DEVELOPMENTAL STAGES
This Erikson stage focuses on identity formation and peer acceptance.
What is Identity vs. Role Confusion?
Rationale:
Adolescents are highly sensitive to peer perception; threats to identity often present as emotional distress or resistance to care.
Micro-win takeaway:
Developmental needs shape behavior.
Sudden confusion, and fluctuating alertness in an older adult point first to this condition.
What is Delirium?
Rationale:
Acute onset and fluctuating cognition are hallmark features of delirium.
Micro-win takeaway:
Sudden change = medical first.
Persistent sadness and loss of interest lasting at least two weeks define this disorder.
What is Major Depressive Disorder?
Rationale:
Duration and functional impairment differentiate normal sadness from illness.
Micro-win takeaway:
Time matters.
Refusing to acknowledge substance use despite evidence demonstrates this defense.
What is Denial?
Rationale:
Denial protects against overwhelming anxiety.
🧠 Micro-win takeaway:
Defense ≠ deception.
This assessment evaluates appearance, behavior, speech, mood, and cognition.
What is the Mental Status Exam?
Rationale:
The MSE provides a structured snapshot of current functioning.
Micro-win takeaway:
Structure improves accuracy.
A school-age child who understands rules and cause-and-effect but struggles with abstract ideas is in this Piaget stage.
What is Concrete Operational?
Rationale:
Concrete thinkers learn best through tangible examples and direct experience.
Micro-win takeaway:
Match teaching to cognition.
Anxiety, tremor, weight loss, and irritability may indicate dysfunction of this gland.
What is the thyroid?
Rationale:
Hyperthyroidism commonly mimics anxiety disorders.
🧠 Micro-win takeaway:
Always think endocrine.
Endocrine imbalances affect:
Neurotransmitters (serotonin, dopamine, norepinephrine)
Energy regulation
Sleep–wake cycles
Stress response (cortisol)
This means they can present as:
Anxiety
Depression
Mania
Psychosis
Cognitive decline
…and get misdiagnosed if you don’t pause and think medically.
Pressured speech, decreased need for sleep, and grandiosity indicate this mood episode.
What is Mania?
Rationale:
Sleep reduction without fatigue is a key diagnostic clue.
Micro-win takeaway:
Sleep is diagnostic.
Attributing one’s own unacceptable feelings to others is this defense mechanism.
What is Projection?
Rationale:
Projection externalizes internal conflict.
🧠 Micro-win takeaway:
What’s loud may be internal.
The most critical assessment completed on psychiatric admission.
What is a suicide risk assessment?
Rationale:
Immediate safety takes priority over comprehensive history.
Micro-win takeaway:
Safety before story.
Failure to achieve this Erikson stage may result in low confidence and feelings of inadequacy in children.
What is Industry vs. Inferiority?
Rationale:
Children measure self-worth by competence; repeated failure affects emotional development.
Micro-win takeaway:
Skill-building supports self-esteem.
This common infection frequently causes new-onset behavioral changes in older adults.
What is a urinary tract infection?
Rationale:
Infections can trigger delirium without classic symptoms like fever.
Micro-win takeaway:
Behavior is a vital sign.
Gradual memory loss with preserved consciousness suggests this disorder.
What is Dementia?
Rationale:
Chronic, progressive decline distinguishes dementia from delirium.
Micro-win takeaway:
Speed of change guides diagnosis.
This is a defense mechanism where a person creates logical-sounding explanations to justify behavior, without actually addressing the behavior itself.
What is Rationalization?
Rationale:
Rationalization reduces guilt without addressing behavior.
e.g.
Substance use:
“I only drink because my job is stressful.”
Medication nonadherence:
“Those meds don’t really work anyway.”
🧠 Micro-win takeaway:
Exams don’t ask “What is rationalization?”
They ask whether you recognize when logic is being used to avoid insight.
Information from family or caregivers used to validate assessment findings is called this.
What is collateral information?
Rationale:
Patients may minimize or lack insight.
Micro-win takeaway:
One source isn’t enough.
This Piaget stage explains why a child may believe illness is punishment.
What is Preoperational thinking?
Rationale:
Magical thinking leads children to connect unrelated events.
Micro-win takeaway:
Misinterpretation ≠ defiance.
Abrupt cessation after prolonged heavy use of this depressant may cause tremors, hallucinations, and seizures.
What is alcohol (withdrawal)?
Rationale:
Alcohol withdrawal is life-threatening and often misinterpreted as psychosis.
🧠 Micro-win takeaway:
Withdrawal can look psychiatric.
Fear of abandonment and unstable relationships are central to this personality disorder.
What is Borderline Personality Disorder?
Rationale:
Core fear drives behavior patterns.
Micro-win takeaway:
Understand the fear, not just the behavior.
This is a defense mechanism in which a person focuses on facts, logic, and analysis to avoid experiencing or expressing emotion.
What is Intellectualization?
Rationale: Emotion is bypassed through excessive reasoning.
The person isn’t denying reality—they’re dissecting it.
It answers, “How does this work?”
while avoiding “How does this feel?”
Micro-win takeaway: Thinking isn’t feeling.
A patient eventually answers the question but includes excessive, unnecessary detail along the way.
What is circumstantial speech?
Rationale:
Circumstantial speech is overinclusive but goal-directed—the point is eventually reached.
Micro-win takeaway:
Long-winded isn’t disorganized.
Life review, meaning-making, and acceptance are key themes of this later-life developmental stage.
What is Ego Integrity vs. Despair?
Rationale:
Unresolved regret may present as depression or hopelessness in older adults.
Micro-win takeaway:
Emotional health reflects life narrative.
A patient on an SSRI presents with agitation, tremor, diaphoresis, and hyperreflexia.
What is Serotonin Syndrome?
Rationale:
Serotonin excess causes neuromuscular hyperactivity and autonomic instability—often mistaken for anxiety or mania.
Micro-win takeaway:
Agitation + reflexes ≠ anxiety.
Six months of hallucinations, disorganized thought, and social decline support this diagnosis.
What is Schizophrenia?
Rationale:
Duration plus functional impairment is key.
🧠 Micro-win takeaway:
Chronicity clarifies diagnosis.
A patient who recently lost mobility becomes overly dependent, speaks in a childlike tone, and asks staff to make simple decisions for them.
What is Regression?
Rationale:
Regression involves reverting to behaviors from an earlier developmental stage when faced with stress or loss, offering temporary emotional safety.
Micro-win takeaway:
Stress can pull people backward.
A patient with repeatedly low CIWA scores becomes acutely confused. Which condition should the nurse suspect?
What is delirium?
Rationale:
Alcohol withdrawal, infection, or metabolic changes can cause acute cognitive fluctuations even with low initial scores.
Micro-win takeaway:
One score doesn’t tell the whole story.