Class 2-Mental Status Assessment Flashcards
Mental status definition
-mental status is a person’s emotional and cognitive functioning
-optimal functioning aims toward simultaneous life satisfaction in work, caring relationships, and within self
-influenced by biological, environmental, and sociodemographic factors
-usually mental health strikes a balance, allowing a person to function socially and occupationally
-stress can be triggered by traumatic life events causing transient dysfunction which can be an expected response
Mental status structure and function
-mental disorder
-organic disorders
-psychiatric mental illnesses
mental disorder
-anxiety; depression
-clinically significant behavioral emotional or cognitive syndrome that is associated with significant distress or disability involving social, occupational, or key activities
organic disorders
-metabolically effecting brain
-due to brain disease of known specific organic cause (delirium, dementia, alcohol and drug intoxication, and withdrawal)
psychiatric mental illnesses
-organic etiology has not yet been established (anxiety or schizophrenia)
-mental status assessment documents a dysfunction and determines how that dysfunction affects self-care in everyday life
When do we need to do a complete mental status exam?
-recent trauma resulting with a change in memory
-report of decline in cognitive ability/emotional
-when the patient requires a thorough exam of emotional and cognitive functioning
Factors effecting mental status
-developmental competence
-infants & children
-developmental
-adolescent-substance abuse, suicide
-aging adults
-age related changes
-grief and despair
-genetics & environment
-family history of mental illness
-food insecurity
-sexual and gender minority-stigma, rejection by society
Components of mental status exam
-a less comprehensive process that is implemented and done during the course of the physical exam. Involves inferences about the mental health or mental dysfunction of a person and can prompt a more comprehensive evaluation if needed
-four main mental status assessment: ABCT
-appearance
-behavior
-cognition
-thought process and perceptions
What are some of the components of the mental status exam?
-consciousness
-language
-mood & affect
-orientation
-attention
-memory
-abstract reasoning
-thought process
-thought content
-perceptions
Appearance (general survey)
-posture
-erect and position relaxed
-body movements
-body movements voluntary, deliberate, coordinated, and smooth and even
-dress
-appropriate for setting, season, age, gender, and social group
-grooming and hygiene
-congruence between grooming and age
-pupils
-note pupil size and reaction to light
Behavior
-level of consciousness
-awake, alert, responds appropriately
-facial expression
-appropriate to situation, comfortable eye contact
-speech
-quality of speech, effortlessly and appropriate conversation
-mood and affect
-body language, facial expression, cooperative
Cognitive functioning
-orientation
-time, place, person
-attention span
-ability to concentrate, stay on task
-recent memory
-Ex: 24 diet recall, ask questions you can corroborate
-remote memory
-ask about historical events, past medical hx
-new learning (4 unrelated words)
New learning: the 4 unrelated words test
-highly sensitive and valid memory test
-requires more effort than recall of personal or historic events, and avoids danger of unverifiable recall
-assessment process:
-pick four words with semantic and phonetic diversity; ask person to remember the four words
-to be sure person understood, have him or her repeat the words
-ask for the recall of four words at 5, 10, and 30 minutes
-normal response for persons younger than 60 is an accurate 3 or 4 word recall after 5, 10, and 30 minutes
Thought Processes
-Thought process: thinking should be logical, goal directed, coherent and relevant
-thought content: what they say is consistent and logical
-perceptions: person should be consistently aware of reality
Screen for anxiety disorders
-anxiety and depression are the two most common mental health disorders seen in individuals seeking health care
-generalized anxiety scale (GAD-7): assesses for anxiety
-consists of 7 itemized scale
-higher the score, greater the likelihood
-first 2 questions relate to core anxiety
-greater or equal than 3 indicates diagnosis
Screening for suicidal thoughts
-assess for possible risk for harm if the person expresses feelings of sadness, hopelessness, despair, or grief
-begin with more general questions and proceed if you hear affirmative answers
-it is very difficult to question people about possible suicidal wishes for fear of invading privacy
-risk is far greater skipping these questions if you have the slightest clue that they are appropriate; you may be the only health professional to pick up clues of suicide risk
-for people who are ambivalent, you can buy time so the person can be helped to find an alternate remedy
-share any concerns you have about a person’s suicide ideation with a mental health professional
Screen for depression disorders
-series of tools that can be used in clinical setting
-patient health questionnaire-2 (PHQ-2)
-asks 2 questions about depressed mood and anhedonia (lack of interest)
-serves as a screening tool to use full PHQ-9 tool
-phq-9 (know that screens for depression)
-series of 9 questions requiring adding column totals that relate to frequency of occurrence of symptoms
-higher the score, the greater the likelihood of functional impairment or clinical diagnosis
What does cognitive impairment look like?
