Topics

• Psychiatric Mental Health
• Cognitive Assessment
• Pediatric Considerations
• Sample Case

NDNP 819: Advanced Health Assessment Across the Lifespan

Module 9: Psychiatric Mental Health, Cognitive Assessment

Sample Case

A 78 year old is brought to the geriatric clinic by her son and daughter in law. Her son tells the examiner that his father passed away 5 months ago and ever since then his mother has “gone downhill”. The son indicates that his mother is no longer keeping her house clean or cooking appropriate meals. Also, her personal hygiene habits have changed dramatically. She has lost interest in getting her hair done, and she no longer likes to get dressed for the day. The son tells the examiner, “When I suggest a retirement home, she becomes very angry and tells me to mind my own business. I am just worried about Mom, and I want to make sure she is well cared for”. During this conversation, the mom sits quietly. She interjects only to say, “I have taken care of you, your brother, and your father. No all of a sudden, you think I am helpless and want to lock me away”. The mom appears clean, although her hair is matted and her clothes are badly wrinkled and do not match. Her speech is clear, but her overall affect is very dull. She does not make eye contact with her son or the examiner.

It would be important to ask SIGECAPS of the patient for depressive symptoms, and conduct a cognitive assessment to rule out memory difficulties. She may not be open to discuss her mood, but appetite and sleep variations may be elicited from her. The APN needs to evaluate her medications and substance use to determine if she has one or mood of these impacting her mood. What are her medical diagnoses? Do they lend themselves to depression? Physical exam must include neurological, HEENT (r/o thyroid issues, CV, Resp. Any positive ROS questions would need examination. There doesn’t seem to be any delirium concerns since she is alert, oriented and not having sudden altered mental status.