Module 2 Part 2 Flashcards
What is the purpose of the Mental Status Exam (MSE)?
To assess a patient’s fundamental mental functioning and guide diagnosis and treatment planning
The MSE offers valuable insights into a patient’s mental health.
What does the General Survey assess in a patient?
Appearance, eye contact, motor activity, and demeanor
Example: Noting if a patient is well-groomed or makes consistent eye contact.
How is a patient’s mood evaluated during the MSE?
By assessing their emotional state, such as happiness, sadness, or anxiety.
What does ‘affect’ refer to in the context of the MSE?
The outward expression of mood and its congruence with the stated mood.
Example: A patient expressing sadness while crying.
What memory functions are tested in the MSE?
Immediate and short-term memory recall
Example: Recalling a list of words after 5 minutes.
What is assessed under attention and orientation in the MSE?
Awareness of time, place, person, and situation.
What aspects of speech are observed in the MSE?
Rate, volume, and coherence patterns.
Example: Patients speaking too fast or incoherently.
What do insight and judgment evaluate in the MSE?
Understanding of situations and decision-making ability.
Example: Acknowledging the consequences of skipping medications.
What does intellect assess in the MSE?
General cognitive abilities through vocabulary use or problem-solving skills.
What is the difference between thought content and thought process?
Thought process analyzes how thoughts are organized; thought content refers to the substance of thoughts.
What is tangentiality in thought process?
Responding with irrelevant answers that never reach the main point.
What is circumstantiality in thought process?
Excessively detailed explanations that eventually reach the intended point.
What are examples of thought content?
Delusions, hallucinations, overvalued ideas, obsessions, compulsions, suicidal ideation, homicidal ideation.
What is the Mini-Mental Status Examination (MMSE)?
A cognitive screening tool designed to measure adult competency status and cognitive impairment.
What cognitive domains does the MMSE evaluate?
- Orientation
- Recognition
- Recall
- Attention/calculation
- Language
- Visual construction
What is the maximum score of the MMSE?
30 points.
What MMSE score range indicates no cognitive impairment?
24-30.
What MMSE score range indicates mild delirium/dementia?
20-23.
What MMSE score range indicates moderate delirium/dementia?
10-19.
What MMSE score range indicates severe delirium/dementia?
0-9.
What mnemonic can help remember the MMSE components?
ORRAL 23 RWD.
What is an example of a question in the MMSE for attention/calculation?
Perform serial sevens or count backward from 100.
What is the definition of a therapeutic relationship in nursing?
A mutual, interactive, interpersonal relationship between patient and nurse focusing on the patient’s needs.
What are the key components of therapeutic relationships?
- Genuineness
- Acceptance
- Nonjudgmental attitude
- Authenticity
- Empathy
- Respect
What does genuineness in a therapeutic relationship involve?
Being open, honest, and transparent in interactions.
What is acceptance in therapeutic relationships?
Recognizing each individual’s unique experience, beliefs, culture, and background.
What does a nonjudgmental attitude entail in nursing?
Removing bias, prejudice, and personal opinions from clinical interactions.
What is empathy in the context of therapeutic relationships?
Demonstrating understanding of patients’ feelings or emotions without imposing personal beliefs.
What is transference in therapeutic relationships?
Patients displacing feelings for significant people from their past onto healthcare providers.
What is countertransference in therapeutic relationships?
Healthcare providers transferring their feelings/emotions to patients.
What is the single most important risk factor for suicide?
Prior suicide attempts.
What is the mnemonic for remembering suicide risk factors?
S.P.A.M. W.R.A.P.S.
What does the CIWA scale assess?
Alcohol withdrawal severity.
What is the treatment initiation score for the CIWA scale?
Starts at a score of 8+ (PRN).
What are FDA-approved medications for alcoholism?
- Disulfiram (Antabuse)
- Acamprosate (Campral)
- Naltrexone (Vivitrol)
What is the mechanism of action of Disulfiram?
Inhibits the enzyme aldehyde dehydrogenase, causing an accumulation of acetaldehyde.
What are common signs and symptoms of alcohol withdrawal?
- Nausea and vomiting
- Tremors
- Anxiety
- Agitation
- Altered mental status
What is the Clinical Opiate Withdrawal Scale (COWS) used for?
To evaluate the severity of opioid withdrawal.
What CIWA score range indicates mild withdrawal?
5-12 points.
What CIWA score range indicates moderate withdrawal?
13-24 points.
What is excessive yawning without feeling drowsy indicative of?
A symptom of opioid withdrawal
This can occur as part of the withdrawal syndrome.
What behavior can indicate a person is becoming more agitated or easily stressed?
Irritability/anxiety
This can manifest in various ways, including mood swings.
What does pupillary dilation indicate in the context of opioid use?
Opioid intoxication
Pinpoint pupils should be monitored closely as they can signify withdrawal.
What is piloerection commonly referred to as?
Goosebumps
This can occur even when the individual is not cold or scared.
What term describes persistent discomfort or pain in muscles without physical exertion?
Muscle aches
This is a common symptom during opioid withdrawal.
What is excessive tearing without emotional triggers known as?
Lacrimation
This can occur during opioid withdrawal.
What is rhinorrhea?
Runny nose
This symptom can be persistent and unrelated to allergies or infections.
What does profuse perspiration with minimal physical activity indicate?
Sweating
It can occur even in cool environments during withdrawal.
