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98 Cards in this Set
- Front
- Back
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what is the incidence rate |
the number of new cases occurring over a specified time, usually 1 year
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what is the prevalence rate
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the number of existing cases of a disorder at a specified time
(one in four adults will be diagnosed with a psychiatric disorder in their lifetime) |
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what is confrontation
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pointing out to the client something that he or she is not paying attention to, is missing or is denying
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what is culture
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the pattern of behavior of a group (racial, social, ethnic, religious grouping) that includes the thoughts, customs, beliefs, values or communication patterns of that particular group
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what is cultural competence
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viewing the client as a unique individual and providing care that is sensitive to issues related to culture, race, gender, and sexual orientation
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what are the 7 focal areas for assessment of cultural issues
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family roles- who is the primary caretaker, who makes the most decisions
family customs religious beliefs beliefs about death and dying dietary preferences meaning of non-verbal gestures physical space |
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When intervening in psychiatric situations that are affected by cultural influences LEARN
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listen
explain acknowledge recommend negotiate |
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what type of communication would you use for a child
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nurturing, play and fantasy
for adolescents, direct and clear |
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what assessment techniques may be used when anger is present (6)
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take time to establish report
extend courtesy and respect use humor to defuse the situation get quickly to the client's agenda and expectations for assessment be clear and honest about the goal of assessment and how the data will be used use limit setting when needed |
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what assessment techniques may be used when psychosis is present 4
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frequently reestablish reality for the client
use clear and concise language avoid word choices that the patient can interpret in concrete ways avoid unnecessary touch |
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what assessment techniques may be used when suspiciousness (3) is present
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explain carefully to the client any physical touch that is necessary before initiating it with him or her
be clear and honest about the goals of assessment and how the data will be used acknowledge the clients suspiciousness |
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what assessment techniques may be used when controlling 3 is present
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provide the client with information about what is happening and will happen
focus initially on intellectual aspects to match the clients control needs allow the client to control aspects of the interview as appropriate |
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what assessment techniques may be used when dependent 4 is present
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set limits as needed
allow time for and show patience during the interview process express an interest in dealing with the client maintain professional boundries |
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what assessment techniques may be used when anxiety 4 is present
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attend to milieu considerations
notice that the client may have a decreased ability to process information repeat questions as needed refocus the client as needed |
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What are the elements of the assessment process (10)
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identifying information
chief complaint history of present illness goals for the HPI Past psychiatric history past medical history social history family history developmental history functional assessment |
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what do you get during the Identifying information
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Age, gender, marital status, race, referral source
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What do you get when you ask for chief complaint
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the clients presenting problem
the clients explanation, regardless of how bizarre or irrelevant it is, should be recorded verbatim and placed in quotation marks |
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what do you get when you ask for history or present illness, or what does it provide or do
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provides a comprehensive and chronological picture of events leading up to the current moment in the clients life
is the most helpful part in making a diagnosis and the most important aspect of the history |
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when getting the HPI what 6 things do you have to ascertain information about the present problem
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Palliative- what makes it better
Provocative- what makes it worse Quality- how and where does the presence of the complaint affect the client's quality of life radiation- is the problem radiating to other areas of the clients life such as work severity- how much does the clients complaint affect day-to-day life? on a scale of 0-10 timing- is this a new complaint, how long has this been a problem, any particular time of day this complaint occurs |
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What are the goals for the HPI
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to develop raport
to record at least half of the MSE to keep track of cues for further exploration of facts or feelings to develop and devise a preliminary diagnosis |
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what is important to determine in the "past psychiatric" history and what does it entail
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determines the course and severity of the disorder
entails past mental disorders, any remissions or exacerbations, family psychiatric history, past treatments and responses, past suicidal or homicidal ideations or attempts |
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why is medical history important
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distinguishes between organic and psychiatric disorders
gives a chronological history of medical problems |
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what 8 things do you need to get in a social history
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home situation
family constellation/marital history, children, dependents work/school situation social network/relationships with others typical pattern of activity spirituality recent stressors legal history |
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what do you need to get in a family history 5
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structure
health history, cause of death, psychiatric disorders and treatments family risk factors conflicting and supporting relationships, cutoffs family strengths |
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what do you need to get in a developmental history
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maternal history of pregnancy
adverse perinatal events history of delivery |
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what aspects do you need to get in the developmental history of a child or adolescent
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birth and infancy history
cognitive development emotional development losses abuse sexual activity childhood illness childhood disorders secondary sexual characteristics parental pressures sense of personal identity |
