307-Mental Status Assessment/putting It All Together

Front 1

Remote Memory

Back 1

brings up years' worth of experiences

Front 2

Recent Memory

Back 2

evokes day to day events

Front 3

organic disorders

Back 3

Mental disorders due to brain disease of known specific organic cause
e.g. delirium, dementia, intoxication, withdrawal

Front 4

Components of the Mental Status Examination

Back 4

ABCT
Appearance, behavior, Cognition, and Thought process

Front 5

Psychiatric Mental Status

Back 5

Organic etiology has not yet been established
e.g. schizophrenia, anxiety disorder

Front 6

Mental Status is inferred through individual's BEHAVIORS

Back 6

Consciousness, Orientation, Memory, Attention, Speech, Mood and Affect, Abstract reasoning, thought process, thought content, perceptions

Front 7

When to perform full mental status examination?

Back 7

Behavior changes
Brain lesions (trauma, tumor, brain attack)
Aphasia (caused by brain damage)
symptoms of psychiatric mental status

Front 8

Aphasia

Back 8

loss of the ability to speak or write coherently, or to understand speech or writing due to CVA

Front 9

Abnormal Findings Level of consciousness

Back 9

Alert
Lethargic (somnolent)
Obtunded
Stupor or semicoma
Coma
Acute confusional state (delirium)

Front 10

Alert

Back 10

Awake or readily aroused, oriented, fully aware of external and internal stimuli and responds appropriately, conducts meaningful interactions

Front 11

Lethargic or Somnolent

Back 11

Not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in normal voice but looks drowsy, responds appropriately to questions or commands but htinking seems slow and fuzzy. Inattentive, loses train of thought spontaneous movements are decreased

Front 12

Obtunded

Back 12

-Transitional state between lethargy or stupor;
-Sleeps most of the time,
-difficult to arouse-needs loud shout or vigorous shake,
-acts confused when aroused, -converses in monosyllables, -speech may be mumbled and incoherent,
-requires constant stimulation for even marginal cooperation.

Front 13

Stupor or Semi-coma

Back 13

-Spontaneously unconsious, -responds only to persistent and vigorous shake or pain,
-has appropriate motor response (ex. avoids hand to avoid pain). Otherwise can only groan, mumble, or move restlessly;
-reflex activity persists

Front 14

Coma

Back 14

-Completely unconscious,
-no response to pain or to any external or internal stimui (e.g. when suctioned, does not try to push the catherer away),
-light coma has some reflex activity but no purposeful movement,
-deep coma has no motor response

Front 15

Acute Confusional State (Delirium)

Back 15

Clouding of consciousness (dulled cognition,
-impaired recent memory and confabularoty for recent events. -Often Agitated, has visual hallucinations;
-disoriented,
with confusion worse at night when environmental stimuli are decreased

Front 16

Global Aphasia

Back 16

The most common and severe form.
Spontaneous speech absent or reduced to few stereotype words
Comprehension absent or reduced to person's own name or few select words

Front 17

Broca's aphasia

Back 17

EXPRESSIVE aphasia. The person can understand but can not express himself using language.
-Auditory and reading comprehensions are intact.
-Lesions in anterior language area called motor speech cortex or Broca's area
-Repition, reading and writing impaired

Front 18

Wenicke's aphasia

Back 18

RECEPTIVE aphasia.
-The person can hear sounds and words but cannot relate them to previous experiences.
-Speech is fluent , effortless, and well articulated but has many paraphasias (word substitutions that are malformed or wrong)
-Reading, writing, repititions are also impaired
-Lesion is posterior language area called the Association auditory cortex or Wernicke's area

Front 19

What doesn't decrease with aging adult?

Back 19

There is no decrease in general knowledge and little or no loss in vocabulary

Front 20

What slows down in aging adult?

Back 20

Response time is slower than youth; it takes longer for the brain to process information and react to it. Thus performance on timed intelligent not advised

Front 21

Why is timed intelligence tests may be lower for the aging adult?

