NR 509 Week 8 Final Stu
80 80 80 80 80
dy Guide80
NR 509 Final Study Guide
Behavior/Mental80Health80Assessment80and80Modification80_for_80Age
1. Assessment:
80a.
b. Many80mental80health80d_is_orders80are80masked80by80other80clinical80c
onditions;8020%80of80primary80care80outpatients80have80mental80d_is_ord
ers(50-70%80go80undetected80and80untreated)
c. Physical80symptoms80account80_for_80approx8050%80of80office80v_is_its
d. ⅓80of80physical80symptoms80are80unexplained;80in8020-
25%80those80symptoms80become80chronic
e. Symptoms80and80Behaviors:
i. Sorting80symptom80_is_80a80challenge;80can80be80unexplained80symptoms
1. Patients80who80have80unexplained80symptoms80depressio
n80and80anxiety80exceeds8050%
ii. Physical80or80“somatic”80symptoms80account80_for_8050%80of80U
.S.80office80v_is_its
1. Pain,80fatigue,80palpitations,80GI80symptoms,80sexual80dysfu
nction,80dizziness80or80loss80of80balance
2. Symptoms80that80present80as80clusters80are80called80“functi
onal80syndromes”80such80as80IBS,80fibromyalgia,80chronic80
fatigue,80TMJ80d_is_order,80and80multiple80chemical80sensiti
vity
3. The80presence80of80symptom80overlap80_is_80high80in80the
80common80functional80syndromes80such80as80fatigue,80hea
dache,80sleep80d_is_turbance,80pain,80GI80upset
iii. Patients80with80unexplained80and80somatic80symptoms80are80often8
0frequent80users80of80the80health80care80system80and80termed80“difficult
80patients”
iv. Patients80with80symptoms80that80last80longer80than80680weeks80are80rec
ognized80as80chronic80and80should80be80screened80_for_80depression80and
80anxiety.
a.8 0 A80two80tiered80approach80_is_80recommended80_for_80scre
ening.80A80brief80screening80with80questions80that80yield80high
,NR 509 Week 8 Final Stu
80 80 80 80 80
dy Guide
80
80sensitivity80then80a80more80detailed80investigation80when80
indicated
V. Patient80who80warrant80a80mental80health80screening80include:
1. medically80unexplained80physical80symptoms
2. Multiple80physical80or80somatic80symptoms
,NR 509 Week 8 Final Stu
80 80 80 80 80
dy Guide 80
3. High80severity80of80the80presenting80somatic80symptom
4. Chronic80pain
5. Symptoms80longer80than80680weeks
6. Physician80stating80“a80difficult80encounter”
7. Recent80stress
8. Low80self-rating80of80overall80health
9. Frequent80use80of80health80care80services
10. Substance80abuse
2. Adjustment80_for_80age:
A. Elderly:
a. Older80adults80may80complain80of80memory80problems80but80us
ually80_is_80due80to80benign80_for_getfulness.
b. Older80adults80retrieve80and80process80data80more80slowly80and80t
ake80longer80to80learn80new80in_for_mation
c. Older80adults80may80have80slower80motor80responses80and80their
80ability80to80per_for_m80complex80task80may80dimin_is_h
d. It80_is_80important80to80try80to80d_is_tingu_is_h80age-
related80changes80from80manifestations80of80mental80d_is_orders
e. Older80patients80are80more80susceptible80to80delirium80which80cou
ld80be80the80first80sign80of80infection,80problems80with80medications
,80or80impending80dementia
B. Newborn:
a. Assess80mental80status80of80a80newborn80by80observing80newborn80activities
i. Look80at80human80faces8 0 and80turn80to80a80parents80voice
ii. Ability80to80shut80out80repetitive80stimuli(such80as80a80vacuum)
iii. Bond80with80caregiver
iv. self-soothe
b. Assess80_for_80mental80status80during80alert80periods
· Normal80VS.80Abnormal80Findings80and80Interpretation
1. Attention:
a. Normal:80able80to80focus80and80concentrate
b. Abnormal:80inattentive80and80easily80d_is_tracted
2. Memory
a. Normal:80able80to80repeat80immediate80repetition80of80material80given;
b. Abnormal:80unable80to80repeat80recent80events
, NR 509 Week 8 Final Stu
80 80 80 80 80
dy Guide
80
3. Orientation:
a. Normal:80aware80of80person,80place,80and80time
80 80 80 80 80
dy Guide80
NR 509 Final Study Guide
Behavior/Mental80Health80Assessment80and80Modification80_for_80Age
1. Assessment:
80a.