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what are 8 cues to developmental problems in children
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enuresis
night terrors thumb sucking frequent tantrums excessive isolation fire setting cruelty to animals frequent truancy from school |
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what is the functional assessment and what does it determine
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looks at the degree of which individuals performance match demands of life
determines impact of illness on overall functioning used to differentiate depression from dementia in elderly people is used to track improvement or decline from his or her baseline includes all activities of daily living |
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how do you go about history taking during a crisis
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determine as the first priority the status of the emergency and assess danger to the client and others
always be alert to risk of impending violence attend to the safety of the physical surrounding focus on the presenting complaint or problem and obtain a supplemental history form others if necessary assess drug or alcohol use, mental status, current meds and past effective coping skills be straightforward, calm and honest and non-threatening |
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cranial nerve olfactory
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1
test sense of smell and ensure patency of nasal passages |
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cranial nerve optic
3 types of tests |
2
test vision using Snellen chart or other suitable chart depending on the clients' acuity and ability to cooperate examine the inner aspect of the eyes with an ophthalmoscope test peripheral vision using the confrontation test |
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cranial nerve oculomotor
2 test and one check |
3rd
this is the motor nerve to the five extrinsic eye muscles test together with cranial nerve 4 (trochlear) and cranial nerve 6 (abducens) test extraocular movments EOM's check equality of pupils, reaction to light and their ability to accomodate test the corneal light reflex (shine light at bridge of nose, light should appear symmetrically in both eyes) |
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cranial nerve Trochlear
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4th
same process as cranial nerve 3 and 6 |
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Cranial nerve trigeminal
2 parts |
5
motor division palpate the masseter muscles with the fingertips while the client clenches his or her teeth look for disparity in tension between the two muscles, which can indicate paralysis on the weak side look for tremor of the lips, involuntary chewing movements and spasm of the masticatory muscles sensory division test tactile perception of the facial skin by touching a wisp of cotton test superficial pain of the skin and mucosa with pinpricks test the sense of touch in the oral mucosa |
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cranial nerve abducens
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6th
use same as 3 and 4 |
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Cranial nerve facial
2 parts |
7th Motor division
inspect face in repose for evidence of flaccid paralysis test by asking the patient to elevate eyebrows, wrinkle forhead and close eyes, smile, puff cheeks facial sensory test taste for sugar, vinegar and salt |
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Cranial nerve acoustic
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8th
check hearing with the audiometer or by the whisper test check for hearing loss using the Weber and Rinne tests |
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Cranial nerve Glossopharyngeal
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test together with cranial nerve 10
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Cranial nerve Vagus
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10
test for elevation of the uvula by having the patient open his or her mouth and say "ah" test the gag refelx by touching the back of the throat with a tongue blade |
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Cranial nerve 11
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test the strength of the sternocleidomastoid and the trapezius muscle against the resistance of your hand
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cranial nerve hypoglossal
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12
look for tremors and other involuntary movement when the client protrudes tongue |
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What test do you do to check for equalibrium
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Romberg test
have the client stand up straight with feet together and arms at side and eyes closed. Only slight swaying is normal and the client will be able to sustain this pose for about 5 seconds more than slight swaying indicates a cerebellar ataxia or vestibular dysfunction |
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what is diadochokinesia
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the ability to perform rapid alternating movements (patting knees, palms of hands, touching thumb to finger)
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dyssynerfia
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- finger to nose test, heel to knee test
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stereognosis
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tests the ability to distinguish forms by placing objects in the clients hands while eyes are closed
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Graphesthesia
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tests the ability to identify figures, letters, or words by tracing a figure on the skin of the palm or the hand
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What are neurological soft signs
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dysdiadochokinesia- inability to perform rapid alternating movements, lesions to the posterior lobe of the cerebellum
astereognosis- inability to discriminate between objects based on touch alone, result of lesion in the parietal lobe Choreiform movements tics agraphesthesia - unable to recognize letters drawn on hand facial grimacing impaired fine motor skills abdnormal blinking abdnormal motor tone |
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What is a normal, overweight and obese BMI
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normal is 20-25
overweight 26-29 obese is 30+ |
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what is the MSE evaluating for
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behavioral, emotional and cognitive functioning
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flight of ideas
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speech pattern charachterized by accelerated speech and rapid shifts in topic
often disorganized and difficult to follow but syntax and vocabulary are intact |
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loose associations or derailment
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shift in thinking in which ideas move from one apparently unrelated topic to another
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poverty of content
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vague, repetitive, and abstractive form or speech that contains many words but little information
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neologisms
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word inventions or unusual application of current words that while having personal significance to the person have no apparent meaning for the listener
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Circumstantiality
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inclusion of unnecessary detail and parenthetical information into the conversation
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Tangentiality
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shifts in topics that often start as related shifts but progressively move farther away from the original topic
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clanging
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form of loose association in which topics change on the basis of sounds of words rather than meaning
