Exam 2 (BH) (U7-10)

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Lewy Body Disease/Dementia

- 2nd most common, rapid progression, irreversible, early appearance of hallucinations and parkinsonian features, depression and delusions also common - Reduction in acetylcholinesterase, presence of lewy bodies in cerebral cortex and brainstem, very sensitive to EPSEs from antipsychotics

Anxiety Tx

- Benzos - Buspar - SSRIs

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Huntington's Disease

- Damage to basal ganglia and cerebral cortex leading to cognitive impairment and ataxia - Progression 10-20y (death from 2nd cause pneumonia, heart disease or choking)

Substance/Medication Induced Depressive Disorder

- Depressed mood as a direct result of substance (physiological) - Intoxication or withdrawal

Premenstrual Dysphoric Disorder

- Depressed mood, excessive anxiety, mood swings and decreased interest in activities the week prior to menses - Symptoms improve after onset of menstruation and are minimal or absent in the week after menses - Symptoms are severe and interfere with functioning and recurrent most cycles over the course of at least 1 year

Depressive Disorder d/t Medical Condition

- Depressive episode that is directly linked to another medical condition - Stroke, TBI, MS, Parkinson's, Huntington's and Cushing's (interfere with functioning)

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Traumatic Brain Injury

- Displacement of the brain - amnesia, confusion, speech, vision and personality changes - May eventually subside or become permanent - Repeated trauma: Dementia Pugilistica (emotional lability, dysarthria, ataxia and impulsivity)

U9 - O5 NRS Dx for Schizo & Psycho disorders

- Disturbed Sensory Perception - Disturbed Thought Process - Social Isolation - Risk for Violence (Self-Directed or Other-Directed) - Impaired Verbal Communication - Self-Care Deficit - Disabled Family Coping - Ineffective Health Maintenance - Impaired Home Maintenance

Psycho Spectrum Disorders: Schizophreniform Disorder

- Features identical to schizophrenia except that duration in all phases is at least 1 month but less than 6 months - Provisional diagnosis - Changed to schizophrenia if lasts more than 6mo

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Other Medical Conditions

- Hypothyroidism - hyperparathyroidism - pituitary insufficiency - encephalitis - brain tumor - epilepsy - pernicious anemia - CNS infections - lupus (inflammation in the brain) - fluid and electrolyte imbalance - MS

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Prion Disease

- Infection caused by prions - insidious onset and rapid progression (2y lifespan once Dx) - Coordination and movement disturbances and rapidly progressing dementia

U7 - O1 Neurocognitive disorders: Mild Cognitive Impairment

- Moderate cognitive decline that doesn't interfere with independent daily functioning - With or without behavioral disturbances

U7 - O4 (2q) Identify nursing diagnosis and appropriate nursing interventions for clients with neurocognitive disorders

- NRS Dx for NCDS - Desired outcomes for NCDs - NRS Interventions for NCDs

U9 - O5 (4q) Formulate nursing diagnoses and outcomes as well as appropriate nursing interventions for the care of clients with schizophrenia and psychotic disorders

- NRS Dx for Schizo & Psycho disorders - Desired outcomes for Schizo & Psycho disorders - NRS Interventions for Schizo & Psycho disorders

U7 - O3 (3q) Discuss predisposing factors and clinical symptoms of neurocognitive disorders

- Predisposition for Delirium - Predisposition for NCDs

U8 - O5 NRS Care plan for Mania - NRS Interventions

- Reduce stimuli, calm environment - Safe environment, remove hazardous objects - Monitor for suicidal ideation, hallucinations, delusions - Focus on reality, reorient if needed but do not argue - Avoid touch - Set limits and expectations - Be patient and consistent - Administer prescribed drugs - Monitor lab levels - High protein, high calorie finger foods - Small, frequent meals - Have snacks and drinks available - Stay with patient during meals or if agitated - Measure I & O, daily weights, calorie count - Limit group activities

U8 - O3 (2q) Identify predisposing factors in the development of depression and mania

- Risk factors for Depression - Risk factors for Bipolar Disorder

U8 - O5 NRS Care plan for Mania - NRS Dx

- Risk for Injury - Risk for Violence; Self-directed or other-directed - Risk for Suicide - Imbalanced Nutrition: Less than Body Requirements - Disturbed thought Processes - Disturbed Sensory Perception - Impaired Social Interaction - Insomnia/Sleep Pattern Disturbance

U7 - O4 NRS Dx for NCDs

- Risk for Injury/Trauma - Impaired memory - Risk for Violence, self-directed or other-directed - Impaired verbal communication - Self-care deficit - Low self-esteem - Complicated grieving (for loss of function)