Back 21

performance may be lower, not because intelligence has declined by because it takes longer to respond to the questions.The slo9we th response time affects new learning if a new presentation is rapidly pace, the older adult doesn't have time to respond to it.

Front 22

Which memory decreases with aging?

Back 22

Recent memory somewhat decreases (e.g. medication instructions, 24 hr diet recall
-Remote memory is not affected

Front 23

How can vision loss affect mental status in aging adult?

Back 23

Vision loss may result in apathy, social isolation, and depression

Front 24

How can hearing affect mental status in aging adult?

Back 24

They have problem with conversation which causes frustration, suspicion, and social isolation, makes person look confused

Front 25

Why can't aging adult hear consonants?

Back 25

because consonants are high frequency sounds

Front 26

What would you suspect a person who has abnormal posturing and bizarre gestures?

Back 26

Schizophrenia

Front 27

A nurse points to articles in the room, parts of the body, articles form pockets, and ask person to name them. What is the nurse testing for?

Back 27

Word comprehension for Aphasia

Front 28

What kind of questions would you ask a person you suspect of having violent/suicide tendencies, delusions or hallucinations?

Back 28

Ask person's daily and life long goals

Front 29

What does mini mental state concentrate on?

Back 29

concentrates only on cognitive functions, not on mood or thought process.
-Valid detector for organic disease

Front 30

How would you interpret the scores in minimental state examination?

Back 30

Score that occur with Dementia and delirium:

18-23 Mild cognitive impairment

0-7 severe cognitive impairemnet

Front 31

What questions would you ask on the mini mental state examination?

Back 31

TPR-SR-NR-CR-WR
Time Orientation -what time of the year it is.

Place orientation -"where r u at right now?"

Registration of 3 words -"im going to say 3 words and say them back to me"

Serial 7s (a test of attention and calculation) -Subtract 7 from 100 and continue to subtract 7 from each subsequent remainder until I tell you to stop.

Recall of 3 words: What were those 3 words I asked you to remember

Naming -"what is this"

Repetition -"now i'm oging to ask you to repeat what I say, no ifs, buts and ands

Comprehension - Listen carefully becasue I'm going to ask you to do something

Reading -Please read the following and do what it says, but do not say it aloud

Writing -Close eyes. Please write a sentence.

Drawing -Please copy this design

Front 32

What would you do before assessing an aging adult's aspect of mental status?

Back 32

Check memory status first before assessing any aspect of mental status. Vision and hearing changes due to aging may alter alerness and leave the person looking confused

Front 33

What is Glasgow's Test for?

Back 33

is a quantitative toll that is useful in testing consciousness in aging person's response in eye opening, best verbal response, and best motor response.

Front 34

The use of Glasgow's Test avoids what?

Back 34

avoids ambiguity when numerous examiners care for the same person.

Front 35

What is the Set Test?

Back 35

-Supplemental Mental Status Exam
-Developed specially for use with an aging population. 65-80 yr
-Quantifiable test, designed to screen for dementia
Easy test, takes 5 min
Ask person to name 10 items in each of the 4 categories or sets: fruits, animals, colors and town.
-Do not use with persons with hearing impairments or aphasia
>25 =no dimentia

Front 36

What is the use of SET test?

Back 36

Tests for Cognitive function.
It assess mental function as a whole instead of examining individual part of cognitive function

Front 37

During Set test, when you asked person to name 10 items from each category, what are you testing?

Back 37

Person's alertness, motivation, concentration, short-term memory, and problem-solving ability

Front 38

Schezophrenia

Back 38

2or more of the following:
1. Delusions- involving a pehnomennon tha tthe person's culture would regard as totally implausible
2. Hallucinations (auditory more common) ex. voices speaking
3. Disorganized speech (incoherence)
4. Grosslyy disorganized or catatonic behavior
5. Negative symptoms (affective flattening, alogia-inability to speak

Front 39

What is the symptom of depression in children and adolescence?

