Mental Status Exam Flashcards
Different LOC
Level of Conciousness Alert Lethargic Obtunded Stupor or semi-coma Coma Delirium
General Survey - Physical Appearance
Age
Gender
Skin Color
Facial Features
General Survey - Body Structure
Posture
Position
BMI
General Survey - Mobility
Gait
ROM
General Survey - Behavior
Facial Expression
Speech
General Survey - Pain
Verbal and nonverbal
Cultural, developmental and gender considerations
Cerebrum
Primarily responsible for mental status
Divided into two hemispheres or lobes
Grey outer layer, the cerebral cortex, houses higher mental fxns and responsible for perception and behavior
Cerebrum - Frontal Lobe
Contains motor cortex associated with
Speech formation (Brocca area)
Goal-oriented behavior
Ability to concentrate and short-term behavior
Parietal Lobe
Responsible for processing sensory data
Temporal Lobe
Perception and long-term memory
Wernicke area - comprehension of written and spoken language
involved in the integration of behaior, emotion and personality
Limbic System
Certain patterns of behavior that determines survival
reactions to emotions
expressions between emotions and behavior is mediated by connections between limbic system and frontal lobe
Reticular Activating System (RAS)
in the brainstem regulates level of wakefulness or arousal
Disruption of ascending RAS can lead to altered mental status
Neuro. Infants and Children
All brain cells present at birth but first years to develop and myelinize
Brain insults such as infection, trauma, or metabolic imbalance, can damage brain cells, leading to potentially serious dysfunction in mental status
Adolescents - Neuro
Abstract thinking develops theories, logical reasoning, making future plans, generalizations, consider risks and possibilities
Judgment begins to develop with education, intelligence and experience
Older Adults - Neuro
Cognitive fxn most sensitive to aging include the speed at which new information is perceived, encoded, processed and retrieved
Minimal decline in cognitive and daily functioning should occur unless systemic or neurologic disorder develops
What other cognitive functions can diminish in older adults?
Remote memory may be more efficient than short-term
Studies suggest higher education achievement leads to better and longer-lasting cognitive function
Loss of recent memory, delayed response time and diminished ability to learn complex information may occur
HPI: Disorientation and Confusion
Onset
Associated health problems
Associated symptoms
Medications
HPI: Depression
Troubling thoughts or feelings low energy level recent changes in living situation SIGECAPS Two questions for depression screening Feel like hurting self, thoughts about dying or suicide Medications: antidepressants
HPI: Anxiety
Sudden unexplained attacks of fear, anxiety or panic
Avoids or feels uncomfortable with people
Experienced extremely traumatic event
Associated Symptoms
DIGFAST
Medications: antidepressants, steroids, BDZ, alternative or complementary therapies
PMH
Neurologic disorder, brain surgery, brain injury, residual effects, chronic disease, or debilitating condition
Requires psychiatric therapy or hospitalization
Family History
Psychiatric disorders, mental illness, alcoholism
ALZ
Learning disorder, mental retardation, autism
Personal and Social Hx
Emotional status
Life goals, attitudes, relationship with family
Intellectual level, education
Communication pattern
Changes in sleep pattern
Use of alcohol, street drugs, especially mood-altering
Children
Speech and language Behavior Performance or self-care activities Personality and behavior patterns Learning or school difficulties
Adolescents
Risk-taking behaviors
School performance and peer interactions
Family interactions, reluctance to communicate and to speak of attitudes and experience
Older Adults
Changes in cognitive functioning, thought processes, and memory
Depression, somatic complaints, hopelessness, helplessness, lack of interest in personal care
How is mental status assessed?
