CH 5: Mental Status Flashcards
mental status is?
emotional and cognitive functioning
optional function aims toward?
simultaneous life w satisfaction in work, caring relationships, and within self
*influenced by environmental, biological, and sociodemographic factors
mental disorder?
clinically significant behavioral/emotional/cognitive syndrome associated w distress, distress, or disability involving social, occupational, or key activities
a response much greater than expected
*anxiety, stress, depression
organic disorders?
brain disease of known specific organic cause (delirium, dementia, alcohol/drug intoxication, withdrawal) anything that metabolically affects brain
psychiatric mental illness?
etiology not established, dysfunction affecting self care in everyday life
*schizophrenic, GAD
when to complete mental status exam?
recent trauma resulting with a change in memory
report of cognitive ability decline
when emotional and cognitive functioning is required
mental status exam components?
less comprehensive, done during course of physical exam- ABCT
A- appearance
B- behavior
C- cognition
T- thought processes and perceptions
components of mental status exam?
consciousness
language
mood and affect
orientation
attention
memory
abstract reasoning
thought process
thought content
perceptions
GAD-7?
7 itemized scales
higher the score, greater the likelihood
first 2 questions relate to core anxiety
greater or equal than 3 = diagnosis
depression screening?
Patient Health Questionnaire-2 (PHQ2): 2 questions about depressed mood and anhedonia (lack of interest), screening tool to use full PHQ-9
PHQ-9: 9 questions adding column totals relating to frequency of occurrence of symptoms, higher the score=greater the likelihood of functional impairment or clinical diagnosis
what does cognitive impairment look like?
clouding of consciousness
impaired alterness
impaired memory (recent most common)
disoriented, language impairment
hallucinations
increased confusion at night
agitation
delirium?
acute disturbance of consciousness and cognition (develops over short period of time)
medical conditions preclude it
no history of dementia
may develop in addition to dementia
*experienced by older adults who develop UTIs (metabolic imbalance)
characterized by rapid emotional changes
dementia
multiple cognitive deficits
chronic disturbance of consciousness and cognition
long and short term memory loss, short term more pronounced
disturbances in executive functioning
speech/language disturbances
level of consciousness?
describes awareness and understanding of what is happening in his or her surroundings
A&O x 3 or 4
awareness-
-awake: interactive
-lethargic: sleepy, drowsy, rousable/responsive
-stuporous: arousable WITH stimuli, resists arousal
-obtunded: cannot maintain arousal w/o repeated stimuli, moans/groans to stimuli
-comatose: non interactive w surroundings
orientation-
-person
-place
-time
-situations
sedation scale?
S= asleep, easy to arouse
1= awake and alert
2= slightly drowsy, easily aroused
3= frequently drowsy, arousable, drifts off to sleep during conversation
4= somnolent, minimal or no response to physical stimulation
Glasgow coma scale?
measures best motor, verbal, and eye response
determinate of level of consciousness
quantitative of level of consciousness
valid and reliable
score of <8 denotes coma
best response: 15
comatose: 8 or less
totally unresponsive: 3
global aphasia?
most common, most severe
causes lesion that affects anterior and posterior language areas
speech is absent/few words
no comprehension
cant repeat, read, or write
Broca’s or expressive aphasia
able to understand
cant express self using language
cant repeat or read aloud
lesion is in the motor cortex of the anterior portion of the brain (broca)
can read, listen, and understand but cannot express
how should you communicate with pt who has wernicke?
picture board
do not keep talking and repeating
do not write
use gestures to help understanding
Wernicke or receptive aphasia
opposite of Broca, posterior area of language center
can hear sounds- can’t relate to them
speech is fluent, urge to speak but words are made up= incomprehensible speech
impaired repetition, reading, writing
speaks but does not make sense
communicating with broca?
speak clearly
books on tape
picture board
written word (yours AND theirs) can read and understand it
yes/no questions
email
mini mental status exam?
tool used to systematically and thoroughly assess mental status, measures 6 areas of mental abilities:
orientation to time and place
knowing the date and where you are
attention/concentration
short term memory (recall)
what is the mini mental status exam used for?
to assess patient’s cognitive status when there is a concern of cognitive impairment. MMSE is sensitive and specific in detecting DELIRIUM and DEMENTIA in patients at a general hospital and in residents of long-term facilities
the aging adult?
get baseline on admission (ABCT)
check sensory status before mental status assessment (vision and hearing)
normally no decrease in knowledge or loss of vocab
slower response time
don’t answer for patient
teach at slower pace
