Class 9 Cognition Learning Guide Faculty Answers Fall 2022 PDF

Cognition Learning Guide Fall 2022 1. Define the concepts: Cognition: The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses Intracranial regulation: Mechanisms or conditions that impact intracranial processing and function Intracra...

Cognition Learning Guide Fall 2022 1. Define the concepts: Cognition: The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses Intracranial regulation: Mechanisms or conditions that impact intracranial processing and function Intracranial: those components that lie within the skull, which include the brain, circulatory system, and dura mater Regulation: Compliance and maintenance of balance Family dynamics: Interrelationships between and among family members or “the forces that work within a family that produce particular behaviors or symptoms 2. Optimal cognitive health: 3. Cognitive impairment: Deficits in intellectual functioning; signifies observable or measurable disturbance in a cognitive process 4. Preventive health activities that promote cognitive health: Maintain a healthy lifestyle: Healthy diet, physically active Stay connected with social activities Keep mind active Manage stress Heart Health=Brain Health (manage blood pressure) Avoid substance abuse Avoid high-risk behaviors (to reduce chance of brain injury) 5. Healthy People 2030 goals for traumatic brain injury (TBI) Reduce fatal traumatic brain injuries Increase the percentage of adults who can resume more than half of their preinjury activities (with or without supports) 5 years after receiving acute inpatient rehabilitation for traumatic brain injury 6. USPSTF recommendations to reduce risk of head injury Recommendation for Preventing Falls in Community-Dwelling Older Adults Recommendation for Screening for Intimate Partner Violence, Elder Abuse and Abuse of Vulnerable Adults 7. Risk factors for traumatic brain injury High-risk behaviors; employment (military, law enforcement); falls; assaults; sports-related injuries; driving while impaired; crashes involving: motor vehicles, bike, pedestrians, recreational vehicles 8. Levels of prevention for traumatic brain injury Primary: Wear seatbelts/helmets; don’t drink/use substances and drive; prevent falls (check environment, safety socks, call light within reach); proper safety equipment while playing sports; firearm safety Secondary: Intimate partner violence screening tool (WAST or HITS); elder abuse screening tools; child abuse screening tools Tertiary: Will depend on extent of injury…may need hospitalization/surgery; rehabilitation 9. Abnormal assessment findings with traumatic brain injury: Mild: Headache, nausea/vomiting, drowsiness, problems with speech, dizziness, change in vision/hearing, sensitivity to light/sound, may/may not have loss of consciousness, concentration problems Moderate/severe: Loss of consciousness, persistent headache/nausea/vomiting, seizures, dilation of pupils, slurred speech, agitation, loss of coordination Children: Irritability, persistent crying, change in sleep habits, decreased attention, drowsiness, seizures 10. Health promotion and health prevention for traumatic brain injury Wear seatbelts/helmets; don’t drink/use substances and drive; prevent falls (check environment, safety socks, call light within reach); proper safety equipment while playing sports; firearm safety 11. How traumatic brain injury impacts self, patient, others There were 1.5 million TBI’s in 2019; TBIs are the leading cause of disability. 12. Elderly population as a vulnerable population 13. Define frailty Frailty: A clinically recognizable state of increased vulnerability. It is the result of normal age- associated decline in reserve and function across multiple physiologic systems, which affect the ability to cope with everyday stressors Operationally defined: Meeting 3 out of the following 5 criteria 1. Compromised energetics 2. Low grip strength 3. Low energy 4. Slowed waking speed 5. Low physical activity 14. Define caregiver role strain: Caregiver role strain: An experience when a caregiver feels overwhelmed and is unable to perform their role to the best of their ability; it is often accompanied by feelings of stress and anxiety 15. Define elder abuse and neglect Elder abuse: Intentional act or failure to act that causes or creates a risk of harm to an older adult (age 60 or older). The abuse comes at the hands of a caregiver or a person the elder trust. Physical, sexual, emotional, financial Neglect: Failure to meet an older adult’s basic needs (food, water, shelter, clothing, hygiene, and essential medical care) 16. Therapeutic communication using Tempa Snow’s Senior Gems techniques Healthy brain Sapphire: Brain that is true blue; not experiencing the changes of dementia; flexible and organized; typically brain of caregiver Describing the brain as it changes through stages of dementia Diamond: Clear and sharp, but rigid and inflexible; don’t like change; patient knows what he/she is doing, but stubborn; good with habit/routine, but doesn’t like change/new stuff Emerald: GREEN=GO (but not sure direction or timeframe); flawed but patient thinks he/she is fine; making mistakes/getting lost/turned around; patient doesn’t like when flaw is pointed out Amber: Patient is caught in a moment of time; all about how it feels (sensations); patient doesn’t have safety awareness; sleep patterns inconsistent Ruby: RED=STOP…especially fine motor skills; may have trouble chewing/swallowing/speaking; retains gross motor movements/strength Pearl: What disease does to the body is ugly…person still inside; patient is ruled by reflexes; caregiver should not worry/spend time on correcting shell 17. Describe mental health assessment- You must know the information listed below: The most common areas of cognition evaluated on a mental status examination are alertness, orientation, attention/concentration, memory, judgment, calculation, and abstract reasoning. If when assessing cognition or any other part of the mental status examination the practitioner finds symptoms