U8 - O5 NRS Care plan for Depression - NRS Dx

- Risk for Suicide - Ineffective Coping - Complicated Grieving - Low Self-Esteem - Powerlessness - Hopelessness - Spiritual Distress - Social Isolation/Impaired Social Interaction - Disturbed Thought Processes - Imbalanced Nutrition - Insomnia - Self-Care Deficit

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Frontotemporal Lobe Degeneration

- Shrinking of frontal and temporal lobes of the brain, cause unknown - genetic factors - Behavioral (impulsive or apathetic) and personality changes and speech and language problems - Steady and rapid decline

Persistent Depressive Disorder (Dysrhythmia)

- Similar to but milder symptoms than MDD - Mood described as sad or "down in the dumps" also irritability (children) - Essential feature is chronically depressed mood for most of the day, more days than not for at least 2y (1 year for children/adolescents) - Poor appetite or overeating - Insomnia or hypersomnia - Low energy or fatigue - Poor concentration or difficulty making decisions - Feelings of hopelessness - Early Onset (diagnosed prior to 21y/o) of Late Onset (diagnosed after 21y/o) - Specify if in remission - partial or full - Specify severity - mild, moderate, severe

U8 - O6 (3q) Identify the various modalities of treatment for depression and bipolar disorder

- Tx modalities for Depression - Tx of Bipolar Disorder

U7 - O1 Delirium

1. Acute disturbance of cognition, attention and awareness - Hallucinations and illusions are common - Difficulty sustaining and shifting focus, easily distractible - Disorganized thinking, reasoning impaired - Speech is rambling, irrelevant, pressured, and incoherent - Disturbances in sleep-wake cycle (sleep during day, awake at night) - Disorientation, memory impairment, emotional instability (Outbursts) - Psychomotor activity ranges from restless, excitable to stupor - Autonomic Manifestations 2. Develops rapidly over a short amount of time, brief course 3. Has underlying cause - goal is to eliminate 4. High mortality rate - D/t safety issues: Falls, Harming others/self

U7 - O3 Predisposing factors for Delirium

1. Age 65-years or older 2. Hx of Depression, falls, elder abuse 3. INFECTION!! - UTIs in elderly, #1 sign in Delirium 4. Serious medical, surgical or neurological conditions - Metabolic disorders (electrolyte imbalance, hypoglycemia) - Hypoxia, COPD, heat stroke Hepatic or renal failure - Head trauma, seizures, migraines, brain tumor or abscess, stroke - Nutritional deficiency - Uncontrolled pain, Burns (Infection risk, fluid volume loss, etc.) - Orthopedic or cardiac surgeries (Joint replacements/repairs) - Social isolation, emotional stress, physical restraints, ICU admission (change of setting, institutionalized, stress or isolation, restraints) 5. Substance intoxication/withdrawal, medications &/ interactions, medical conditions

U10 - O3 (1q) Describe the types of anxiety, obsessive-compulsive, and trauma related disorders and their symptomology

1. Anxiety: Differential Dx 2. Generalized Anxiety disorder 3. Panic disorder 4. Panic attack 5. Agoraphobia 6. Specific phobias 7. Social anxiety disorder 8. Obsessive-Compulsive disorder 9. Other compulsion disorders 10. Post-traumatic stress disorder 11. 4 levels of Anxiety - Mild anxiety - Moderate anxiety - Severe anxiety - Panic

U8 - O2 (1q) Describe various types of bipolar disorder and mania

1. Bipolar disorder 2. Mania - 3 stages; Hypomania, Acute mania, Delirious mania 3. Types of Bipolar disorders - Bipolar I disorder - Bipolar II disorder - Cyclothymic disorder - Substance/Medication induced Bipolar disorder - Bipolar disorder d/t other Medical condition

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Alzheimer's Disease (pt. 1)

1. Cause unknown - Brain size reduced. Reduced production of ACh. Excess Glutamate. - Plaques & Tangles destroy/kill neurons. 2. Slow onset, insidious. Progressive, deteriorating 3. Dx: CT or MRI - Brain atrophy, Enlarged ventricles - 3 biomarkers: Amyloid-beta plaques. Tau neurofibrillary tangles. Neuronal damage. - If Biomarkers present before symptoms > Potential prevention 4. Risk factors: - Head trauma - Family Hx (40%) - Down syndrome - Link w/ inflammation

