and privacy
  • be nonjudgmental
  • show empathy
  • be advocate for patient
  • maintain calm milieu
  • know own thoughts and feelings regarding abuse and abuser
  • know agency policies
  • assist w/ contacting outside agencies (eg law enforcement, clergy) as requested by patient
55
Q

indicators of physical abuse: any actions such as…

A
  • hitting
  • burning
    0- withholding food, water, and other basic needs
  • other activities that go beyond accidental contact
  • request to stop ignored or mocked by the perpetrator
  • activity repeating itself in future situations
  • frequent visits to emergency department (for all forms of abuse)
  • excessive bruising or bruising on unusual areas of body
  • withdrawal from friends and social groups
56
Q

nursing interventions for suspected physical abuse

A
  • provide safety
  • be nonjudgmental
  • show empathy and reassunce
  • take the time to time to develop a trusting relationship
  • be an advocate for patient
  • maintain calm milieu
  • reinforce self esteem
  • reinforce that victims should not blame themselves for the abuse
  • know own thoughts and feelings regarding abuse and abuser
  • know agency policies
  • assist w/ contact outside agencies (eg law enforcement, clergy as needed
57
Q

indicators of emotional abuse

A
  • willful use of words or actions that undermine self esteem; includes the ‘silent treatment” (causes the other person to guess at the problem) and other types of game playing, name calling, frequent degrading and harsh and/or cruel criticism
58
Q

nursing interventions for suspected emotional abuse

A
  • same as for physical abuse
  • counter patient’s self depreciating comments
  • reinforce positive traits
59
Q

indicators of child abuse/neglects

A

-sexual, physical, and/or emotional abuse: act of comission (doing) or omission (not doing)
- victim may believe that abuse is child’s own fault
- child confused about what is happening and why
- abuer often larger, more powerful than the child, which is intimidating
- excessive absences from school
- child may display inappropriate behaviors, eg sexual

60
Q

nursing interventions for suspected child abuse/neglect

A
  • same as for physical abuse
  • encourage use of play and art for child to express feelings
  • provide touch and support if the child will accept
  • if child uncomfortable being touched, respect that and provide support in other ways
  • accept that child may be mistrustful
61
Q

indicators of domestic violence/intimate partner violence

A
  • physical, emotional, sexual, and “button-pushing” kinds of abuse
  • most typically reported by women
  • kept isolated from friends and family
  • withdrawal from friends and social groups
  • use of substance abuse to cover distress
62
Q

nursing interventions for suspected domestic violence/intimate partner violence

A
  • same as for physical abuse
  • recognize that victim may return to abuser initially
  • help identify possible threats that victim is facing eg child custody, loss of financial security
63
Q

indications of elder abuse

A
  • victim is usually dependent on abuser in some way
  • may be slapped, burned, tripped, neglected, humiliated
  • can include economic abuse where victim’s funds are misused or stolen
64
Q

nursing interventions for suspected elder abuse

A
  • same as for physical abuse
  • listen to patient’s concerns and report them even if patient is confused
  • provide follow-up in the home
65
Q

general nursing interventions for abuse

A
  • ensure safety
  • know your own thoughts and feelings about abuse
  • remain nonjudgmental/show empathy
  • know your agency policy and use your resources
66
Q

In the 1950s….were developed which opened up the world for people living with ____ and for those caring for them

A

psychotropics (phenothiazines); mental disorders
- phenothiazines calm and tranquilize people
- some patients improved so dramatically that it was o longer necessary f them to remain hospitalized and dependent on others

67
Q

psychotropics were so effective, that______

A
  • state hospitals and other facilities dedicated to the care and treatment with mental illness saw a decline in population
  • it became costly to run these large buildings and ontinue to employ staff
  • this along with new laws pertaining to this population’s care resulted in a movement called deinstitutionalization
68
Q

Due to psychotropics, people who formerly required long hospital stays were now able to….

A

leave the institution and return to their communities

69
Q

today, hospitals treat patients with psychological needs according to the….

