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NURS2518 : The Older Client > Week 4: Mood and Affect > Flashcards

Week 4: Mood and Affect Flashcards

1
Q

it is true that older adults are the least likely to use services for mental health

A

yes sadly…

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2
Q

true of false: 1 of 3 Canadian have a mental illness sometime in their life

A

true

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3
Q

what does mood mean?

A

this is defined as the way a person feels

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4
Q

what does affect mean?

A

defined as the observable response a person has to his or her own feelings

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5
Q

can mood and affect be associated with the risk of suicide?

A

yes

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6
Q

please explain the scope of mood and affect.

A

low range of mood and affect: melancholy (flat affect), depression (medical diagnosis), corresponding decline in functional ability

Normal range: euthymia, optimal functional ability

Elevated range: mania(medical diagnosis) corresponding decline in functional ability

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7
Q

what is the definition of mental health?

A

WHO states “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

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8
Q

true or false: this is a diagnosable mental illness: “characterized by a combination of abnormal thoughts, perceptions, emotions, behavior and relationship with others. Mental disorders include depression, bipolar disorder, schizophrenia and other psychoses, dementia and developmental disorders including autism”

A

true

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9
Q

please describe these terms describing mood:
Euthymia, melancholy, depression and mania

A

euthymia: normal and healthy fluctuations of mood (normal experiences of sadness)
Melancholy: undiagnosed mood state characterized by sadness, despair and decreased
functional ability
Depression: diagnosed mood state
Mania: diagnosed mood state: a euphoric or agitated affective state

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10
Q

what are some interacting components of affect during normal (Euthymic) Mood

A

Cognition, Mood and Energy
Cognition: Normal information processing (thoughts are occurring at a normal rate) stay within the euthymic range and curve upwards with low mood and energy and downward with mania
Mood: Generally follows the curve of energy
Energy: Generally follows the curve of mood

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11
Q

true of false: suicide in older adults tend to be less lethal than in younger adults

A

false; more lethal

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12
Q

true or false: Suicide rate for white “oldest” men is higher than the general population

A

true

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13
Q

big difference between mood and affect

A

mood - feeling inside, would not know until we ask

affect - something we can see

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14
Q

true or false: risk of suicide is an aspect of untreated mental health disorder

A

true

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15
Q

select all that are true:
- The impact of an event depends on the persons experience through their lifetime
- Most adults cope well with early life challenges
- Trauma in the life course impacts the way people experience life events and increases risk for mental health disorders (e.g. generational trauma of indigenous people)

A

true except second one; late

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16
Q

what are some psychosocial challenges the older adult faces?

A

ageist stereotypes
retirement
death of friends
widowhood
relocation
chronic illness
grief associated with adjustment to each other

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17
Q

what are some risk factors: medications and alcohol

A

depression - adverse effect of some meds
- poly pharmacy increases risk for adverse meds affects including depression
-withdrawal of meds cause depressive symptoms
depression can lead to alcohol abuse

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18
Q

true of false: alcohol can cause depression - age related changes increase risk for the older client adult to experience the adverse effects of alcohol

A

true

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19
Q

what are some factors that impact the experience of mental health?

A

life course
culture
sexual orientation
past trauma

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20
Q

true or false: contributing factors in later life are medical conditions and medications

A

true

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21
Q

main difference between melancholy and depression

A

melancholy - undiagnosed
depression: diagnosed

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22
Q

what is this an example of: “During those bad times, I didn’t get along with my family at all. I didn’t know if they felt I was not doing a good job, like maybe they weren’t sympathetic enough, but I think they just didn’t know how people can feel when these things happen to you…being retired, being sick….I didn’t get along with them for a long time. I had to, but I didn’t. Just like that. That was tough. “

A

depression

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23
Q

what are some risk factors of depression for older adults

A

Four occurrences in the population:
Older adults who have had depression in their younger adulthood
Older adults who become depressed in later life
People with dementia
People with medical conditions

financial worries
genetic predispositions
social isolation/loneliness

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24
Q

what are some more sings of melancholy and depression within function

A

Functional Impairment
Decline in individual’s performance to perform functions they could do when not depressed (ADL’s, IADL’s and executive function)

persistent mood disturbance - longer than 2 weeks

disturbed vegetative function - somatic symptoms: fatigue, decreased energy, increased or decreased appetite, weight, sleep disturbances, and psychomotor agitation

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25
Q

true or false: Suicidal ideation and psychotic features are associated with more severe depression

A

true

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26
Q

what something that can be noticed within the function assesement for mental status

A

change in ADLs and IADLS and executive function

27
Q

what falls under mental status exam (MSE)

A

Appearance
Speech
Emotion (mood and affect)- see screening tools
Perception
Thought
Insight and judgement
Cognition – see screening tools

28
Q

what are some mental health assessments ?

A
  • Geriatric Depression Scale (GDS)
  • Cornell scale for depression in dementia
  • Assessment of recent changes in functional status
  • Careful observation of affect
29
Q

what is grief?

A

associated with any loss, mourning

30
Q

how is energy expressed in a depressive disorder?

A

fatigue
decreased energy
sleep disturbance
psychomotor agitation
dependence, poor grooming, decreased ability to manage ADL’s

31
Q

how are cognitive changes expressed through depression?

A

decreased concetration
suicidal thoughts or actions

32
Q

how is mood expressed through depression?