U10 - O3 Obsessive-Compulsive disorder

1. Characterized by involuntary recurring thoughts or images (Obsession) which the person is unable to ignore and/or recurring impulses to perform seemingly purposeless activity (Compulsion) 2. DSM-5 criteria: - Presence of obsessions, compulsions or both. - Obsessions are defined by: a. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress b. The individual attempts to ignore or suppress such thoughts , urges, or images or to neutralize them with some other thought or action (ie.. By performing a compulsion. - Compulsions are defined by: a. Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. b. The behaviors or mental acts are aimed at preventing or reduc

U10 - O3 Generalized Anxiety disorder

1. Characterized by persistent, unrealistic and excessive anxiety and worry that occurs more days than not for at least 6mo - Can't be attributed to organic factors 2. Client worries about everything, all of the time 3. DSM-5 criteria - Anxiety and worry are associated with 3 or more of the following a. Restlessness or feeling keyed up b. Being easily fatigued c. Difficulty concentrating or mind going blank d. Irritability e. Muscle tension f. Sleep disturbance - The anxiety, worry or physical symptoms cause clinically significant distress or impairment in functioning - The disturbance is not attributable to the physiological effects of a substance or another medical condition - The condition is not better explained by another mental disorder

U10 - O3 Panic disorder

1. Characterized by recurrent panic attacks, the onset of which are unpredictable and manifested by intense apprehension, fear, or terror. 2. Often associated with feelings of impending doom and intense physical discomfort 3. DSM-5 criteria - Recurrent unexpected panic attacks with four or more of the following symptoms: a. Palpitations b. Sweating c. Trembling or shaking d. SOB, smothering e. Feelings of choking f. Chest pain or discomfort g. Paresthesia h. Nausea, abdominal distress i. Derealization j. Dizzy, unsteady, lightheaded k. Depersonalization l. Chills or heat sensations m. Fear of losing control or going "crazy" n. Fear of dying - At least one of the attacks has been followed by 1 month (or more) of one or both of the following: a. Persistent concern or worry about additional panic attacks or their consequences b. A significant maladaptive change in behavior related to the attacks-behavior designed to avoid having panic attacks - The disturbance is not attributable to the p

U10 - O3 Post-traumatic stress disorder

1. Characterized by the development of behavioral symptoms following a psychologically traumatic event that is generally outside the range of usual human experience - War, rape, abuse 2. DSM-5 criteria - Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: a. Directly experiencing the traumatic event b. Witnessing, in person, the traumatic event as it occurred to others c. Learning that the traumatic event occurred to a close family member or close friend. d. Experiencing repeated or extreme exposure to aversive details of the traumatic events ( e.g., first responders collecting body parts). - Presence of one or more of the following intrusion symptoms associated with the traumatic event: a. Recurrent, involuntary, and distressing memories of traumatic event b. Recurrent distressing dreams in which the content are related to the traumatic event c. Dissociative reactions-flashbacks in which the individual feels or acts as if th

Major Depressive Disorder

1. Characterized by: - Depressed mood - Loss of interest or pleasure in usual activities - Impaired social or occupational functioning 2. Symptoms have existed for at least 2wks 3. No Hx of manic behavior 4. Can't be attributed to use of substances or medical condition 5. Diagnosed as a single episode or recurrent 6. Severity of symptoms identified: mild, moderate or severe 7. Evidence of psychotic, catatonic or melancholic features 8. Note presence of anxiety or suicidality 9. Specifiers; - With anxious distress - With mixed features - With melancholic features - With atypical features - With mood-congruent psychotic features - With mood-incongruent psychotic features - With catatonia - With peripartum onset - With seasonal pattern

U8 - O5 NRS Care plan for Depression - NRS Interventions

1. Create Safe Environment - Suicide precautions, 1:1, assess for suicidal ideation/plan, create safety plan, identify support system, spend time with client, observe closely, 2. Develop trust, establish rapport and have patience 3. Explore feelings of anger, sadness, loss of control, grief - encourage open, honest communication 4. Spend time with the client 5. Encourage group attendance, therapy 6. Teach coping mechanisms, effective communication, assertiveness, 7. Medication and illness teaching 8. Include client is goal-setting and decision making 9. Assist client to identify what they can control, encourage strengths 10. Encourage activities: art, music, gardening, walking, exercise

U9 - O5 NRS Interventions for Schizo & Psycho disorders

1. Decrease stimuli and remain calm 2. Observe patient for pos/neg symptoms, aggression 3. Avoid touch - Can be seen as aggressive/hostile or sexual 4. Avoid whispering or laughing in front of client 5. Delusions of persecution, can cause agitation/aggression 6. Orient as needed 7. Assist with ADL's as needed - Reminders, Providing supplies 8. Develop trust 9. Monitor for WATER INTOXICATION 10. Maintain safe environment 11. Do not reinforce hallucinations, illusions or delusions 12. Medications 13. Distraction Techniques 14. Avoid competition 15. Clear direct communication 16. Family education and support