Back 39

Irritable mood

Front 40

What catagory of Integration of the health assessment is vision using snellen's eye chart?

Back 40

Measurement

Front 41

Measurement

Back 41

WHCV
weight
height
compute body mass index
vision using Snelle's eye chart

Front 42

Skin

Back 42

Examine both hands and inspect the nails

Front 43

Vital signs

Back 43

RRBT

Radial pulse
Respirations
BP
Temperature (if indicated)

Front 44

Head and Face

Back 44

Inspect and Palpate:
scalp, hair, cranium

Inspect FACE: Expression, symmetry, (Cranial nerve VII)

Palpate: Temporal artery, then TMJ as theperson opens and closes moutth

Palpate: Maxillary and frontal sinuses.

Front 45

Upon palpating the Maxillary and frontal sinuses, the patient tells you they feel tender. What would you next?

Back 45

If tender, transilluminate the sinuses

Front 46

What tests would you perform for the Eye during complete assessment?

Back 46

Test visual fields by confrontation (Cranial nerve II)

Test Extraocular muscles: corneal light reflex, six cardinal positions of gaze (CN III, IV, VI)

Test pupil: size, response to light and accommodate

Front 47

What would you inspect in the eye?

Back 47

Inspect external structures
Inspect conjuctivae, sclerae, corneas, irides
DARK ROOM: inspect ocular fundus using an opthalmoscope.

Front 48

When inspecting ocular fundus using the opthalmoscope, what should you see?

Back 48

Ocular fundus: red reflex, disc, vessels, and retinal background

Front 49

How would you test for visual fields and what cranial nerve?

Back 49

Confrontation Test (Cranial Nerve II)

Front 50

How would you test for Extraocular muscles?

Back 50

Corneal light reflex, 6 cardinal positions of gaze

Cranial Nerve III, 1V, VI

Front 51

When testing the pupil, what are you looking for?

Back 51

size, response to light and accomodation

Front 52

EAR:
What should you inspect in the external ear?

Back 52

position
alignment
skin condition
auditory meatus

Front 53

EAR:
Why would you move the auricle and push tragus?

Back 53

to check for tenderness

Front 54

EAR:
When inspecting the tympanic membrane, what do you look for?

Back 54

Color, position, landmarks, and integrity

Front 55

EAR:
Sing the otoscope, what should you inspect before inspecting the tympanic membrane?

Back 55

inpect the canal then the tympanic membrane

Front 56

Nose:
When assessing the nose, what should you inspect?

Back 56

Inspect external nose
inspect facial symmetry (cranial nerve VII)
Test the patency of each nostril
Inspect the nares

Front 57

Nose:
When inspecting the external nose, what are you looking for?

Back 57

symmetry, lesions

Front 58

Nose: When inspecting the nares, what should you look for?

Back 58

nasal mucosa, septum, and turbinaes

Front 59

NOSE: What instrument do you use when inspecting the nares?

Back 59

Speculum

Front 60

NECK:
What do you inspect in the neck region?

Back 60

symmetry, lumps, and pulsations

Front 61

When testing the pupil, what are you looking for?

Back 61

size, response to light and accomodation

Front 62

EAR:
What should you inspect in the external ear?

Back 62

position
alignment
skin condition
auditory meatus

Front 63

EAR:
Why would you move the auricle and push tragus?

Back 63

to check for tenderness

Front 64

EAR:
When inspecting the tympanic membrane, what do you look for?

Back 64

(C-L-I-P)

Color, landmarks, integrity, and position

Front 65

EAR:
Using the otoscope, what should you inspect first before the tympanic membrane?

Back 65

inpect the canal then the tympanic membrane

Front 66

Nose:
When assessing the nose, what should you inspect?

Back 66

Inspect external nose
inspect facial symmetry (cranial nerve VII)
Test the patency of each nostril
Inspect the nares

Front 67

Nose:
When inspecting the external nose, what are you looking for?