A

Loss of pleasure in usual activities
Feelings of worthlessness or guilt
Expressed despair, sadness, or irritable

33
Q

what are some mental health disturbances that can be seen in depression?

A

paranoia, delusions, psychotic features (can be other mental disorders too)

34
Q

what are some risk factors for psychotic features?

A

social isolation, sensory deficits, physical illness, cognitive impairment and polypharmacy

35
Q

can paranoia indicate a medical emergency?

A

yes

36
Q

what are some risk factors to paranoia?

A

meds, vision and hearing loss

37
Q

true or false: older adult with memory impairment need to be evaluated for depression

A

true

38
Q

true or false: Suicide in older adults tends to be more lethal than in younger adults

A

true

39
Q

true or false: Suicide rate for white “oldest” men is higher than the general population

A

true

40
Q

true of false: depressive disorders - low suicide risk in older adult

A

false; high

41
Q

What biopsychosocial factors are associated with melancholy/depression?

A

older clients with: depression in younger life, depressed in later life, people with dementia and medical conditions
social isolation/loneliness
financial worries
genetic predisposition

42
Q

under Cornell scale, what are the suicidal warning signs? (11 identified)

A
  • History of depression
  • Trouble sleeping
  • Feelings of hopelessness, helplessness, anxiousness or worthlessness, * Loss of interest in things they once cared about
  • See no reason for living or lost sense of purpose in life
  • Switching suddenly from deep sadness to calmness or happiness
  • Feelings of being trapped
  • Overwhelming feelings or inability to cope
  • Experienced trauma or past suicide attempt
43
Q

true or false: Depression and the Older adult with dementia can result in responsive behaviors

A

true

44
Q

what is responsive behaviour?

A

person-entered term recognizing how behaviours uncomfortable for us indicate an unmet need in the older adult

45
Q

true or false: Some behaviors that are called responsive behaviors are acceptable to engage in ADL’s and wandering

A

false; they are resistance to engage

46
Q

how to assess signs and symptoms of major depression in persons with dementia

A

*Mood-related signs
*Behavioral disturbance
*Physical signs
*Cyclic function
*Ideational disturbances

47
Q

differentiating delirium, depression, and dementia

what are the onset characteristics for delirium, depression , and dementia ?

A

delirium= sudden, abrupt
depression= recent, may relate to life change
dementia= insidious, slow ( over the years), often unrecognized until deficits are obvious

48
Q

what are some pharmacotherapy used to improve affects of ex. dementia?

A

SSRI’s (selective serotonin reuptake inhibitors)
- increase risk for hyponatremia
-adverse side effects: nausea, dizziness, hyponatremia

Cyclic Anti-depressants:
adverse effects on cardiovascular system
anti-cholinergic effect: blurred vision, urinary retention, cognition impairments

49
Q

what is the guideline for nursing interventions?
PPPMOSE

A

provide - therapeutic relationship and referrals to other health care professionals
promote - health through physical activity and nutrition
provide - education and counselling
Maximize - person’s sense of meaning control and autonomy
Optimize - pain control and relaxation therapy
Support - strengths, capabilities and hope
Ensure - safety

50
Q

what are some interventions to improve an older adults experience with melancholy/depression?

A
  • Reduce risk
  • Pharmacotherapy
  • Psycho-social
  • Nursing interventions
  • Providing interpersonal support
  • Evidence based geriatric nursing protocols for best practice
51
Q

state whether or not this is true: Evidence that older adults with high levels of spirituality and depression maintained meaning of life.

A

true

52
Q

Spirituality has a protective factor against loss of meaning of life and this was associated with less depressive symptoms.

A

yes

53
Q
A
54
Q

name the characteristics over the course over 24 hours for delirium, depression, and dementia

A

delirium = fluctuating, often worse at night

depression- fairly stable, may be worse in the morning

dementia= fairly stable, may change with stress

55
Q

name the characteristics over conciousness in differentiating delirium, depression, and dementia

A

disturbed= delirum
clear= depression
clear = dementia

56
Q

what are the alert level of a patient with dementia, delirium, and depression

A

dementia= generally normal
depression= normal
delirium= increased, decreased, or variable

57
Q

what are the pyschomotor activity for delirium, depression and dementia

A

increased, decreased, or mixed
variable, agitated, or slowed down
normal, may have apraxia, agnosia

58
Q

what is the duration for delirium, depression, and dementia

A

hours to weeks
variable, agiated, or slowed down
years

59
Q

what is the attention characteristics for delirium, depression, and dementia

A

disordered, fluctuates
little impairment
generally normal but may have trouble focusing

60
Q

what is the orientation for delirium, depression and dementia

A

usually imapired, fluactuate
usually normal : may not have any answer ‘i dont know ‘ to questions or may not answer
often impaired

61
Q

in the category ‘thinking’ , what are differentiating for delirium, depression, and dementia

A

disorganized, rambling, illogical, or incoherent
may be slow; hopelessness, helpness
difficulty finding words, preservation impoverished thoughts, difficulty with abstraction, delusions ins severe cases

62
Q

what is the perception between delirium, depression and dementia

A

disturbed, illusions, hallucinations and misperceptions
misperception usually absent
intact, hallucinations in severe cases

63
Q

what is the affect between delirium, depression, and dementia

A

variable but may look disturbed, frightened
flat
slowed response, may be labile

NURS2518 : The Older Client (13 decks)

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