U7 - O1 (2q) Define and differentiate between delirium and dementias

1. Delirium 2. Neurocognitive disorders - Mild - Major: Dementia

Pathological Anxiety

1. Diffuse, vague apprehension associated with feelings of uncertainty and helplessness that occurs from some form of dysfunction in the regulation of our normal fear response circuity and interferes with one's functioning. 2. An emotional, behavioral or physiological response to an internal or external threat, real of imagined. The source of anxiety is often unknown or unrecognized. - Anxiety is considered pathological when it interferes with functioning OR when it's out of proportion to the situation creating it

U9 - O4 Negative Schizo symptoms (*Taken away from Individual*)

1. Disturbances in Affect - Inappropriate Affect (incongruence) - Bland or Flat Affect (void of emotional tone) 2. Apathy (indifference) 3. Avolition (inability to initiate goal-directed activity) 4. Lack of Interest or Skills in Interpersonal Interaction (intrusion or withdrawal) 5. Lack of Insight - Anosognosia (lack of awareness of an illness) > Extreme lack of insight 6. Anergia 7. Anhedonia (inability to experience pleasure) 8. Lack of Abstract Thinking Ability (concrete thinking/literal interpretations)

U8 - O3 Risk factors for Depression

1. Genetic link - 7 times more common among 1st degree biological relatives - Twin and Adoption Studies: 1 twin diagnosed, the other one will too. Adoption link to depression 2. Biochemical - Deficiency of serotonin, dopamine and norepinephrine - Acetylcholine also plays a part: very complicated and not well understood 3. Neuroendocrine Disturbances - Hypothalamic-Pituitary-Adrenocortical Axis (elevated cortisol) - Hypothalamic-Pituitary-Thyroid Axis (hypothyroidism linked to depression) 4. Medication Side Effects - Direct effect on CNS 5. Neurological Disorders - CVA, brain tumors, Alzheimer's, Parkinson's, Huntington's, MS 6. Electrolyte Imbalances - Increase Sodium Bicarbonate or Calcium, Decrease Magnesium or Sodium, Potassium 7. Hormonal Disturbances - Addison's and Cushing's, hyper- and hypothyroidism and parathyroidism, changes in estrogen and progesterone (PMDD) 8. Nutritional Deficiencies - Anorexia, deficiencies in protein, carbohydrates, vitamins (thiamine, riboflavin, pyrid

U9 - O4 Positive Schizo symptoms - Disturbances in perception

1. Hallucinations - Auditory: hearing voices - Visual: seeing an elephant - Tactile: feelings bugs crawl on you - Gustatory: taste dirt when eating candy - Olfactory: smell food when there isn't any 2. Illusions - Misperceptions or misinterpretations of reality 3. Echopraxia - Imitates movements made by others

U10 - O3 Other compulsion disorders

1. Hoarding compulsion - Never throw anything away - Collect and keep things - Creates difficult & sometimes unsafe environments 2. Body Dysmorphic Disorder - Exaggerated belief that the body is deformed or defective in some way 3. Trichotillomania - Recurrent pulling out of one's hair resulting in hair loss 4. Dermatilomania - Recurrent picking at one's skin resulting in visible wounds

U9 - O4 Positive Schizo symptoms - Manifested in speech

1. Loose Associations - States/believes 2 completely unrelated things are/as related 2. Neologisms - Meaning to them but not to you 3. Clang Associations - Compulsion to rhyme words, without meaning 4. Word Salad - String of random words, without meaning 5. Circumstantiality - Excessive details that distract from the point 6. Tangentiality - Excessive stories off topic from the point 7. Perseveration - Repeat conversation/words 8. Echolalia - Repeating what another person says

U10 - O3 Specific phobias

1. Marked fear of a specific object or situation 2. Over 700 documented phobias - Common specific phobias: Snakes, Spiders, Flying, Heights 3. Phobic object or situation almost always provokes immediate fear or anxiety 4. Phobic object or situation is actively avoided or endured with intense fear or anxiety 5. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation 6. Fear, anxiety, or avoidance is persistent 7. Fear, anxiety, or avoidance causes clinically significant impairment in functioning 8. The disturbance is not better explained by the symptoms of another mental disorder

