NR 548 Week 8 Final Exam Study Guide (Week 5-8)

 Behavior and a琀��tude -How does pt behave toward NP? -Consider context of interview – i.e. scheduled or in an ED -Descriptors are similar to a昀昀ect but emphasis is on rela琀椀onship toward someone  Speech -Important diagnos琀椀c indicator  Rate/rhythm -Rapid or pressured speech may be d/t mania or anxiety -Slow or normal speech  Volume -Speaking loudly may be d/t mania, irritability, anxiety -Low volume may be d/t depression or shyness  Latency of response -Pausing to think a昀琀er being asked a ques琀椀on before responding is normal -Decreased latency (not pausing or responding before ques琀椀on has fully been asked) may be d/t mania -Increased latency (long pause) may be d/t depression -Absence of speech may be seen in demen琀椀a -Non-sensical speech may be seen in psycho琀椀c disorders  General quality -Can you follow what the pt is saying or is it disconnected and confusing? o Cogni琀椀ve Assessment -Awareness: alert and oriented, somnolent, drowsy, comatose -Memory: immediate recall, short-term, and long-term; assess with orienta琀椀on test, 3-object recall, or recall of personal events  A琀琀en琀椀on and concentra琀椀on -Observe pt’s responses; can pt stay on topic? Can pt focus and respond to ques琀椀ons? -Con琀椀nuum from a琀琀en琀椀ve and focused to confused and distrac琀椀ble  Digit span test -Pt is given 5-7 numbers and asked to repeat them forward and backward **Not endorsed by research studies  SSST -Pt is asked to subtract 7 from 100 and con琀椀nue coun琀椀ng back by sevens un琀椀l told to stop **Not endorsed by research studies; no di昀昀erences bt hospitalized psychiatric pts and healthy controls  MBT (months backward test) -Pt recites 12 months in reverse -Errors of omission are strongly sugges琀椀ve of cogni琀椀ve impairment **Fairly sensi琀椀ve, most research support  Insight -Pt’s awareness of illness or situa琀椀on -Good, fair/limited, poor -Lack of insight: mania, schizophrenia “Why do you think you’ve been having these problems?”  Judgment -Pt’s ability to an琀椀cipate the consequences of their bx and safeguard their well-being -Good, fair/limited, poor -Assess based on material gathered during interview Ex: did pt seek help when feeling depressed? Did pt apply for unemployment bene昀椀ts when laid o昀昀? – good judgment Ex: did pt treat depression with a coke binge? – fun, but poor judgment o Mini-Cog (MMSE) -Used to determine memory de昀椀cits and r/o signi昀椀cant cogni琀椀ve issues -Considera琀椀ons: age, educa琀椀on level, culture  Scoring -Recall score: 1 point for each word correctly recalled without prompt (0-3) -Clock drawing score: 2 points for normal clock or 0 points for abnormal clock *Normal clock shows numbers 1-2 in correct order and direc琀椀on with one hand poin琀椀ng to 11 and other poin琀椀ng to 2 (0-2; pass/fail) -Score of 0-2  higher likelihood of cogni琀椀ve impairment -Score of 3-5  lower likelihood of demen琀椀a, does not r/o some degree of cogni琀椀ve impairment Hospitaliza琀椀ons, OP tx, current/past meds, types of therapy, suicide hx or violence hx from early childhood to present General statement, caregivers, hospitaliza琀椀ons, med trials, psychotherapy -SU hx Alcohol, drugs, ca昀昀eine, tobacco Consequences of use, pa琀琀ern of use, last use, and tx