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Advanced Health Assessment > geriatric and mental health > Flashcards

geriatric and mental health Flashcards

1
Q

how to assess a ptients mental status and behavior

A

discern the patients level of alertness, mood, orientation, attention, and memory
learn about their insight, judgement , and any thought disorders or disorders of perception as you talk to them

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2
Q

level of consciousness

A

how aware the person is of his environment

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3
Q

attention

A

the ability to focus or concentrate

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4
Q

describe alert

A

awake and aware

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5
Q

lethargic

A

you must speak to patient in loud forceful manner to get a response

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6
Q

obtunded

A

you must shake patient ot get a response

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7
Q

stuporous

A

patient is unarousable except by painful stimulu (sternal rub)

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8
Q

coma

A

patient is completely unarousable

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9
Q

short term memory

A

covers events or memories that occured minutes to days before

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10
Q

long term memory

A

covers events or memories that occured months to years before

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11
Q

orienatation

A

aware of person, place, and time

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12
Q

perceptions

A

awareness of the objects in the environment to the 5 senses and their interrelationships

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13
Q

thought processes

A

the logic, coherence, and relevance of patients thoughts as they lead to thoughts and goals, HOW people think

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14
Q

Insight

A

awareness that thought, symptoms, or behaviors are normal or
abnormal; e.g., distinguishing that a daydream or hallucination is not real

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15
Q

Judgment:

A

process of comparing and evaluating different possible courses of
action

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16
Q

Affect

A

the observable mood of a person expressed through facial expression,
body movements, and voice

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17
Q

mood

A

the sustained emotion of the patient
◦ Euthymic, Dysthymic, Manic

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18
Q

Language:

A

the complex symbolic system for
expressing written and verbal thoughts, emotion, attention, and memory

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19
Q

Higher cognitive functions

A

level of intelligence
assessed by vocabulary, knowledge base, calculations, and abstract thinking

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20
Q

what consists of the mental status examination

A

Appearance and behavior
◦ Speech and language
◦ Mood
◦ Thoughts and perceptions
◦ Cognitive function: memory, attention, information and vocabulary, calculations, abstract thinking, and
constructional ability

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21
Q

how ot assess LOC

A

is patient awake and alert
does he understand your questions
does patient respond appropriately and quickly or lose track of topic or fall asleep

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22
Q

how to assess a patient posture and motor behavior

A

does patient lie in bed or prefer to walk
is patient sitting or lying comfortably
is patient agitated with repepititve movements

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23
Q

when can you see a flat affect?

A

parkinsons or profound depression

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24
Q

grooming and hygiene typically deteriotate from what:

A

depression or schizophrenia

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25
how to assess speech and language
quantity rate loud articulation of words fluency
26
hesistancies in speech
seen in patients with aphasia from strokes
27
monotone inflections
schizophrenia or severe depression
28
circumlocutions
words or phrases substituted for word a person cannot remember
29
paraphasias
words are malformed, wrong, or invented
30
how to assess a patients mood
use open ended questions (how do you feel about that, how are you feeling) how long has your mood been this way how good or bad has patient felt dont be afraid to ask about self harm or suicide
31
circumstantiality
speech characterized by indirection and delay due to the patient’s excessive use of details that have no connection to the point
32
derailment
speech in which a person shifts topics with no apparent relation between the topics
33
flight of ideas
accelerated change of topics in a very fast but generally coherent manner
34
neologisms
invented or distorted words
35
incoherence
speech that is incomprehensible bc it is illogical
36
blocking
sudden interruption of speech, before the completion of an idea, occurs in normal people
37
clanging
choosing a word based on sound rather than meaning
38
confabulation
fabrication of facts to hide memory impairment
39
perservation
persistent reptition of words or ideas
40
echolalia
repitition of words or phrases of others
41
compulsions
repetitive behaviors that a person feels driven to perform to prevent or produce some future state of affairs
42
obsessions
recurrent, uncontrollable thoughts, images, or impulses that a patient considers unacceptable
43
phobias
persistent fear of a stimuli the patient feels is irrational (spiders, snakes, the dark)
44
anxiety
apprehension or fear that may be focused (phobia) or free floating (general sense of dread)
45
delusions
false, fixed beliefs that are not shared by other members of the person’s culture
46
the types of delusions:
persecution, grandeur, or jealousy reference of being controlled by outside forced somatic- believing one has a disease or defect that he does not systematized- a single delusion with elaborations around a single theme all systematized into a complex network
47
illusion
misinterpretations of real stimuli; e.g., the postman leaves mail, therefore there is a plot to poison patient
48
hallucinations
a subjective external stimuli the patient hears or sees that others do not hear or see and that the patient may not recognize as false; these can be auditory, visual, olfactory, gustatory, or tactile
49
how to calculate ability
ask the patient to perform more difficult calculations such as making change (e.g., if you had a dollar’s worth of nickels and someone needed 65 cents how many nickels would you have left?
50
how to assess abstract thinking
Interpreting proverbs: “A stitch in time saves nine” ◦ Similarity exercises: What do a ball and an orange have in common?
51
how to assess constructional ability
ask patient to copy a shape onto a sheet of paper ask patient to draw a clock indicating 5:00
52
what is aging
Normal physical and behavioral changes that occur under normal environmental conditions as people mature and advance in age
53
how to interview the older adult
Plan for adequate time- older adults can take longer to process and answer questions ◦ Physical Limitations and Impairments: ◦ Fatigue ◦ Hearing impairments ◦ Cognitive Function and mental status exam: incorporate into the interview
54
general survey of the older adult
note normal aging changes in body habitus, posture, height/weight, skin, vitals
55
“Liver spots” – flat, brown macules (forearms and hands)
senile lentigines
56
raised thickened areas of pigmentation – look crusted, scaly and warty
keratoses
57
Red-tan scaly plaques that become raised and roughened over time. Premalignant to squamous cell carcinoma
actinic keratosis
58
characteristic of the aging skin
skin tags dry skin thickness mobility/turgor hair growht decreases nails decrease growth, toenails thicken
59
characteritsics of the eyes
decreased visual acuity cataracts
60
characteristics of the ears
hearing impairment cerumen
61
chracteristics of mouth
dentures dry mouth
62
cardiovascular changes in the older adult
orthostatic hypotension increase in AP diameter systolic murmrers irregular heart rhythm
63
lungs and GI changes in the older adult
Decreased lung elasticity Increased breathing workload Rales may be common in normal people but disappear with deep inspiration. Decreased saliva, less effective chewing Decreased acid production; decreased absorption of iron, calcium, vitamin D Slowed transit of the colon
64
renal, musculoskeletal and hematopoietic changesi n older adults
Decreased renal mass and nephrons Decrease in muscle mass, Loss of muscle strength Decreased bone density and joint cartilage changes Decreased bone marrow – slower response to blood loss and hypoxia.
65
examples of activities of daily living
Eating  Bathing  Grooming  Dressing  Toileting  Walking  Using stairs  Transferring
66
examples of instrumental ADLS
Shopping  Meal preparation  Housekeeping  Laundry  Managing finances  Taking medications  Using transportation
67
cognitive domains
Attention * Memory * Orientation * Language * Visuo-spatial skills * Higher cognitive functions
68
causes for alterations in cognition:
dementia delirium depression
69
types of elder mistreatment
physical sexual emotional psychological abandonment neglect
70
screening tool for elder abuse
screen for abuse think about risk factors ominous danger signs present physical findings history address issue of elder mistreatment report to adult protective services manage with prevention and risk factor modification
71
what is polypharmacy
means “many drugs” ◦Two or more medications used to treat the same condition ◦Two or more medications of the same class ◦Two or more agents with the same or similar actions to treat different conditions.

Advanced Health Assessment (8 decks)

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