U10 - O3 Agoraphobia

1. Marked fear or anxiety about 2 or more of the following situations: - Using public transportation - Being in open spaces - Being in enclosed spaces - Standing in line or being in a crowd - Being outside of the home alone 2. The individual fears or avoids these situations because of thoughts that escape might be difficult or help may not be available

U8 - O5 (3q) Develop individualized nursing care plans for patients experiencing disturbances of mood including depression and mania

1. NRS Care plan for Depression - NRS Dx - Desired outcomes - NRS Interventions 2. NRS Care plan for Mania - NRS Dx - Desired outcomes - NRS Interventions

U10 - O3 Anxiety: Differential Dx

1. Physical symptoms of anxiety can mimic physical symptoms of other diseases 2. A thorough work-up must be done to rule out other diseases or disorders to ensure proper diagnosis - Example: MI > Chest pain, Angina, Rapid HR & RR

U8 - O6 Tx for Bipolar Disorder

1. Psychopharmacology - Mood-Stabilizing Agents (lifetime treatment): Lithium, anticonvulsants, antipsychotics 2. Individual psychotherapy - Interpersonal and Social Rhythm Therapy (IPSRT) - helps clients regulate social rhythms and daily activities (sleep-wake cycle, exercise routines), interpersonal therapy (relationship problems) 3. Group therapy - Group psychoeducation and group CBT, support groups, self-help groups 4. Family therapy - Family functioning and marital relationships are often disrupted (disloyalty, financial issues) - families need to be involved in treatment 5. Cognitive behavioral therapy - Client taught to control thought distortions 6. The Recovery Model - Recovery is a continuous process - clients identify goals based on personal values and their purpose in life and develops treatment plan with provider to achieve goals. Develop strategies to management symptoms of bipolar disorder. 7. Electroconvulsive therapy - Induction of grand mal seizure through applicat

U8 - O6 Tx modalities for Depression

1. Psychopharmacology - SSRIs, SNRIs, MAOIs, TCAs, tetracyclics, atypical antidepressants, combination therapies 2. Individual psychotherapy - Focuses on client's current interpersonal relationships 3. Group therapy - Peer support: security, perspective 4. Family therapy - Initiate or restore adaptive family functioning, psychological well-being of whole family 5. Cognitive behavioral therapy - Client taught to control thought distortions 6. Electroconvulsive therapy - Induction of grand mal seizure through application of electrical current to brain 7. Repetitive Transcranial Magnetic stimulation - Short pulses of magnetic energy used to stimulate nerve cells in the cerebral cortex 8. Vagal nerve stimulation - Electrical device implanted under skin to stimulate the vagal nerve 9. Deep brain stimulation - Electrode implanted deep into brain via craniotomy 10. Light therapy - Client sits in front of light box with eyes open in 10-15 min sessions which increase in length - Retinal sti

U7 - O2 Cognitive function: Assessment techniques

1. Pt Hx: Mental & Physical changes, Age of occurrence - H/O head trauma - Obtain Hx from family d/t client being unreliable or unable to 2. Med review - R/o substance abuse 3. Physical signs of damage to nervous system - Mental Status exam 4. Neuropsychological testing 5. Differential Dx 6. Labs: Blood tests, Tox screen, Lumbar puncture 7. Neuro Imaging: CT, MRI, PET scan

U7 - O4 NRS Interventions for NCDs

1. Safety - Bed in lowest position, floor free from clutter, room arranged to accommodate ability (assistive device), room near nurse's station, close observation, 1:1, assist with ambulation, reorient as needed 2. Lower stimuli for agitation (light and noise), use night lights 3. Medications when appropriate 4. Remain calm, be patient, consistency of staff and caregivers, validate feelings 5. Structured schedules, remind client they are safe 6. Easy to read clocks and calendars, large signs, lists 7. Diversional activities (radio, television, music), touch may be appropriate here 8. Ensure client has hearing aids, dentures and glasses 9. Speak slowly, clearly and use simple words, one question/direction at a time 10. Identify self and use client's name when interacting 11. Assist with ADLs - toileting schedule, incontinence care, rest/activity balance 12. Small frequent meals/snacks, offer foods client likes 13. Reminiscence Techniques 14. Validation Therapy - Instead of reality reori

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Vascular Dementia/Disease

1. Significant cerebrovascular disease (impaired blood flow to brain - small strokes) 2. Abrupt onset, deterioration more like "steps" - Marked decline then stability, repeating 3. High blood pressure, emboli (solid, liquid or gas), silent strokes or large CVA