-clouding of consciousness
-impaired alertness
-impaired memory (recent most common)
-disorientated, language impairment
-hallucinations
-increased confusion at night
-agitation
Cognitive function important concepts
-avoid stereotyping
-distinguish between dementia and delirium
-know difference between cognitive function (can they recall history; make goals) and consciousness (awake; alert)
Dementia
-multiple cognitive deficits
-chronic disturbance of consciousness and cognition
-long and short-term memory loss
-disturbances in executive functioning
-speech and language disturbances
-slowly overtime; slow declines
-irreversible
Delirium
-acute disturbance of consciousness and cognition (develops over short period of time)
-medical conditions preclude this condition
-no history of dementia
-may develop in addition to dementia during period or hospitalization
-can develop after being admitted
-can get with UTI’s
-reversible
-when we put into normal environment become more alert
Impairment: level of consciousness vs cognitive impairment
-what are the differences?
-what are the various levels of consciousness?
-what is the sedation scale?
-what is the Glasgow Coma Scale?
-how do these factor in to a mental status exam?
Levels of consciousness
-patient’s loss of awareness-don’t confuse with orientation
-awake-interactive
-lethargic-sleepy, drowsy, rousable/responsive
-stuporous-arousable with stimuli, resists arousal
-obtunded-cannot maintain arousal without repeated stimuli, moans/groans to stimuli
-comatose-non interactive with surroundings
-orientation (appropriateness)
-person, place, time, situation (a & o x4)
“what holiday did we just celebrate?”
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
**see slide 22
-measure best motor, verbal and eye response
-determinant of level of consciousness
-quantitative in nature
-valid and reliable
-score <8 denotes coma (under 8 intubate)
Types of aphasia
-global aphasia
-broca or expressive aphasia
-wernicke or receptive aphasia
Global aphasia
-most common
-most severe
-caused by a large lesion that affects anterior and posterior language areas
-speech is absent or only a few words
-no comprehension
-can’t repeat, write or read (use picture board)
Broca’s or expressive aphasia
-broken speech
-able to understand
-can’t express self using language
-can’t repeat or read aloud
-lesion is in the motor cortex of the anterior portion of the brain (contains Broca’s area)
-auditory (hearing) and reading comprehension are intact
Wernicke or receptive aphasia
-opposite of Broca, posterior area of language center
-can hear sounds but can’t relate to them
-speech is fluent, patient has a great urge to speak, but words are made up and frequented with word substitutions, result is incomprehensible speech
-impaired repetition, reading and writing
Communicating with broca or expressive patients
-speak clearly
-books on tape
-picture board
-written word (yours and theirs) can read and understand it
-yes/no questions
-email
communicating with wenicke or receptive patients
-picture board
-don’t keep talking and repeating
-don’t write, can’t read
-use gestures to help with understanding
mini mental status exam
**slide 28
-what is it?
-how is it used?
The aging adult
-check for hearing; visual
-get a baseline on admission (appearance, behavior, cognition, thought processes and cognition)
-always check sensory status before doing a mental status assessment (vision and hearing)
-normally no decrease in knowledge or loss of vocabulary
-actual response time is slower, so go slower, be patient and allow time for patient to respond
-don’t answer for the person
-plan teaching at a slower pace
-consider if person has had multiple losses
