Assignment: Neurological And Psychological Symptoms

Assignment: Neurological And Psychological Symptoms

Assignment: Neurological And Psychological Symptoms

Each discussion board should be at least 250 words with at least 1 peer-reviewed source within the past 5 years.

Discussion 1:  A patient is experiencing delirium after the initiation of a new medication. What questions would you want answered and what physical findings would you be looking for?

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Discussion 2:  Choose a special population and detail the approach to history taking and physical examination with the patient and/or family member.

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Assignment: Neurological And Psychological Symptoms Sample

Discussion 1

The questions to ask a patient experiencing delirium will assess the following elements: Mental status, Attention, Level of consciousness, and Thinking pattern (Duggan et al., 2021).

Mental status

How can you describe your mood today?

Do you have thoughts that you are better off dead?

What can you see, hear, and smell in this room?

What did you have for lunch today?

How would you describe your current health status?

Attention: Spell your name forward and backward

State the months of a year from the last to the first.

What number do you get when you add 16 to 7?

Level of consciousness

What is your name?

Where are you?

What time of the day is it?

Can you tell me where you are?

Thinking pattern

Can stones float on water?

Are there monkeys in the forest?

What weighs more, one pound or two pounds?

Physical findings: The physical findings I would look for in this patient include abnormal vital signs like hyperthermia, tachypnea, bradypnea, tachycardia, bradycardia, elevated blood pressure, and hypotension. In addition, I will examine signs of dehydration, hypoxia, and hypoglycemia. These include dry mucous membranes, poor skin turgor, peripheral and central cyanosis, diaphoresis, anxiety, shakiness, and confusion (Wilson et al., 2020). Physical exams that I will conduct include eye, pulmonary, cardiovascular, psychomotor, and abdominal exams. Delirium patients with anticholinergic overdose, hallucinogen use, and stimulant use often present with pupillary dilation and abnormalities in extraocular and funduscopic exams (Wilson et al., 2020). Furthermore, the examiner should look for signs of hepatic and splenic enlargement when examining the abdomen, which are common in drug intoxication

References

Duggan, M. C., Van, J., & Ely, E. W. (2021). Delirium Assessment in Critically Ill Older Adults: Considerations During the COVID-19 Pandemic. Critical care clinics37(1), 175–190. https://doi.org/10.1016/j.ccc.2020.08.009

Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020). Delirium. Nature reviews. Disease primers6(1), 90. https://doi.org/10.1038/s41572-020-00223-4

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Discussion 2

Older  adults are considered a special population and thus have a unique way of history taking and physical exams. The history taking for an elderly patient should focus on the patient’s emotional state, social circumstances, mental function, and sense of well-being in addition to other elements (Garrard et al., 2020).

Medical history: The patient is asked about chronic illnesses and the year of diagnosis. The examiner also asks about the patient’s history of immunizations and the dates for the last Tetanus and Flu shots.

Medication history: The examiner notes the past and current medications used to manage the patient’s chronic illnesses, including their effectiveness, side effects, and reasons for stopping them (Garrard et al., 2020).

Substance abuse history: The examiner asks about current and past use of alcohol, tobacco, and other illicit substances.

Nutrition history: The type, quantity, and frequency of food the patient eats are determined. The examiner should ask the elderly patient questions on Special diets, recent weight changes, accessibility to healthy food stores, and difficulties related to chewing, swallowing, digestion, or elimination (Garrard et al., 2020).

Mental Health History: The examiner asks about delusions and hallucinations, past mental health care, use of psychoactive drugs, and recent changes in circumstances.

Functional status: The examiner inquires about the patient’s ability to function independently, if they need help with activities of daily living, or require total assistance (Garrard et al., 2020).

Social history: The examiner obtains information on the patient’s living arrangements, accessibility of their residence, social contacts,  Caregivers and support system, transportation options, and the family members’ ability to help the patient.

Elderly abuse: The examiner asks the patient whether they feel neglected and any previous cases of being physically, sexually, emotionally, or financially abused (Rosen et al., 2018).

The physical exam follows the head-to-toe or systemic approach. The vital signs and anthropometric measurements should be recorded at each visit. A musculoskeletal and neurological exam is vital to assess the patient’s fall risk (Rosen et al., 2018). This includes assessing cranial nerves, motor function, muscle strength, coordination, gait, posture, reflexes, and sensation. Lastly, a mental status exam is vital for people above 65 years with concerns about cognitive decline.

References

Garrard, J. W., Cox, N. J., Dodds, R. M., Roberts, H. C., & Sayer, A. A. (2020). Comprehensive geriatric assessment in primary care: a systematic review. Aging clinical and experimental research32(2), 197–205. https://doi.org/10.1007/s40520-019-01183-w

Rosen, T., Stern, M. E., Elman, A., & Mulcare, M. R. (2018). Identifying and Initiating Intervention for Elder Abuse and Neglect in the Emergency Department. Clinics in geriatric medicine34(3), 435–451. https://doi.org/10.1016/j.cger.2018.04.007

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