Neuro and Mental Health Flashcards
What are some factors influencing Mental Health
internal and emotional poblems
familial and social network
community, including health care systems, employment, and housing
Larger social issues (poverty, racism)
What is mental health
Finding a balance in all aspects of life
capacity to think, feel and express emotions and behave in ways that enhance personal capacity to manage life
sense of emotional and spiritual wellbeing
What is a mental disorder
constellations of co-occuring symptoms involvin alterations from absence of illness to maximal illness
Why is assessing mental health important
Early intervention
stigma
delay of treatment
housing difficulties
early treatment discontinuation
negative economic effect
addiction
Rwduce mental health stigma as providers
self reflect
self moniter
address own beliefs
address ow behaviours
Relational practices for mental health
respect
no judgment
reflection
Mental Health Nursing assesment
observation-manic phase?
interview
examination
physical assessment
collaboration with others
Mental status examination
emotional and cognitive functioning
domains include appearance, behaviour (mood and affect and speech, cognition (concentration, comprehension and abstract reasoning) and thinking (perception, content, process, insight, judgement)
Appearance for mental disorders
How do they look
grooming
facial expression
tremors
position
altertness
affect
What are their behaviours?
physical-pacing, crying, agitated, eye contact, withdrawn
Speech-loud, pressured, incoherant, slurred
self-care-excessive, appetite?
Cognition
orientation (time, place, person)
State of consciousness-lathergic, drowsy, alert
Mood-depressed, euphoric, labile
Memory-impaired (past/present)
Concentration (poor, good)
Judgement (impaired, good)
insight (none, limited, good)
thoughts
content-suicidal, homicidal, guilt, worthlessness, obsessions, phobias, paranoias, hallucinations, delusions
Process-coherent, logical, fleeting, tangential, attention(distracted or focused)
Indication for comprehensive Nursing Assessment
behaviour changes
brain lesions
aphasia
symptoms of psychiatric mental illness
Developmental considerations for mental health in adolescents
suicide
mental health disorders started around age 14
common disorders include depression, anxiety, ADHD, substance use
Eating disorders are also so common among Canadian Female teens
Mental Health assessment in adults
identification/biographical information
Reasons for seeking care
past health
family health hisotry
current health
Objective data-appearance
posture
body movements
dress
grooming and hygeine
objective data-bahviour
level of consciousness
facial expression
mood
affect
Objective data-cognitive functions
orientation
attention span
immediate memory
recent memory
remote memory
four unrelated word tests )additional testing for patientd with aphasia)
Objective data-higher intellectual functions
insight and judgement
thought process
thought content
perceptions
Supplemental Mental Status Examination
quick to administer
sensitivity for 90% for detecting mild cognitive impairement
good for dementia detection and delirium and difrentiationg these from psychiatric mental illness
MOCA is like the animals and shapes and fun little square drawings
Risk assessment
Suicidal thoughts
assaultive or homicdal ideation
elopement risk
Developmental considerations in children for mental health
knowledge of developmental milestones
Nipissing Developmental screen
other reliable screening tools
Developmental considerations for older adults and adults
Greater risk of alziehmers
CNO guideliness
Establishing therapeutic relations
-therapeutic communication
-client centered care
maintaining boundaries
-protecting client from abuse
Neurologic assessment developmental considerations for infants
neurons are not yet myeinated
neurologic assessment developmental considerations for older adults
general atrophy and loss of neurons in brain and spinal cord
decrease in weight and volume of brain
decreased muscle strength ad impaired fine coordination
slowed reaction time
dizziness and loss of balance
Cultural and social considerations for neurologic examinations
Greater risk for heart disease and stroke
intersecting factors of socio-economic factors, health care and preventative services and exercise
social circumstances and ability to manage post-stroke condition
importance of social resources
Subjective data for neurologic risks
headache
head injury
diziness or vertigo
seizures
tremors
weakess
incoordination
numbness or tingling
difficulty swallowing
difficulty speaking
significant past hisotry
envionmental hazards
medications
Additional neurologic examination health history questions for infants
maternal health
neonatal period
reflexes
weakness and balance
seizures
physical development
enviornmental hzards
ognitive development
family history
Additional health history questions
older adults
risk for falls
tremors
vision
Critical findings in neurological exams
sudden changes in alterness
sudden changes in speech or onset of new difficulties
signs of a stroke
signs of increased intracranial pressure (headaches and vommiting)
sudden onset weakness, numbness, double vision
seizures
lathargy that persists or worsens
Stroke
Face-drooping?
