Mental Status Flashcards
1
Q
General Mental Status Exam (assessment for…)
A
- LOC
- Appearance & Behavior
- Speech & Language
- Mood
- Thoughts & Perceptions
- Cognitive Function
- Memory
- Attention
- Information & Vocabulary
- Calculations
- Abstract Thinking
- Constructional Ability
2
Q
Speech & Language (Looking at…)
A
- Quantity
- Rate
- Volume
- Articulation of words
- Fluency: gaps in flow, monotone
- Dysarthria: defective articulation (could be due to paralysis, stroke, etc.)
- Mania: speaking rapidly and switching from one topic to next (flight of ideas) w/o it making sense in between (diff from someone that just talks fast and makes sense)
- Aphasia: disorder of language
- Test: ask pt to repeat phrase, name of object, read paragraph, write sentence, follow simple command
3
Q
Mood (what is labile)
A
Labile: switching between moods very fast
4
Q
Thought & Perception (assess for…)
A
- Logic
- Echolalia: repeating other people’s words and phrases
- Sign of underlying problem if adult but not as child
- Echolalia: repeating other people’s words and phrases
- Relevance
- Organization
- Flight of ideas: continuous flow of accelerated speech where person changes from topic to topic w/ little to no association
- Coherence of pt’s thought process
- Incoherent thought process in children are normal
- Incoherence: illogical, lack of meaning
5
Q
Depression (what + exam questions)
A
- What: leading cause of disability worldwide (it’s common, expensive, undertreated)
- ~5% of adults in US experience Major Depressive Disorder (MDD) at any given time - Exam Questions: If pt answers “yes” to at least 1 of these questions ⇒ need follow up
- Have you felt down, depressed, blue, hopeless, or irritable over past 2 wks?
- Over past 2 wks, have you lost interest or pleasure in thing you normally enjoy doing?
6
Q
Depression S&S + requirements
A
- requirements:
- dysphoria or anhedonia
- other listed S&Ss below must be present nearly everyday, most days
- causes impairment in social/occupational aspects of life
- not attributed to recent bereavement, meds, medical condition
- S&S:
- Dysphoria: state of unease, generalized dissatisfaction w/ life (opposite of euphoria)
- Anhedonia: inability to feel pleasure in activities that’re considered pleasurable
- Changes in appetite
- Changes in sleep
- Psychomotor retardation/agitation
- Psychomotor retardation: talking/moving slower than norm for them
- Psychomotor agitation: talking/moving faster than norm + fidgeting & pacing
- Guilt/worthlessness
- Fatigue/lack of energy
- Decreased concentration/indecisiveness
- Suicidal thoughts/plan ⇒ if they have plausible plan and if they’ve alrdy tried before
7
Q
EtOH Abuse Exam Questions + Requirements
A
- If pt answers “yes” to at least 2 or more of these CAGE questions ⇒ increases likelihood they have EtOH abuse
- Cut down: Have you ever felt you should cut down on your drinking?
- Annoyed: Have people annoyed you by criticizing you abt your drinking?
- Guilty: Have you ever felt bad or guilty abt your drinking?
- Eye opener: Have you ever had a drink first thing in morning to steady your nerves, get rid of hangover, or start the day?
8
Q
Suicide (males, females, included as part of assessment for ___, asking abt ___)
A
- Males more “successful”
- Females have more attempts
- Should be included as part of assessment for all pts w/ Sxs of MI
- Asking abt suicidal ideation is NOT encouraging your pt to attempt suicide
9
Q
Anxiety (clinical lvl anxiety, hypochondriac, Tx)
A
- Clinical lvl anxiety: pt is worried or anxious when there’s nothing wrong or in manner that’s disproportionate to what’s wrong
- Constantly worrying abt diff domains of their life that’s above and beyond what’s considered everyday worries
- Hypochondriac: anxiety condition where pt overthinks everything to an extreme
- Ie. has small lump and think it’s cancer or cough and think it’s lung cancer
- Tx: Possible to treat anxiety disorders w/ therapy and good therapist bc they help change frame of feelings and thinking
- Won’t get rid of all Sxs but will likely help w/ coping mechanisms
- Downside to meds therapy like Xanax that help pts relax is that they’re addictive ⇒ should only use short-term
- Selective serotonin reuptake inhibitors (SSRIs): aka antidepressants used to treat anxiety in long-term
10
Q
Generalized Anxiety Disorder (GAD) Requirements + S&S
A
- Requirements:
- Worry
- 3 of Sxs below present in addition to worry for 6 months, most days (in children, only 1 of Sxs below is needed for diagnosis of GAD)
- cause impairment of quality of life
- not due to medical conditions, meds, or other substances
- S&S:
- Excessive anxiety/worry abt variety of events and situations
- May want lots of assurances ⇒ as nurse → be patient w/ them
- Worry is challenging to control and may shift from one topic to another in adults and children
- Feeling tense, keyed up, or restless
- Fatigue, tiring easily
- Difficulty concentrating, mind goes blank
- Irritability
- Muscle tension, aches, soreness
- Changes in sleep pattern (Insomnia: can’t sleep because of too many thoughts + Waking up very tired)
- Somatic Sxs: sweating, nausea, diarrhea
- Excessive anxiety/worry abt variety of events and situations
11
Q
Delirium (onset, duration, status, S&S, types, cause)
A
- Rapid onset
- Short duration
- Reversible
- S&S:
- Attention deficit
- Disorganized thinking
- Confusion
- Disorientation
- Restlessness
- Incoherence
- Anxiety
- Sundowning: as evening hrs approach, older pts can have sudden Sxs of delirium then returning to norm baseline when daylight comes around again (common in older adults who just got admitted to hospitals)
- Post-Anesthesia Delirium: occurs in children, more common in boys where they go into anesthesia alrdy agitated and come out even more agitated w/ delirium-like Sxs then returning to baseline soon
- Cause: meds
12
Q
Dementia (onset, duration, status, S&S, types, common in)
A
- Insidious/slow onset
- Progressive
- Not reversible, gets worse overtime
- S&S:
- Forgetfulness
- Short-term memory loss
- Disorientation
- Wandering
- Agitation
- Aggression
- Obsessive compulsive behavior
- Types:
- Alzheimer’s: slow, steady downward slope of development
- Vascular Dementia: stepwise progression of disease where pt is stable for a while then significant increase in Sxs, then stability, and repeat
- Common in older adults
13
Q
Substance Abuse (accessibility note, general S&S, Tx)
A
- Ppl in professions who have easy access to substances have higher rates of using/abusing it → accessibility matters a lot
- S&S:
- Unclean, poor personal care, poor physical and oral health
- Tired, confused, or seems spacey
- Poor memory or poor historian on past events
- Loses things
- Arrives late
- Forgets
- Multiple services w/ little or no progress
- Tx:
- SBIRT: Screening, Brief Intervention, Referral to Tx
- Recovery Model:
- Harm reduction: set of practical strategies and ideas aimed at reducing neg consequences associated w/ drug use + a movement for social justice built on belief in, and respect for, rights of ppl who use drugs
- Abstinence is ideal but “we’ll take what we can get + any decrease is progress”
14
Q
Opiates S&S
A
- bloodshot eyes
- dilated or constricted pupils
- appetite changes
15
Q
Marijuana S&S
A
- Loss of train of thought during convos
- Increased appetite
