Symptom: Irritability

Initial Grading Reminder

Grade 1: Mild; easily consolable
Grade 2: Moderate; limiting instrumental ADLs; increased attention indicated
Grade 3: Severe abnormal or excessive response; limiting self-care ADLs; inconsolable

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you (or he/she) ever been overly irritable in the past? Is the melanoma known to be in your brain? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How irritable are you (or he/she)? Can you be consoled? Are you able to function?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Have/has you (or he/she) fainted? Are you short of breath? Does your heart seem to be racing? Do you have chest pain? A headache or a stiff neck? Are there other personality changes? Any inappropriate language?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new-onset moderate or worse (or worsening) irritability should be seen. Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of irritability?