U10 - O3 Social anxiety disorder

1. Social Phobias are characterized by a persistent fear of behaving or performing in a way that will be humiliating or embarrassing to the individual-public speaking, eating, public restrooms, answering a question in class 2. DSM-5 criteria - Social situations always cause fear - Social situations are avoided or endured with intense fear or anxiety - The fear, anxiety or avoidance is out of proportion to the actual threat posed - The fear, anxiety or avoidance is persistent-lasting 6 months or more - The fear, anxiety or avoidance causes clinically significant impairment in functioning - The fear, anxiety or avoidance is not attributable to the physiological effects of a substance - The fear, anxiety or avoidance cannot be better explained by another mental disorder - If another medical condition is present the fear, anxiety or avoidance is excessive

U9 - O4 Associated features of Schizo

1. Waxy Flexibility - Individual allows body parts to be placed in bizarre or uncomfortable positions (catatonia) a. Like leaving your arm extended after a BP check 2. Posturing (inappropriate or bizarre postures) 3. Pacing and Rocking 4. Regression - Retreat to an earlier level of development (childlike behaviors) 5. Abnormal Eye Movements - Difficulty maintaining focus on a stationary object or difficulty following a moving object 6. Religiosity - End of world, God is coming/has spoken to them, They are God/the devil, etc.

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Alzheimer's Disease (pt. 2)

5. Clinical findings - AD is most common form of NCD (5.8mil in U.S.) - # of people w/ AD doubles q5y after 65 y/o - 200k individuals w/ AD younger than 65 y/o - 5th leading COD for over 65 y/o - 2/3 women - greatest health cost of any disease - AD not normal in aging - Survival after Dx: typical 4-8y

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Alzheimer's Disease (pt. 3)

6. Stages of AD Stage 1 No apparent Symptoms (but changes in brain - PET scan) Stage 2 Very mild changes: ST memory decline (forget names, aware of changes - depression, anxiety) Stage 3 Mild cognitive decline: decline in thinking & reasoning: noticeable and starts interfering with functioning Stage 4 Moderate cognitive decline: Forget major events - Denial (Confabulation: imaginary events to fill memory gaps) Stage 5 Moderately severe cognitive decline: Loss of independence completely, Disorientation, Frustration, Withdrawal, Apraxia Stage 6 Severe cognitive decline: Unable to perform ADLs, Delusions, Incontinence, Wandering, Loss of language, Institutionalized. Sundowning (symptoms worsen in late afternoon to evening) Stage 7 Very severe cognitive decline: End stage - Won't recognize family, Aphasic, Feeding issues, Often confined to bed

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Parkinson's Disease

75% of clients with Parkinson's, loss of nerve cells, diminished dopamine activity

Schizophrenia

A disabling psychological disorder that is characterized by disturbances in thought processes, perception and affect that invariably results in severe deterioration of social and occupational functioning. 1. Not a single disease but a spectrum of disorders - 1% of general of population - Symptoms typically appear in late adolescence/early adulthood - 25y shorter life span - Longer hospitalizations, greater chaos in family life and more exorbitant cost - Increased risk of suicide ~ 20-40% attempt suicide ~ 5% complete - No single treatment (meds, therapy, social and living skills training, rehabilitation and recovery)

Psychosis

A severe mental condition where there is disorganization of personality, deterioration of social functioning and loss of contact with or distortion of reality.

U8 - O2 Types of Bipolar disorders: Bipolar Disorder d/t other Medical Condition

Abnormally and persistently elevated, expansive or irritable mood and excessive energy or activity as a direct result of another medical condition - Thyroid disorders, stroke, TBI, MS, lupus, AIDS

U8 - O2 Mania

Alteration in mood expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts and accelerated speech - Motor activity is excessive and frenzied

Depression

Alteration in mood expressed by feelings of sadness, despair and pessimism - Loss of interest in usual activities - Changes in appetite, sleep patterns and cognition (brain fog, short-term memory loss) are common - Oldest and most frequently diagnosed psychiatric illness

Psycho Spectrum Disorders: Catatonic Disorder due to Medical Condition

Catatonic symptoms directly linked to another medical condition based on medical history, physical exam and laboratory findings

U8 - O3 Risk factors for Bipolar Disorder

Chemical imbalance in the brain (cause unknown) with hereditary factors and environmental triggers - Genetic Link: twin and family studies - Biochemical: excessive dopamine and norepinephrine, low serotonin, excessive glutamate, acetylcholine - Neuroanatomy: decreased anterior brain function - Medication side effects: steroids, amphetamines, antidepressants, anticonvulsants and narcotics can induce mania - Childhood trauma: gene changes

U8 - O2 Types of Bipolar disorders: Bipolar II Disorder

Client has recurrent bouts of major depression with episodes of hypomania - Never had full manic episode (no hospitalization)