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word salad
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form of very disorganized speech in which syntax is lost and worked use is random and idiosyncratic
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perseveration
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persistent repetition of words or phrases
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Blocking
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sudden stoppage of speech attributed to losing thought or forgetting what was being talked about
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echolalia
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echoing words or phrases just spoken by another
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hallucination
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false sensory perception without stimuli present, can be tactile, olfactory, gustatory, auditory, or visual, can be pervasive or episodic
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Delusional
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false belief firmly maintained despite evidence to the contrary
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illusion
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false perception of a real external stimulus
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Anhedonia
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Inability to derive pleasure from ordinarily pleasurable activities
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Depersonalization
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feeling self far away, disconnected
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derealization
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sense that one's environment has changed and is different form the way it has been before
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delusions of reference
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other peoples thoughts, words, or actions refer to the individual
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thought insertion
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delusion that thoughts are being placed into a persons mind by another person or force
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thought withdrawal
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delusion that thoughts are being removed by another person or force
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thought broadcasting
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delusion that others can hear a persons thoughts or a persons thoughts are being broadcast over air
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thought control
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delusion that a person's thoughts are being controlled by another person or force
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somatic delusion
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false belief involving a function of the body
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in the MSE how do you test concentration
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digit span test
serial number test backward spelling test |
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how to you test MSE memory
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long term memory
president testing event testing short term testing three object recall immediate recall number string testing |
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MSE abstraction testing
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proverb testing
similarity testing |
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Delirium or dementia will show what on a MSE
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clouded or wandering sensorium
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when testing cognition, depressed clients will say ___ and dementia clients will____
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"I don't know"
dementia will confabulate |
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MMSE
attention and calculation |
subtract serial 7's
spell world backwards |
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MMSE
recall |
recall three objects previously named
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what part of the thyroid test is used to determine thyroid status
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free portion (only a small amount is bound to protein)
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when you test thyroid and want the T4 what specifically are you testing and what level
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Free Thyroxine FT4
0.8-2.8 |
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what do increased levels of thyroid T4 indicate
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Graves disease
Thyrotoxicosis due to T4 Hashimoto's thyroiditis acute thyroiditis |
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what do decreased levels of T4 indicate
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Primary or secondary hypothyroid
tertiary hypothytriod (hypothalamic failure) Thyrotoxicosis due to T3 renal failure cushings Cirrhosis |
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what are the normal values of TSH
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2-10
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When T4 and T3 are high what happens to TSH
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decreases
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in primary hypothyroid TSH levels rise because of low levels of
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Thyroid hormone
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if the pituitary gland fails, TSH is not secreted and blood levels of TSH....
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faill
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TSH is used to diagnose
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primary hypothyroidism
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what results in high levels of TSH
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primary hypothyroidism
thyroiditis |
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decreased TSH results
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hyperthyroidism
secondary and tertiary hypothyroidism |
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what are normal calcium levels
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8.8-10.5
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what is a low CA associated with
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tetany
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high CA associated with
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hyperparathyroidism
>13.5 metastatic cancer |
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what are the 6 functions of calcium
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cofactor for clotting
hormone secretion function of cell receptors required for plasma membrane stability and permeability required for transmission of nerve impulses and the contraction of muscles |
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what are some reasons for increased levels of CA
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acidosis
hyperparathyroid cancer drugs vitamin D intoxication addisons disease hyperthyroidism lots of milk with Lithium tx, diuretics |
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some reasons for decreased levels of CA
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alkalosis
hypoparathyroidism renal failure pancreatitis inadequare VIT d incatke and calcium drugs- barbiturates, anticonvulsants, adrenocorticosteroids |
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side effects of a low CA
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increased neuromuscular excitabiltiy
confusion parathesias around the mouth and digits muscle spasms in the hands and feet hyperreflexia convusions tetancy sever muscle spasms EKG changes, prolonged QT interval intestinal cramping hyperactive bowel sounds |
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side effects of a high CA
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fatigue
weakness nausea constipation behavioral changes impaired renal funciton lethargy anorexia short QT interval bradycardia heart block |