Back 67

symmetry, lesions

Front 68

Nose: When inspecting the nares, what should you look for?

Back 68

NST
nasal mucosa, septum, and turbinates

Front 69

NOSE: What instrument do you use when inspecting the nares?

Back 69

Speculum

Front 70

Mouth and Throat:
Using you your penlight, what do you inspect in the mouth?

Back 70

buccal mucosa, teeth and gums, tongue, floor of mouth, palate and uvula

Front 71

Mouth and Throat:
When you ask the patient to say, "ahh" what are you checking?

Back 71

mobility of uvula

Front 72

Test for gag reflex and mobility of uvula upon phonation tests for what nerves?

Back 72

Cranial nerve IX and X

Front 73

When you ask your patient to stick out his tongue, what cranial nerve are you checking?

Back 73

Cranial nerve XII

Front 74

How would you palpate the mouth?

Back 74

With gloved hand, bimanually

Front 75

Neck:
When assessing the neck, what should you inspect?

Back 75

Symmetry, lumps and pulsations

Inspect and palpate: carotid pulse

Front 76

Neck:
What should you palpate in the neck region?

Back 76

Palpate:
cervical lymph nodes
Trachea in midline

Front 77

Neck:
How should you inspect and palpate the carotid pulse?

Back 77

One at a time! If indicated, listen for bruit.

Front 78

Neck:
How will you test neck ROM and muscle strength against your resistance?

Back 78

Head forward, and back, head turned to each side, and shoulder shrug

Front 79

Neck:
What cranial nerve are you testing when you ask the patient to shrug his shoulder?

Back 79

Cranial nerve XI

Front 80

How would you examine the thorax?

Back 80

Open the person's gown to expose all of the back for examination of the thorax,
but leave the gown on shoulders and anterior chest.

Front 81

Chest, Posterior and Lateral:

What would you inspect in the posterior chest?

Back 81

-Configuration of the thoracic cage -skin characteristics,
-symmetry of shoulders and muscles

Front 82

What would you palpate on the chest region?

Back 82

Palpate:
-symmetry expansion
-tactile fremitus
-lumps/tenderness
-length of spinous process

Front 83

Chest, Posterior and Lateral:

What would you percuss on the chest region?

Back 83

Percuss:
-over all lung fields
-diaphragmatic excursion
-Percuss costovertebral angle (note tenderness)

Front 84

Chest, Posterior and Lateral:

why would aucultate breath sounds?

Back 84

To note any adventitious sounds

Front 85

Chest, Posterior and Lateral:

Before lifting the female patient's gown, what should you do?

Back 85

Ask for permission to lift gown to drape on shoulders, exposing anterior chest

Front 86

How would position male patient's gown when assessing anterior chest region?

Back 86

Lower the gown to the lap

Front 87

How would you assess the patient's anterior chest region?

Back 87

Inspect: respirations and skin characteristics
Palpate: tactile fremitus, lumps or tenderness
percuss anterior lung fields
Auscultate breath sounds

Front 88

Your patient is in seated position as you listen to her heart sounds. What would you ask your patient to do before?

Back 88

Ask patient to lean forward and exhale briefly; ausculate cardiac base for any murmurs

Front 89

What part of upper extremities would you test ROM and muscle strength?

Back 89

hands, arms, shoulders

Front 90

When assessing upper extremities, what node would you palate?

Back 90

Palpate the epitroclear node

Front 91

When inspecting for symmetry, mobility, and dimpling of a woman's breast, what would you ask her to do?

Back 91

The woman lifts arms over the head, pushes the hands on the hips,and leans forward.

Front 92

What other areas should you inspect when assessing the breast?

Back 92

Supraclavicular and infraclavicular areas

Front 93

When palpating the breast, what position should the patient be at?

Back 93

supine with head at 0 to 30 degrees angle.

Front 94

When palpating the axilla and regional lymph nodes, how would you do it?

Back 94

support the patient's arm