U8 - O2 Types of Bipolar disorders: Bipolar I Disorder

Client is currently having manic episode or has a history of 1 or more manic episodes - Manic episodes require hospitalization

U7 - O2 (1q) Identify techniques used in the assessment of client's cognitive functioning

Cognitive function assessments

U8 - O2 Bipolar Disorder

Cycles of Depression & Mania - Mood swings from profound depression to extreme euphoria with intermittent period of normalcy - Delusion or hallucination may or may not be present - Marked impairment to functioning

U9 - O4 Positive Schizo symptoms - Disturbances in thought

Delusions 1. Delusion of persecution/paranoid delusions 2. Grandiose delusions 3. Delusions of reference - Thinks that someone is relaying specific info just to them 4. Delusions of control or influence/magical thinking - Govt. mind control - Sky is raining because I'm crying 5. Somatic delusions - False belief of pregnancy 6. Nihilistic delusions - Thinks that something doesn't exist or has been destroyed 7. Erotomanic delusions - Thinks that someone in a higher position than them is in love/lust with them 8. Jealous delusions - Seen btw romantic partners where they believe they've been unfaithful, accused of cheating but lover is a delusion

Hallucinations

Disturbance in perception - False sensory perceptions that may involve any of the 5 senses

Delusions

Disturbance in thought - False beliefs that are irrational, but that individual maintains are true despite evidence of the contrary

Stress

External or internal pressure - Physical stressors: Extreme temps. Loud, repetitive sounds. Bright lights. Pain. Childbirth. - Chemical stressors: Drugs. Pollutants. Toxins. Gasses. - Microbio stressors: Viruses. Molds. Parasites. Infectious organisms. Physiological disease processes. - Psych stressors: Anticipated marriage or death. Emotional involvement. Threats to self-concept. Rejection/Separation by a loved one. Role changes. Actual or perceived failures. - Developmental stressors: Prematurity (birth). Aging process. Developmental tasks. Transitions (growth, puberty, relationships). - Sociocultural stressors: Changing social norms. Racism, Sexism, Ageism. Culture-bound stressors. - Environmental stressors: Unemployment. War. Natural disasters. Crime.

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... HIV Infection

HIV-1-Associated Cognitive/Motor Complex - brain infections by other organisms

Psycho Spectrum Disorders: Psychotic Disorder due to Medical Condition

Hallucinations/Delusions directly linked to another medical condition

Psycho Spectrum Disorders: Substance/Medication Induced Psychotic Disorder

Hallucinations/Delusions directly linked to substance intoxication or withdrawal or exposure to medication or toxin

U8 - O2Stage 2 of Mania: Acute Mania

Marked impairment, hospitalization - Mood: euphoria and elation, volatile - anger, irritability, sadness, crying - Cognition and Perception: fragmented and psychotic, racing thoughts, flight of ideas - Activity and Behavior: excessive motor activity, poor impulse control, sexuality increased, lacks insight, denial of problem, unreliable reporting, no sleep, unlimited energy, hygiene neglected, excessing make-up or jewelry

U8 - O2 Types of Bipolar disorders: Substance/Medication induced Bipolar Disorder

Mood disturbance (elated, expansive or irritable w/ inflated self-esteem, decreased need for sleep and distractibility) as a direct result of substance (physiological) - Intoxication or withdrawal

U7 - O1 Neurocognitive disorders: Major Cognitive Impairment - Dementia

Not a disease - loss of mental function - Significant decline in cognitive ability in the presence of clear consciousness - Impairs social and occupational functioning - Can be primary or secondary - Progressive and irreversible - Interferes with basic functioning - Severity: mild, moderate or severe

U8 - O2 Stage 1 of Mania: Hypomania

Not sufficiently severe - Mood: cheerful w/ underlying irritability, volatile and fluctuating - Cognition and Perception: great self-worth and ability, flighty and distractible - Activity and Behavior: talk and laugh loudly and inappropriately, extroverted, social

Affect

Outward, physical expression of mood

U8 - O2 Types of Bipolar disorders: Cyclothymic Disorder

Over the period of 2y (1y for children and adolescence) client experienced symptoms of depression and mania that are not severe enough to meet criteria for major depressive episode, mania or hypomania and are never without symptoms for more than 2mo at a time

