geriatric and mental health Flashcards
how to assess a ptients mental status and behavior
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
level of consciousness
how aware the person is of his environment
attention
the ability to focus or concentrate
describe alert
awake and aware
lethargic
you must speak to patient in loud forceful manner to get a response
obtunded
you must shake patient ot get a response
stuporous
patient is unarousable except by painful stimulu (sternal rub)
coma
patient is completely unarousable
short term memory
covers events or memories that occured minutes to days before
long term memory
covers events or memories that occured months to years before
orienatation
aware of person, place, and time
perceptions
awareness of the objects in the environment to the 5 senses and their interrelationships
thought processes
the logic, coherence, and relevance of patients thoughts as they lead to thoughts and goals, HOW people think
Insight
awareness that thought, symptoms, or behaviors are normal or
abnormal; e.g., distinguishing that a daydream or hallucination is not real
Judgment:
process of comparing and evaluating different possible courses of
action
Affect
the observable mood of a person expressed through facial expression,
body movements, and voice
mood
the sustained emotion of the patient
◦ Euthymic, Dysthymic, Manic
Language:
the complex symbolic system for
expressing written and verbal thoughts, emotion, attention, and memory
Higher cognitive functions
level of intelligence
assessed by vocabulary, knowledge base, calculations, and abstract thinking
what consists of the mental status examination
Appearance and behavior
◦ Speech and language
◦ Mood
◦ Thoughts and perceptions
◦ Cognitive function: memory, attention, information and vocabulary, calculations, abstract thinking, and
constructional ability
how ot assess LOC
is patient awake and alert
does he understand your questions
does patient respond appropriately and quickly or lose track of topic or fall asleep
how to assess a patient posture and motor behavior
does patient lie in bed or prefer to walk
is patient sitting or lying comfortably
is patient agitated with repepititve movements
when can you see a flat affect?
parkinsons or profound depression
grooming and hygiene typically deteriotate from what:
depression or schizophrenia
how to assess speech and language
quantity
rate
loud
articulation of words
fluency
hesistancies in speech
seen in patients with aphasia from strokes
monotone inflections
schizophrenia or severe depression
circumlocutions
words or phrases substituted for word a person cannot remember
paraphasias
words are malformed, wrong, or invented
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
circumstantiality
speech characterized by indirection
and delay due to the patient’s excessive use of details
that have no connection to the point
derailment
speech in which a person shifts topics with no apparent relation
between the topics
flight of ideas
accelerated change of topics in a very
fast but generally coherent manner
neologisms
invented or distorted words
incoherence
speech that is incomprehensible bc it is illogical
blocking
sudden interruption of speech, before the
completion of an idea, occurs in normal
people
clanging
choosing a word based on sound rather than meaning
confabulation
fabrication of facts to hide memory impairment
perservation
persistent reptition of words or ideas
echolalia
repitition of words or phrases of others
compulsions
repetitive behaviors that a person feels driven to perform to prevent or produce
some future state of affairs
obsessions
recurrent, uncontrollable thoughts, images, or impulses that a patient considers
unacceptable
phobias
persistent fear of a stimuli the patient feels is irrational (spiders, snakes, the dark)
anxiety
apprehension or fear that may be focused (phobia) or free floating (general sense of
dread)
delusions
false, fixed beliefs that are not shared by other members of the
person’s culture
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
illusion
misinterpretations of real stimuli; e.g., the postman leaves mail, therefore there is a
plot to poison patient
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
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?
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?
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
what is aging
Normal physical and behavioral
changes that occur under normal
environmental conditions as people
mature and advance in age
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
general survey of the older adult
note normal aging changes in body habitus, posture, height/weight, skin, vitals
“Liver spots” – flat, brown macules (forearms
and hands)
senile lentigines
raised thickened areas of pigmentation – look
crusted, scaly and warty
keratoses
Red-tan scaly plaques that become raised
and roughened over time. Premalignant to squamous cell
carcinoma
actinic keratosis
characteristic of the aging skin
skin tags
dry skin
thickness
mobility/turgor
hair growht decreases
nails decrease growth, toenails thicken
characteritsics of the eyes
decreased visual acuity
cataracts
characteristics of the ears
hearing impairment
cerumen
chracteristics of mouth
dentures
dry mouth
cardiovascular changes in the older adult
orthostatic hypotension
increase in AP diameter
systolic murmrers
irregular heart rhythm
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
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.
examples of activities of daily living
Eating Bathing Grooming Dressing Toileting Walking Using stairs Transferring
examples of instrumental ADLS
Shopping Meal preparation Housekeeping Laundry Managing finances Taking medications Using transportation
cognitive domains
Attention * Memory * Orientation * Language * Visuo-spatial skills * Higher cognitive functions
causes for alterations in cognition:
dementia
delirium
depression
types of elder mistreatment
physical
sexual
emotional
psychological
abandonment
neglect
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
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.