What is regular difficulty falling asleep or staying asleep despite feeling tired called?
Insomnia
This is another symptom that can be associated with opioid withdrawal.
What is the memorable acronym for opioid withdrawal symptoms?
YIP PLRSI
Stands for Yawning, Irritability, Pupils, Piloerection, Lacrimation, Rhinorrhea, Sweating, Insomnia.
What does the COWS scale assess?
Opioid withdrawal symptoms
It is important to differentiate COWS from CIWA scores.
How many items does the Cow’s Scale (COWS) consist of?
11 items
These items assess a range of withdrawal symptoms.
Which patient has the highest risk factors for opioid withdrawal?
Patient B: Appears agitated, has enlarged pupils, and excessive sweating
This combination indicates withdrawal symptoms.
What does the MMSE stand for?
Mini-Mental State Examination
It measures cognitive impairment in individuals.
What does the SLUM scale measure?
Cognitive impairment
It is another tool alongside MMSE.
What are the score ranges for MMSE indicating normal cognitive function?
25-30
Scores of 21-24 indicate mild cognitive impairment.
What is the HAM-D scale used for?
Evaluating the severity of depressive symptoms
It is one of several depression assessment scales.
What score range on the PHQ-9 indicates moderate depression?
10-14
A score of 15-19 indicates severe depression.
What does the GAD scale measure?
Anxiety levels
It has ranges from mild to severe anxiety.
What is the purpose of the Edinburgh Postnatal Depression Scale (EPDS)?
To screen for post-natal depression or depression during pregnancy
It is a specialized tool for this purpose.
What does SBIRT stand for?
Screening, Brief Intervention, Referral for Treatment
It is a process for identifying and addressing substance use disorders.
What does the CAGE questionnaire assess?
Problematic alcohol use
It includes 4 questions related to drinking behavior.
What is the maximum score on the CAGE questionnaire?
4
A score of 2 or higher suggests potential alcohol problems.
What does the DAST-10 scale screen for?
Abuse of alcohol and/or other drugs
It is designed for population screening and clinical case finding.
What is a delusion?
A false, unwavering belief despite evidence to the contrary
Understanding delusions is key in mental health evaluations.
What is referential thinking?
Irrational thoughts about personal connection to random events or objects
It can be a symptom in various mental health conditions.
What syndrome is characterized by short-term cognitive changes with acute onset?
Delirium
It causes symptoms like disorientation and inattention.
What is the preferred medication for agitated delirium?
Haloperidol (Haldol)
It is commonly used for managing symptoms.
What is the 1-year mortality rate for patients with delirium?
40%
This highlights the severity of the condition.
What does the acronym ‘D.A.R.T.’ stand for in relation to delirium features?
D = Delirium itself; A = Acute onset; R = Altered mental status; T = Trouble focusing/Inattention
This acronym helps remember the key characteristics of delirium.
What are the hallmark symptoms of delirium?
Fluctuating consciousness and cognition
These symptoms are critical for diagnosis and management of delirium.
What is the 1-year mortality rate for delirium patients?
40%
This statistic highlights the severity and risks associated with delirium.
What is the preferred medication for agitated delirium?
Haloperidol
Haloperidol is commonly used to manage agitation in delirium.
Define dementia.
A group of disorders that involve gradual cognitive decline, impacting various mental functions like memory, problem-solving, and organization.
What are the main cognitive deficits associated with dementia?
- Impaired executive functions
- Impaired global intellect
- Impaired problem-solving
- Impaired organizational skills
- Altered memory
What type of dementia affects language and memory?
Cortical Dementia
Examples include Alzheimer’s and Pick’s Disease.
What are symptoms associated with subcortical dementia?
- Depression
- Irritability
- Apathy
- Motor symptoms
What is the most common type of dementia?
Dementia of Alzheimer’s Type (DAT)
This type features gradual onset and progressive decline.
What are the typical early-stage symptoms of Frontotemporal Dementia?
- Personality changes
- Behavior changes
- Language changes
What characterizes Creutzfeldt-Jakob Disease?
Cortical dementia; fatal and rapid progression
Symptoms can progress from flu-like to aphasia and psychosis.
What are the early signs of HIV Dementia?
- Cognitive decline
- Motor abnormalities
- Behavioral abnormalities
True or False: Vascular Dementia is the most common type of dementia.
False
Alzheimer’s is the most common type of dementia.
What is a common symptom associated with Huntington’s Disease?
Choreoathetosis movement
This movement disorder is a hallmark of Huntington’s.
Fill in the blank: The first-line agent for dementia treatment is _______.
Atypical antipsychotics
List the FDA-approved medications for dementia.
- Cholinesterase inhibitors (e.g., Donepezil, Rivastigmine, Galantamine)
- Glutamate regulators (e.g., Memantine)
- Combination therapy (e.g., Donepezil + Memantine)
What is the hallmark of vascular dementia?
Cardiovascular involvement
This includes conditions like high blood pressure.
What is a key memorization tip for Alzheimer’s?
Alzheimer’s starts with ‘A’
This can help in distinguishing it from other types of dementia.
What type of dementia is characterized by visual hallucinations?
Lewy Body Disease
True or False: Vitamin B12 deficiency can lead to irreversible dementia.
False
Vitamin B12 deficiency is rare but potentially reversible.
What are the late-stage symptoms of HIV Dementia?
- Mutism
- Seizures
- Hallucinations
