NR 509 Final Study Guide week 8

Behavior/Mental Health Assessment and Modification _for_ Age 1.Assessment: a. b.c.d.e.Many mental health d_is_orders are masked by other clinical conditions; 20% of primary care outpatients have mental d_is_orders(50-70% go undetected and untreated) Physical symptoms account _for_ approx 50% of office v_is_its 1⁄3 of physical symptoms are unexplained; in 20-25% those symptoms become chronic Symptoms and Behaviors: i. Sorting symptom _is_ a challenge; can be unexplained symptoms 1. Patients who have unexplained symptoms depression and anxiety exceeds 50% ii. Physical or “somatic” symptoms account _for_ 50% of U.S. office v_is_its 1. Pain, fatigue, palpitations, GI symptoms, sexual dysfunction, dizziness or loss of balance 2. Symptoms that present as clusters are called “functional syndromes” such as IBS, fibromyalgia, chronic fatigue, TMJ d_is_order, and multiple chemical sensitivity 3. The presence of symptom overlap _is_ high in the common functional syndromes such as fatigue, headache, sleep d_is_turbance, pain, GI upset iii. Patients with unexplained and somatic symptoms are often frequent users of the health care system and termed “difficult patients” iv. Patients with symptoms that last longer than 6 weeks are recognized as chronic and should be screened _for_ depression and anxiety. a. A two tiered approach _is_ recommended _for_ screening. A brief screening with questions that yield high sensitivity then a more detailed investigation when indicated V. Patient who warrant a mental health screening include: 1. medically unexplained physical symptoms 2. Multiple physical or somatic symptoms 3. High severity of the presenting somatic symptom 4. Chronic pain 5. Symptoms longer than 6 weeks 6. Physician stating “a difficult encounter” 7. Recent stress 8. Low self-rating of overall health 9. Frequent use of health care services 10. Substance abuse 2. Adjustment _for_ age: A. Elderly: a. Older adults may complain of memory problems but usually _is_ due to benign _for_getfulness. b. Older adults retrieve and process data more slowly and take longer to learn new in_for_mation c. Older adults may have slower motor responses and their ability to per_for_m complex task may dimin_is_h d. It _is_ important to try to d_is_tingu_is_h age-related changes from manifestations of mental d_is_orders e. Older patients are more susceptible to delirium which could be the first sign of infection, problems with medications, or impending dementia B. Newborn: a. Assess mental status of a newborn by observing newborn activities i. Look at human faces and turn to a parents voice ii. Ability to shut out repetitive stimuli(such as a vacuum) iii. Bond with caregiver iv. self-soothe b. Assess _for_ mental status during alert periods · Normal VS. Abnormal Findings and Interpretation 1. Attention: a. Normal: able to focus and concentrate b. Abnormal: inattentive and easily d_is_tracted 2. Memory a. Normal: able to repeat immediate repetition of material given; b. Abnormal: unable to repeat recent events 3. Orientation: a. Normal: aware of person, place, and time