of a possible neurocognitive disorder, more thorough screening is possible with additional evaluation tools such as Mini-Mental State Examination (MMSE)—please know what MMSE. Alertness is the level of consciousness of a patient. This can be described as alert, somnolent, obtunded, in a stupor, or comatose. Alert means that the patient is fully awake and can respond to stimuli. Somnolent means that the patient is lethargic or drowsy. Somnolence is considered to be a reduced level of consciousness, but the patient is still able to perceive stimuli and can be awakened fairly easily. Obtunded means that mild to moderate stimuli may not arouse the patient, and when the awoken patient will be drowsy with delayed responses. A patient in a stupor is unresponsive to almost all stimuli and when aroused may quickly go back to sleep without continued stimulation. A comatose patient is unresponsive to all stimuli, including vigorous and noxious stimuli. An altered level of consciousness or sensorium may indicate that a patient may have had a head injury, ingested a substance, or have delirium from another medical condition. Orientation refers to the patient’s awareness of their situation and surroundings. This is assessed by asking the patient if they know their name, current location (including city and state), and date. Someone who is normally oriented fully but is acutely not oriented may be experiencing substance intoxication, a primary psychiatric illness, or delirium. Delirium can be easily missed and miscategorized as a primary psychiatric illness. It is important to be able to differentiate this altered mental state because it may mean there is a critical medical condition that needs to be evaluated and treated. Attention/concentration is assessable throughout the interview by observing how well a patient stays focused on the questions asked. Alternatively, this can be directly tested in a multitude of ways. One way is to ask a patient to tap their hand every time they hear a certain letter in a string of random letters. If they have good math skills, then another method is to ask the patient to count back from 100 by 7. Additionally, a practitioner may ask a patient to spell a word forwards and backward or ask them to repeat a random string of numbers forward and backward. Impairment in attention/concentration may be a symptom of anxiety, depression, poor sleep, or a neurocognitive disorder. When describing the patient’s performance, a practitioner may document the performance as poor, limited, fair, or in the case of a previous comparison worsening versus improving. Additionally, a practitioner can specifically describe the task and the patient’s performance. Memory subdivides into immediate recall, delayed recall, recent memory, and long-term memory. A practitioner can choose to assess one or all types of memory during evaluation. Immediate recall is asking the patient to repeat something back to you. This determines if a patient can register new information. It can be a list of random words, random numbers, or a sentence. The delayed recall is asking the patient to repeat the same thing to you after a certain amount of time (usually 1 to 5 minutes) after performing another task that prevents the patient from doing repetitions to practice the answer. Even if a patient does not have delayed recall, they may be able to remember the information if given hints. In this case, a patient’s delayed recall would not be intact but prompted recall would. Recent memory is an assessment of how well a patient remembers recent events. This can be determined during the interview by asking about the history of present illness, what they ate earlier in the day, or what they have been doing with their time. Long-term memory assesses a patient’s memory of long- past events. Examples of this are asking a patient about when they had a child, what high school they went to, their childhood home, or their wedding. If a patient has impaired responses to recall testing and/or memory, this may point to a neurocognitive disorder that requires further screening with one of the assessments mentioned at the beginning of this section. Abstract reasoning is a patient’s ability to infer meaning and concepts. This is assessable by asking a patient what two objects have in common or how to interpret a common saying, adage, or proverb. Literal interpretations and answers indicate concrete thinking, which is seen in many psychiatric disorders but also some intellectual disabilities and neurocognitive disorders. Insight This refers to a patient’s understanding of their illness and functionality. It is usually described as poor, limited, fair, or if there is a previous comparison worsening versus improving. If a patient can acknowledge that their auditory hallucinations are not real, then that patient has fair insight. If a patient does not realize that their paranoia about all food being poisoned cannot be true, then their insight is poor. Judgment This refers to a patient’s ability to make good decisions. A way to directly assess judgment is to ask a patient what they would do in specific scenarios. Often this is assessed through a patient’s history during an interview and their observed actions. This, like insight, is also rated as poor, limited, fair, or if there is a previous evaluation to compare to, worsening versus improving. Patients that repeat the same mistakes over and over or refuse to take medications show poor judgment. It is not uncommon to have an encounter with a patient who does not believe their medications affect them positively or have any affect at all. Regardless of their poor insight, some patients show fair judgment by taking their medications because they know that when they do not take them, they return to the hospital for inpatient treatment. Those with poor judgment tend to have poor functioning due to the severity of their psychiatric illness. Patients with this kind of poor judgment and functioning are usually gravely disabled and often require inpatient psychiatric treatment. Example