A

size of the hospital and its resources

70
Q

to comply wih regulations surrounding mental health issues…

A

these patients may be seen in a hospital emergency department and then referred to other clinics or hospitals

71
Q

communities large enough to suport such programs may provide

A

in house mental health treatment as well as outpatient treatment and after care

72
Q

with the effectiveness of phenothiazines, state hospitals and other facilities…

A

declined and closed down.
- this allowed this population to live in the community

73
Q

milieu

A

the therapeutic environment
- the milieu is the setting that provides safety and where stress is minimized during the patient’s day
- must be comfortable and safe
- milieu therapy is intended to combine social and therapeutic environments, creating the opportunity for at= therapeutic interaction between the nurse and patient on a regular basis
- respect is also part of the therapeutic milieu. nurses cannot move walls and change decorating themes on a mental health unit, but you can allow the patient to choose the room for therapy or move to an area where the patient feels more comfortable
- nurses work to keep the environment calm and quiet arranging for room mate changes if needed

74
Q

coping

A
  • the way a person deals with a stressor psychologically, physically, and behaviorally
  • it is the ability a person develops to deal consciously with problems and stress
  • individuals have different methods of coping or dealing with their stressors
  • effective coping skills are specifically identified to offer healthy choices to the patient
  • ineffective coping is when the coping techniques people try are not successful or are hazardous
  • people often allow themselves to fall into habits that give them he illusion of coping
75
Q

defense mechanisms

A
  • mental; “pressure valves”
  • the purpose of defense mechanisms is to reduce or eliminate anxiety
  • when used in very small doses, they can be helpful. it is when they are overused that they become ineffective and can lead to a brekdown of the personality
76
Q

commonly used defense mechanisms

A
  • denial
  • depression
  • dissociation
  • rationalization
  • compensation
  • reaction formation
  • regression
  • projection
  • displacement
  • isolation
  • conversion reaction
  • avoidance
  • scapegoating
77
Q

denial

A
  • usually the first defense learned and used
  • unconscious refusal to see reality
78
Q

repression

A
  • an unconscious bearing or “forgetting” mechanism
  • excluding or withholding from the consciousness events or situations that are unbearable
  • he stepped deeper than “denial”
79
Q

dissociation

A
  • painful events are situation are separated or dissociated from the conscious mind
  • could be described as an “out of body experience”
80
Q

rationalization

A
  • substitution acceptable reasons for the true causes for personal behavior because admitting the truth is too threatening
81
Q

compensation

A
  • making up for something a person perceives as an inadequacy by developing some other desirable trait
82
Q

reaction formation (overcompensation)

A
  • similar to compensation, except the person usually develops the opposite trait
83
Q

regression

A
  • emotionally returning to an earlier time in life when there was far less stress
  • commonly seen in patients while hospitalized
84
Q

sublimation

A
  • unacceptable traits or characteristics are diverted into acceptable traits or characteristics
  • ex people who choose not to have children run a daycare center
85
Q

projection

A
  • attributing feelings or impulses unacceptable to oneself to others
86
Q

displacement

A
  • the “kick the dog” syndrome
  • transferring anger and hostility to another peon or object that is perceived to be less powerful
87
Q

isolation

A
  • emotion that is separated from the original feeling
88
Q

conversion reaction

A
  • anxieties channeled into physical symptoms.
  • often the symptoms disappear soon after the threat is over
89
Q

avoidance

A
  • unconsciously staying away from events or situations that might lead to feelings of aggression or anxiety
90
Q

scapegoating

A
  • blaming others
91
Q

stress produces ____

A

anxiety

92
Q

eustress

A

the stress from positive experiences, such as getting married or receiving a promotion at work

93
Q

stressor

A

any person or situation that produces anxiety responses
- stress and stressors are different for each person; therefore, it is important that you ask what the stress producers are for each patient