Arms-can you raise both
Speech-is it slurred or jumbled
Time-call 911
Stroke prevention
early recognition of symptoms
vision changes
trouble walking, dizziness, loss of balance or coordination
sudden weakness
sudden severe headaches
(less common is vommiting, fainting)
Modifiable risk factors of strokes
Cardiovascular disease
hypertension
smoking/second hand exposure
diabetes
atrial fibrillation
other cardiac conditions
dyslipidemia
asymptomatic carotid stenosis
sickle cell disease
postmenopausal hormone therapy
diet and nutrition
inactivity
obesity
ischemic attack history
immodifiable risk factors for strokes
age
gender
low birth weight
ethnocultural background
genetic factors
Prevention of strokes
diet
limit sodium intake
moderate excercis
maintain healthy weight
smoking cessation
limit alcohol intake
manage underlying health issues
Physical Exam for Neuro
Prep-screen neuro
complete neuro exam
neuro recheck exam
equipment needed-penlight, tongue blade, cotton swab, cotton ball, tuning fork, percussion hammer, aromatic substances
Cranial Nerves
I-Olfactory
II-Optic
III-oculomotor
IV-Trochlear
VI-Abducens
V-Trigeminal
VII-Facial
VIII-Acoustic
IX-glossopharyngeal
XI-spinal accessory
XII-hypoglossal
OH OH OH To Taste and Feel Very good velvet ah heavenly
Olfactory
optic
oculomotor
trochlear
trigeminal
abducens
facial
vestibulocochlear
glossopharyngeal
vagus
accessory
hypoglossal
Some say money matters but my brother says big brains matter more
correlates to order of cranial nerves
Olfactory
sensory-sense of smell
Optic nerve
sensory-visual acuity, visual fields, opthaloscope
Snellen chart
oculomotor
pupillary, light response (motor)
PERRLA
eyelid droop
Trochlear
Motor
cardinal gazes
Trigeminal
sensory and motor
light touch to forehead (feel it)
try to open mouth while clenching and palpate
Abduecens
motor
facial
sour taste on tongue
smile, frown
acoustic
sensory
whispered voice test, Weber and Rinne
Glossopharyngeal
Motor and sensory
say ahhhh (gag reflex)
Vagus
motor and sensory
Spinal accessory
motor
rotate head and shoulders against movement
Hypoglossal
motor
say light, tight, dynamite
Anosmia
decrase or loss of smell
from tobacco smoking, allergic rhinitis, cocaine use
normal is aging decreases smell
When to worry with cardinal gazes
unilateral dilation
non-reactivity
deviation in gaze
nystagmus
nystagmus
eye makes repetitive uncontrolled movements
When to worry with facial nerve
muscle weakness
flattening of nasolabial fold
lower eyelid sagging
escape of air from only one cheeck
How to test acoustic cranial nerve? Vestibulocochlear
whisper test
weber test
rinne test
Cranial Nerve
motor function of the tongue
Objective Exam-Motor System
inspect and palpate muscles (size, strength, tone, involuntary movements)
cerebellar function (balance test-gait, tandem walking, romberg test(feet together and eyes closed)
Coordination and skilled movement (heel to shin test, rapid alternating movements)
Physical Exam-sensory system
person is alert, cooperative and comfy
spinothalamic tract-pain, temp, light touch
posterior column tract-vibration, position, tactile discrimination (fine touch)
Posterior column tract physical exam
vibration
position(kinesthesia)
Tactile discrimination (fine touch)
sterognosis-what object in hand
graphesthesia (write on hand)
two point discrimination
extinction
point location
Neuro exam objective-sensory system rundown
pain-sharp vs dull
light touch-cotton whisp
vibration-tuning fork
position sense
graphesthesia-number tracing on hand
stereognosis-object recognition
2 point discrimination
extinction-both sides at same time
point location-point to location of touch
objective Data-Physical Exam
test the deep tendon reflexes
-technique, grading, reinforcement, biceps reflex, triceps reflex, brachioradialis reflex, quad-patellar jerk), achilles, clonus (quivering reflex)
What are the superficial reflexes
abdominal reflex
cremastic reflex
plantar reflex
List 4 reflexes (common
bicep
tricep
quadricep
achilles
Scale for reflexes
0=absent
1=hypoactive
2=normal
3=hyperactive
4=hyperactive with clonus
5=sustained clonus
Developmental considerations for infants and neuro exam
spontaneuous walking activity, response to enviornment, social smile
cranial nerves-cant be directly tested
motor system-Nipissing District Developmental Screen
Head control
reflexes-plantar grasp, rooting, landau, babinski, moro, tonic neck
Developmental considerations for reflexes in preschool and school age children
observation of dress/undress/buttons
milestones NDDS
test balance, fine motor coordination
sensation not reliable for testing
Older adult neurologcal developmental considerations for objective exam
decrease in muscle bulk
snile tremors
dyskineasis (difficulty with smooth movements)
Difference in gait
loss of ankle jerk
deep tendon relfexes less brisk
Neurological recheck
lovel of consciousness (time, place, person)
motor function
pupillary response
vital signs
glasgow coma scale
Intracranial pressure signs
behavioural changes
decreased level of consciousness
headache (BAD)
lethargy
seizures
vommitting
Glasglow Coma Scale
eye opening
4=spontaneuous
3=to sound
2=to prssure
1=no response
verbal response
5=oriented
4=confused
3=words
2=sounds
1=none
motor response
6=obeys
5=localizing
4=withdrawal
3=abnormal flexions
2=extension
1=none
GlawGlow coma scaling scoring
Mild is 13-15
Moderate is 9-12
Severe is 3-8