U10 - O3 Panic attack

Panic attack is not a mental disorder, but can occur in the context of any mental disorder ie... PTSD with panic attacks. Panic attack requires 4 or more of the following symptoms: - Palpitations - Sweating - Trembling or shaking - SOB, smothering - Feelings of choking - Chest pain or discomfort - Paresthesia - Nausea, abdominal distress - Derealization - Dizzy, unsteady, lightheaded - Depersonalization - Chills or heat sensations - Fear of losing control or going "crazy" - Fear of dying

U7 - O3 Predisposing factors for mild/major NCDs: Specify d/t... Substance/Medication Abuse

Persist beyond usual duration of intoxication/withdrawal (alcohol, sedatives, hypnotics, anxiolytics, inhalants, lead and mercury)

Mood

Pervasive and sustained emotional state that influences a person's perception of the world - personality, outlook, daily functioning

U10 - O3 Moderate anxiety

Physical signs: - Perception starts to narrow - Voice tremors - Change in voice pitch - Shakiness - Increased Resp, Pulse, Muscle tension - Pacing Interventions: - Assist to focus - Utilize open-ended communication - Ask what they need - Ask what worked in past - Stay calm - Encourage to talk - Encourage problem-solving

U9 - O4 (5q) Identify the symptomology associated with these disorders and compare & contrast positive and negative symptoms

Positive Schizo symptoms; - Disturbances in thought - Manifested in speech - Disturbances in perception Negative Schizo symptoms; - Disturbances in affect - Apathy - Avolition - Lack of interest or Skills in Interpersonal interaction - Lack of insight - Anergia - Anhedonia - Lack of Abstract thinking Associated features; - Waxy flexibility - Posturing - Pacing & Rocking - Regression - ABN Eye movement - Religiosity

Psycho Spectrum Disorders: Delusional disorder

Presence of delusions for at least 1 month

Catatonia

Psychological disturbance characterized by stupor or excitement

Psycho Spectrum Disorder: Schizoaffective Disorder

Same symptoms of schizophrenia but also includes strong element of mood disorder (depression or mania)

U8 - O2 Stage 3 of Mania: Delirious Mania

Severe clouding of consciousness, rare - Mood: labile, despair to ecstasy to irritable or indifferent, may have panic level anxiety - Cognition and Perception: confusion, disorientation, stupor, incoherent, psychosis - Activity and Behavior: frenzied, agitated, purposeless movement, exhaustion, safety

Psycho Spectrum Disorders: Brief Psychotic disorder

Sudden onset of psychotic symptoms that last at least 1 day but less than 1 month

U8 - O5 NRS Care plan for Mania - Desired outcomes

The Client has... - Exhibits no evidence of physical injury - Has not harmed self or others - Is no longer exhibiting signs of physical agitation - Eats a well-balanced diet - Verbalizes accurate interpretation of environment - Verbalizes or demonstrates no evidence of psychosis - Accepts responsibility for own behaviors - Does not manipulate others for own needs - Interacts appropriately with others - Is able to fall asleep and stay asleep

U8 - O5 NRS Care plan for Depression - Desired outcomes

The Client has... - Experienced no physical harm - Discussed feelings - Expressed hopefulness - Set realistic goals - Expressed personal satisfaction - Interacted willingly and appropriately with others - Ate a well-balanced diet - Been able to concentrate, reason, problem solve and make decisions - Maintained reality orientation - Attempted new activities - Identified aspects of self-control over life situations

U7 - O4 Desired outcomes for NCDs

The client... - Hasn't experienced physical injury - Hasn't harmed self or others - Has maintained reality and orientation to the best of their ability - Is able to communicate with caregivers - Is able to complete ADLs with assistance or has needs met by caregiver - Discuss positive aspects about self and life

U9 - O5 Desired outcomes for Schizo & Psycho disorders

The client... - Relates to others - Has not harmed self or others - Recognizes distortions of reality - Perceives self realistically - Can perceive the environment correctly - Anxiety at a manageable level - Can trust others - Appropriate verbal communication - Performs self-care independently - Increased self-esteem - Increased functioning (social, family, occupational)

U10 - O3 Mild anxiety

Typically doesn't cause a disturbance so it's not treated often 1. Physical signs: - Perception increased - Slight discomfort - Restlessness - Foot tapping - Fidgeting

Fear

intellectual appraisal of danger

Normal Anxiety

normal response to an observable threat

U7 - O3 Predisposing factors for Dementia - mild/major NCDs: Specify d/t...

•Alzheimer's Disease •Frontotemporal Lobe Degeneration •Lewy Body Disease •Vascular Disease •Traumatic Brain Injury •Substance/Medication Use •HIV Infection •Prion Disease •Parkinson's Disease •Huntington's Disease •Another Medical Condition •Multiple Etiologies •Unspecified