94
Q

central nervous system response to stress

A
  • flight, fight, or freeze response occurs
  • alterations take place in the sympathetic nervous system
  • brain signals the body to react
95
Q

outcome of CNS response to stress

A
  • increase in blood pressure
  • increase in heart rate
  • increase in blood glucose - increase in
96
Q

endocrine system response to stress

A
  • message sent to the brain from the hypothalamus
  • liver produces more glucose for quick energy
  • increase in thyroid stimulating hormone (TSH) boosts metabolism
97
Q

outcome of endocrine system response to stress

A
  • production of stress hormone
  • increase in steroid hormone
98
Q

respiratory system response to stress

A
  • alteration in air flow
  • alteration in gas exchange
99
Q

outcome of respiratory system response to stress

A
  • increase in respiration (hyperventilation)
  • may create shortness of breath
  • exacerbates problems for people with chronic obstructive pulmonary disease (COPD)
  • asthma attach
100
Q

cardiovascular system response to stress

A
  • increase in blood pressure
  • increase in heart rate
  • constriction of coronary vessels
  • increased epinephrine and norepinephrine
101
Q

outcomes of cardiovasular system response to stress

A
  • inflammation of coronary arteries
  • increased risk of heart attack and/or stroke
  • long term negative effect on kidneys and endocrine system
102
Q

gastrointestinal system response to stress

A
  • increased stomach acid
  • increased or decreased appetite
  • affects peristalsis
  • weakens intestinal barriers
103
Q

outcomes of gi system response to stress

A
  • diarrhea
  • constipation
  • gas
  • bloating
  • nausea and/or vomiting
  • heartburn
  • gastroesophageal reflux
104
Q

musculoskeletal system response to stress

A
  • increase or decrease in muscle contraction
  • affects respiratory accessory muscles
105
Q

outcomes of musculoskeletal system response to stress

A
  • muscle tension
  • tension headaches, migraines
  • backache, muscle spasms
106
Q

reproductive system response to stress

A
  • alterations in menstrual/ovulation cycle
  • alterations in sexual function
107
Q

outcomes of reproductive system response to stress

A
  • irregular menstrual periods
  • increased cramping and menstrual pain
  • erectile dysfunction
  • decreased libido (sexual drive)
  • increased susceptibility to bacterial and viral infections/other illnesses
108
Q

mental status exam: appearance

A
  • observation of patient stress, hygiene, posture, actions, and reactions to hcp
  • observe for wounds and scars
  • normal parameters: clean, hair combed; clothing intact and appropriate to weather or situation; teeth in good repair; posture erect; cooperates with hcp
  • alterations to normal assessment: displays either unusual apathy or concern about appearance
109
Q

mental status exam: behavior

A
  • objective: normal paraneters; cooperates with hcp, makes direct eye contact
  • alterations to normal assessment
  • displays uncooperative, hostile or suspicious type behaviors toward hcp; restless
110
Q

mental status exam: level of consciousness

A
  • subjective and objective assessment of the patient’s degree of alertness (wakefulness)
  • normal parameters: awareness is measured on a continuum that ranges from unconsciousness to mania. “normal alertness” is the desired behavior
  • alert: patient can open eyes, look at you, and respond fully and appropriately
  • alterations to normal assessment: if the pt is difficult to arouse and keep awake or finds it difficult to feel calm, that is not within normal limits
  • lethargic, drowsy; can open eyes, look at the examiner, and respond. falls back to sleep easily.
  • obtunded: open eyes when commanded to and looks at you, offers confused responses, has lack of interest in the environment
  • stuporous: wakens only with painful stimuli. verbal responses slow or absent; falls back into unresponsive state when stimuli ceases
  • comatose: unarousable to any stimuli
111
Q

mental status examination: orientation

A
  • the degree of patient’s knowledge of self
  • normal parameters: orientation measures the person’s ability to know who they are, where they are, and the day and time, usually within one or two days of the actual day and time
  • alterations to normal assessment: abnormal results of orientation are the patient’s inability to correctly answer questions pertaining to themselves or to commonly known social information
112
Q