Documentation for Patient Charting Appearance: 25-year-old African American female, appears stated age, wearing paper hospital scrubs that have been cut to reveal abdomen with vertical abdominal scar visible, and multiple tattoos of various names visible on forearms bilaterally. Behavior: Not in acute distress, difficult to redirect for interviewing, inappropriately laughing and smiling Motor Activity: Minimal psychomotor agitation present. Regular gait. Regular posturing. No tics, tremors, or EPS present. Speech: Hyperverbal, fluent, pressured rate, regular rhythm, regular volume, happy tone Mood: “Fantastic” Affect: Elated, inappropriate, congruent Thought Process: Flight of ideas Thought Content: Denies suicidal ideations, denies homicidal ideations. Grandiose delusions elicited of being “an angel on a mission.” Perceptions: Endorses auditory hallucinations of God commanding her to go to California. Denies visual hallucinations. Does not appear to be actively responding to internal stimuli. Cognition: Sensorium/orientation: Alert and oriented to person, place, and date Attention/concentration: Poor. Unable to spell WORLD forward and backward. Memory: Able to recall 3/3 objects immediately and after 1 minute. Recent memory - Intact to breakfast this morning. Long-term memory - Intact to what high school she attended. Abstract reasoning: Intact with the ability to identify a bird and tree as both living. Insight: Poor Judgment: Poor Voss RM, M Das J. Mental Status Examination. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546682/ A component of the general health history; consider patient appearance, behavior and cognitive function compared with the characteristics of a healthy personality 18. Define BE WELL BU dimensions of wellness Spiritual: All aspects of a person’s life and helps a person to find meaning, purpose, hope, and peace. Cultural: Accepting, valuing, and even celebrating the different cultural ways people interact in the world. Emotional: Ability to understand and deal with your feelings. It involves attending to your own thoughts and feelings, monitoring your reactions, and identifying obstacles to emotional stability. Occupational: Level of happiness and fulfillment you gain through your work. Physical: Body's overall condition and the absence of disease. Social: Requires participating in and contributing to your community and society. Environmental: The livability of your surroundings and appropriately stewarding resources, both natural and man-made. Intellectual: Constantly challenging the mind. People who enjoy intellectual wellness never stop learning. Financial: Ability to live within your means and manage your money in a way that gives you peace of mind. Terminology: Cognition: The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses Intracranial regulation: Mechanisms or conditions that impact intracranial processing and function Intracranial: those components that lie within the skull, which include the brain, circulatory system, and dura mater Regulation: Compliance and maintenance of balance Family dynamics: Interrelationships between and among family members or “the forces that work within a family that produce particular behaviors or symptoms Cognitive health: Ability to clearly think, learn and remember Cognitive impairment: Deficits in intellectual functioning; signifies observable or measurable disturbance in a cognitive process Traumatic brain injury: Results from a blow or sudden jolt to the head Alertness: A condition of being mentally quick, active, and keenly aware of the environment Orientation: The awareness of one’s physical environment in regards to time, place, person Attention/concentration: Ability to focus on a particular area of conscious content, which implies selection as well as ability to direct cognitive effort Immediate recall: A type or stage of memory in which an individual recalls information recently presented, such as a street address or telephone number, although this information may be forgotten after its immediate use. Delayed recall: The ability to recollect information acquired earlier Recent memory: Working memory; the temporary storage of information that is used in managing cognitive tasks, like learning, reasoning, and comprehension Long-term memory: A relatively permanent information storage system that enables one to retain, retrieve, and make use of skills and knowledge hours, weeks, or even years after they were originally learned Insight: an awareness of underlying sources of emotional, cognitive, or behavioral responses and difficulties in oneself or another person Judgement: The capacity to recognize relationships, draw conclusions from evidence, and make critical evaluations of events and people Mood: A disposition to respond emotionally in a particular way OR any short-lived emotional state, usually of low intensity Affect: The outward expression of feelings and emotion Behavior: The way in which one acts or conducts oneself, especially toward others OR an action, activity, or process which can be observed and measured Motor activity: Movement quality and quantity that both influence and are influenced by states of arousal. Imbedded in activity levels are the qualitative aspects of movement that include muscle tone, posture, coordination, symmetry, strength, purposefulness, and planning Speech: The utterance of articulate vocal sounds that form words Thought processes: Any of the cognitive processes involved in such mental activities as reasoning, remembering, imagining, problem solving, and making judgments Thought content: describes what the patient is thinking and includes the presence or absence of delusional or obsessional thinking and suicidal or homicidal ideas Perception: Interpretation of the environment OR the sensory experience of the world, which includes how an individual recognizes and interprets sensory information Abstract reasoning: The ability to understand and think with complex concepts that, while real, are not tied to concrete experiences, objects, people, or situations