Evaluate: Physical appearance and behavior State of consciousness Cognitive abilities Speech and language skills Emotional stability
Physical Appearance and Behavior
Grooming: poor hygiene, lack of concern, inappropriate appearance
Emotional status: carelessness, apathy, insensitivity, docility, rage, irritability
Body language: slumped posture, lack of expression or eye contact, excessively energetic, constantly watchful
State of Consciousness
Person disorientation: cerebral trauma, seizures, or amnesia
Place disorientation: psychiatric disorders, delirium, and cognitive impairment
Time disorientation: anxiety, delirium, depression, and cognitive impairment
Time is usually the first to go, followed by place then person
Screening tests to test cognition
Mini-Mental State Examination (MMSE)
Mini-Cog
Three unrelated words
Clock face (clock drawing test CDT)
Testing cognitive abilities
Analogies – what is similar peach and lemon, ocean and lake
Abstract reasoning – stitch in time saves nine
Arithmetic calculation – start at 100 and substract 7
Writing ability – write name and address
Execution of motor skills – comb hair
Memory – four words, repeat series of numbers
Attention span – Spell World forward and backwards
Judgment – plans for future
When is emotional stability evaluated?
when the patient does not seem to be coping well or does not have resources to meet his or her needs.
Mood and feelings
Thought process and content
Perceptual distortions and hallucinations
Depression/Sadness in Infants
Levels of activity Lethargic Drowsy Stuporous Alert Active Irritable
Depression in Children
Types of words and speech patterns Mood Activity level Preferences Responsiveness to parent and ability to separate Self-comforting measures Does the child play and have fun? Attempt memory testing at about age 4.
Pregnant Women and Postpartum Depression
Risk factors for postpartum depression
History of depression
Prior postpartum depression
Depression may interfere with the mother’s attachment to the newborn and the infant’s subsequent development.
Cognitive Decline in Older Adults
problem-solving skills deteriorate with age and disease.
Skills involving vocabulary and inventories of available information remain at younger adult level performance
Isaac Set Test: name 10 items in each of four groups―fruits, animals, colors, towns
Recent memory is believed to deteriorate before remote memory.
What are some other causes of dementia/delirium/confusion?
Cardiovascular
Hepatic
Renal
Metabolic
Medication effect on older adults
Slow reaction times Disorientation Confusion Loss of memory Tremors Anxiety
Other things to assess with older adults
ADLs
Facial expressions and stance
masklike and dramatic
stooped and fearful
What is a concussion?
An alteration in mental status resulting from a blow to the head or neck
transient disruption in the reticular neurons that maintain alertness.
What causes a concussion?
Sports injuries
Motor vehicle accidents
Falls
S/S of concussions
Dizziness or dazed look Slurred speech Slow motor and verbal responses Irritability Nausea and vomiting Loss of consciousness may indicate severe injury. Amnesia Deficits in coordination, memory, attention
What causes delirium?
Impaired cognition, consciousness, mood and behavioral dysfunction of acute onset Risk factors Serious illness Injury Preexisting cognitive decline
Somatic complaints of depression
altered appetite, sleep problems, constipation, headache, and fatigue
S/S of depression
Memory loss, poor concentration, lack of motivation, indecisiveness
Slow, sluggish speech
Delusions of worthlessness or paranoid ideation
Disorder may result from grief, reaction to medical or neurologic diseases, or change in lifestyle.
Specific disorders of anxiety
Imbalances of serotonin and NE Panic attacks Generalized anxiety disorder Specific phobias Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD)
S/S of anxiety
Palpitations, tachycardia
Sweating, shaking, trembling, choking
Chest pain or discomfort, nausea, abdominal distress
Dizziness, faintness
Feeling unreal or detached from self, “going crazy”
Paresthesias
S/S of mental retardation in children
delayed motor development
delayed speech and language skills
S/S of ADHD
dopamine disturbances
Short attention span
Easily distracted
Trouble completing assignments
Fidgets and squirms, moving, running, jumping
Disruptive behavior, poor impulse control
Autistic Disorder
Pervasive neurodevelopmental disorder of unknown etiology
Refers to a wide spectrum of disorders typically prior to 3 years of age
Believed to have multifactorial causes and a strong genetic influence
Dementia
A chronic, slowly progressive disorder of:
Failing memory
Cognitive impairment
Behavioral abnormalities
Personality changes
Often begins after 60 years of age
Usually related to structural diseases of the brain
S/S of dementia
Impaired memory, forgets appointments
Getting lost in familiar areas, wandering
Unable to manage shopping, food preparation, medication, finances, and driving
Behavioral changes, inappropriate dress or conduct, impaired grooming, impulsiveness, disinhibition,
Aphasia, agnosia, apraxia
Apathy, withdrawal
Anxiety, irritability
Changes in mood
