Assessment: Cognition, Sensory Perception and Mobility

Question 1

the structure of the neurological system

Answer 1

The structure of the neurological system has 2 parts, the central nervous system (brain and spinal cord) and the peripheral nervous system (consists of nerves that branch off from the spinal cord and extend to all parts of the body).

Question 2

function of the neurological system

Answer 2

control, regulate, and communicate.

It is responsible for regulating and maintaining homeostasis.

It is the center of all mental activity including thought, learning, and memory.

Question 3

Describe specific assessments performed during an examination of a patient’s cognition

Answer 3

Orientation Interview
Attention Span
Recent Memory
Remote memory
New learning – 4 Unrelated Words Test
Judgment

Question 4

Orientation interview

Answer 4

Assess the:
Time – day of the week, date, year, season
Place – where the person lives, present location, type of building, name of city and state
Person – own name, age, who examiner is

*Many hospitalized people normally have trouble with the exact date but are fully oriented to other items, so consider a hospitalized person who knows the month and year as being oriented to time

Question 5

Attention span

Answer 5

check the person’s ability to concentrate by noting whether a thought is completed without wandering

Note any distractibility or difficulty attending to your questions

Can also provide a series if directions to follow and note the correct sequence of behaviors

Be aware that attention span commonly is impaired in people who are anxious, fatigued, or drug intoxicated

Question 6

Recent Memory

Answer 6

Assess recent memory in the context of the interview, by the 24-hour diet recall

Question 7

Remote memory

Answer 7

Assess recent memory in the context of the interview, ask the person verifiable past events (ex: past health, first job, birthday and anniversary dates, and historic events)

Question 8

New learning – 4 Unrelated Words Test

Answer 8

Say to the person: “I am going to say four words. I want you to remember them. In a few minutes I will ask you to recall them.”

To be sure the person has understood, have the person repeat the words.

Pick 4 words with semantic and phonetic diversity
After 5 min; ask for recall of the 4 words

To test the duration of memory, ask for recall at 10 minutes and at 30 minutes

The normal response for people younger than 60 years old is an accurate 3 or 4 word recall after a 5-, 10-, and 30- minute delay

Question 9

Judgment

Answer 9

Note what the person says about plans, social or family obligations, and plans for the future

Also ask the person to describe the rationale for personal health care, including compliance with prescribed health regimens

The person’s actions and decisions should be realistic

Question 10

Describe specific assessments performed during an examination of a patient’s sensory perception status

Answer 10

Awareness of objects through any of the 5 senses

Is the patient having hallucinations? Are they hearing voices? What do the voices say? You definitely want to ask these questions directly when you are interviewing the patient as part of the mental status exam.

Question 11

Describe the specific assessments included in the Glasgow Coma Scale (assesses how the brain functions as a whole and not as individual parts)

Answer 11

The scale assesses three major brain functions:

Eye opening

Motor response

Verbal response

• A completely normal person will score 15 on the scale overall. Scores of less than 7 reflect coma.

*Using the scale consistently in the healthcare setting allows healthcare providers to share a common language and monitor for trends across time

Question 12

Best eye opening response

Answer 12

1 = no response
2 = to pain
3 = to speech
4 = spontaneously

Question 13

Best Motor response

Answer 13

1 = no response
2 = extension - abnormal
3 = flexion - abnormal
4 = flexion - withdrawal
5 = localizes pain
6 = obeys verbal commands

Question 14

Best verbal response

Answer 14

1 = no response
2 = sounds - incomprehensible
3 = speech - inappropriate
4 = conversation - confused
5 = oriented x3

Question 15

Identify the specific subjective data necessary to obtain a health history of a patient’s cognition, sensory perception, and mobility status

Answer 15

History of numbness, tingling, or tremors
History of seizures
History of headaches or dizziness
History of trauma to the head or spine
History of high blood pressure or stroke
Changes in the ability to hear, see, taste, or smell
Loss of ability to control bladder and bowel
History of smoking (how long, how many packs/day)
History of chronic alcohol use
History of diabetes mellitus or cardiovascular disease
Use of prescription and over-the-counter medications

Question 16

Describe specific assessments performed during the examination of a patients mobility status

Answer 16

general ease of movement
-gait and posture
alignment
-joint structure and function
-muscle mass, tone, and strength
-endurance

Question 17

Identify the specific subjective data necessary to obtain a health history of a patient’s mobility status