mental status examination: content of thought

A
  • subjective assessment of what the patient is thinking and the process the patient uses in thinking
  • processes: assess the logic, relevance, organization, and coherence of the pts thought processess
  • content: pay attention for abnormalities of thought content and ask questions designed to reveal these abnormalities
  • interview them to discover if they have any abnormal perceptions
  • normal parameters: usually undertaken by the psychologist or psychiatrist to determine the patient’s general thought content and pattern. although nurses may contribute to the assessment of thought by documenting statements the patient makes regarding daily care and routines
  • alterations to normal assessment: behaviours including flight of ideas, loose associations, phobias, delusions, and obsessions may become apparent
113
Q

mental status examination: memory

A
  • subjective assessment of the patient’s ability to recall recent
  • and remote information and/or events
  • recent memory: recall of events that are immediately passed or up to withintwo weeks before the assessment. one measurement technique is to verbally list 5 items, and after one minute the patient shouldbe able to recall 4-5 of those items
  • remote memory: recall events of the past beyond 2 weeks before assessment. questions pertaining to where they were born, where they went to grade school, and so on
114
Q

mental status examination: speech and ability to communicate

A
  • objective and subjective assessment of aspecs of patient’s use of verbal and nonverbal commnication
  • normal parameters: patient can coherently produce words appropriate to age and education. rate of speech reflects other psychomotor activity. volume is not too soft or too loud
    1. quantity: talkative or silent?
    2. rate: too fast, too slow, just right?
    3. volume: too loud, too quiet, just right?
    4. articulation: can you understand what the patient is saying physically? if not, why not?
  • alterations to normal assessment: limited speech production; rate of speech is inconsistent w/ other psychomotor activity. volume is not appropriate to situation. stutterin, word repetition, or neologisms may indicate physical or psychological illness. hypertalkative; mumbled or slurred speech
115
Q

affect

A
  • are the patients responses and body language devoid of emotion?
  • are their responses hyper emotional?
  • do the patient’s responses changed dramatically through the interview?
  • are the responses appropriate to the patient’s situation or what they are saying?
  • does the patient have poor eye contact
116
Q

mental status exam: mood and affect

A
  • subjective (mood) and objective assessment of the patient stated feelings and emotions
  • affect measures the outward expression of those feelings and emotions
117
Q

mood

A
  • “how are your spirits these days?”
  • labile mood?
  • intensity of mood?
  • is the patient suicidal?
  • is the mood appropriate to the patient situation?
  • normal parameters: facial expression and body language. affect shold match stated mood. affect should change to fluctuate with the changes in mood
  • alterations to normal assessment: mood and affect d onot match. flat/blunted is associated w/ depression. labile: rapid cycling bipolar or schizophrenia? inapprorpriate responses may be a sign of intoxication, schizophrenia, organic brain disease, be aware that poor eye contact may be cultural.
118
Q

mental status examination: abstract thinking/judgment

A
  • subjective assessment of a patient’s ability to make appropriate decisions about their situation or to understand concepts
  • judgment is the ability to evaluate a situation and form an appropriate response
  • assess by asking patients to propose a solution to their current problems
  • assess by asking patients to propose a solution to a hypothetical problem
  • give patients a proverb to interpret, such as “you can’t teach an old dog new tricks” patient should be able to give some sort of acceptable interpretation, such as “old habits are hard to break”
  • or give the patient a situation to solve (judgment)
  • alterations to normal assessment: patient cannot interpret the proverb in an acceptable manner. patient cannot complete problem solving questions appropriately
119
Q

mental status examination: perception

A
  • assesses the way a person experiences reality. assessment is based on the patient’s statements about their environment and the behaviors associated with those statements
  • normal parameters: all 5 senses are monitored for interaction w/ the patient’s reality. patient’s insight into their condition is also assessed
  • alterations to normal assessment. presence of hallucinations and illusions
120
Q

therapeutic communication: principles of therapeutic communication

A
  • genuineness
  • respect
  • honesty
  • concreteness
  • assistance
  • protection
  • permission
121
Q
A
122
Q

respect

A
  • nurse must have unconditional positive regard for the patient
  • nonjudgmental acceptance of patient’s ideas and beliefs communicate nurse’s willingness to work with the patient
123
Q
A

PNC 103 lecture (31 decks)

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