b. Many80mental80health80d_is_orders80are80masked80by80other80clinical80c
onditions;8020%80of80primary80care80outpatients80have80mental80d_is_ord
ers(50-70%80go80undetected80and80untreated)
c. Physical80symptoms80account80_for_80approx8050%80of80office80v_is_its
d. ⅓80of80physical80symptoms80are80unexplained;80in8020-
25%80those80symptoms80become80chronic
e. Symptoms80and80Behaviors:
i. Sorting80symptom80_is_80a80challenge;80can80be80unexplained80symptoms
1. Patients80who80have80unexplained80symptoms80depressio
n80and80anxiety80exceeds8050%
ii. Physical80or80“somatic”80symptoms80account80_for_8050%80of80U
.S.80office80v_is_its
1. Pain,80fatigue,80palpitations,80GI80symptoms,80sexual80dysfu
nction,80dizziness80or80loss80of80balance
2. Symptoms80that80present80as80clusters80are80called80“functi
onal80syndromes”80such80as80IBS,80fibromyalgia,80chronic80
fatigue,80TMJ80d_is_order,80and80multiple80chemical80sensiti
vity
3. The80presence80of80symptom80overlap80_is_80high80in80the
80common80functional80syndromes80such80as80fatigue,80hea
dache,80sleep80d_is_turbance,80pain,80GI80upset
iii. Patients80with80unexplained80and80somatic80symptoms80are80often8
0frequent80users80of80the80health80care80system80and80termed80“difficult
80patients”
iv. Patients80with80symptoms80that80last80longer80than80680weeks80are80rec
ognized80as80chronic80and80should80be80screened80_for_80depression80and
80anxiety.
a.8 0 A80two80tiered80approach80_is_80recommended80_for_80scre
ening.80A80brief80screening80with80questions80that80yield80high
,NR 509 Week 8 Final Stu
80 80 80 80 80
dy Guide
80
80sensitivity80then80a80more80detailed80investigation80when80
indicated
V. Patient80who80warrant80a80mental80health80screening80include:
1. medically80unexplained80physical80symptoms
2. Multiple80physical80or80somatic80symptoms
,NR 509 Week 8 Final Stu
80 80 80 80 80
dy Guide 80
3. High80severity80of80the80presenting80somatic80symptom
4. Chronic80pain
5. Symptoms80longer80than80680weeks
6. Physician80stating80“a80difficult80encounter”
7. Recent80stress
8. Low80self-rating80of80overall80health
9. Frequent80use80of80health80care80services
10. Substance80abuse
2. Adjustment80_for_80age:
A. Elderly:
a. Older80adults80may80complain80of80memory80problems80but80us
ually80_is_80due80to80benign80_for_getfulness.
b. Older80adults80retrieve80and80process80data80more80slowly80and80t
ake80longer80to80learn80new80in_for_mation
c. Older80adults80may80have80slower80motor80responses80and80their
80ability80to80per_for_m80complex80task80may80dimin_is_h
d. It80_is_80important80to80try80to80d_is_tingu_is_h80age-
related80changes80from80manifestations80of80mental80d_is_orders
e. Older80patients80are80more80susceptible80to80delirium80which80cou
ld80be80the80first80sign80of80infection,80problems80with80medications
,80or80impending80dementia
B. Newborn:
a. Assess80mental80status80of80a80newborn80by80observing80newborn80activities
i. Look80at80human80faces8 0 and80turn80to80a80parents80voice
ii. Ability80to80shut80out80repetitive80stimuli(such80as80a80vacuum)
iii. Bond80with80caregiver
iv. self-soothe
b. Assess80_for_80mental80status80during80alert80periods
· Normal80VS.80Abnormal80Findings80and80Interpretation
1. Attention:
a. Normal:80able80to80focus80and80concentrate
b. Abnormal:80inattentive80and80easily80d_is_tracted
2. Memory
a. Normal:80able80to80repeat80immediate80repetition80of80material80given;
b. Abnormal:80unable80to80repeat80recent80events
, NR 509 Week 8 Final Stu
80 80 80 80 80
dy Guide
80
3. Orientation:
a. Normal:80aware80of80person,80place,80and80time
