Mental Status Examination chapter 7

expressive language / Broca'swhich language area of the brain: -frontal love of dominant hemisphere -allows you to express yourself in spoken and written wordsexpressive language / Broca'sdamage to which language area results in a frustrating situation, the pt knows what others are saying and understand context of the words but physically cannot communicatethe dominant left sidelanguage areas of the brain are located on which side of the brain?parietal lobewhich lobe of the brain: -perception and interpretation of sensory information -dominant _____ _____ is responsible for praxis (formation of the idea of a purposeful motor act which is then executed by the frontal love)parietal lobewhich lobe of the brain (tests for function) -stereognosis: recognition by touch -ask pt to perform a purposeful motor act on commanddyspraxia_____ means there is an issue with the parietal lobe; the individual can do the complex task but may take longer than normalapraxia_____ means there is an issue with the parietal lobe; the individual cannot complete a complex task alloccipital lobewhich lobe of the brain: -vision, recognition of colors, faces, objects, perceiving motionoccipital lobewhich lobe of the brain (tests for function) -naming of objects -vision and color testing (part of CN and eye exam)-time of day -stress, fatigue, anxiety, pain -medication -pts social and educational backgroundsometimes a pt might "fail" or do poorly on a mental status examination. what are some contributing factors that could cause issues/"traps"?intactcognitive functions should be _____ in health older adultsdeclineafter 60-70 years, some pts have a _____ in cognitive function but this should not be considered "normal"20-30 yearscognitive decline leading to dementia can occur over _____-_____ years30speed of processing information and psychomotor speed starts to decline after _____ years of age-grooming/hygiene -emotional staus/affect -body languagewhat are the 3 areas that are evaluated for physical appearance and behavior?grooming / hygiene-inspection of hygiene, dress, concern for appearance -is dress appropriate? -1 sided neglect: lesion opposite parietal lobeDepression, Schizophrenia, Dementiaif poor or inappropriate in a previously well groomed pt what mental health concerns may have developed? (3)OCDif excessive about grooming and hygiene, what may that be a sign of ?affect_____ is an emotional response to an event -consider cultural variations -appropriate, abnormal, flatemotional staus / affect-observe for indifference, loss of sympathy, irritability, rage -note if pt is uncooperative, hostile, guarded, seductive or apatheticapathy_____ is lack of interest, enthusiasm, or concern about a human being, a thing, or activitybody language-observation of posture, eye contact; consider cultural variations -anxiety, metabolic disorder, drug effect: tense, anxious, fidgetydepression_____ body language:: poor posture, lack of facial expression and eye contactmanic_____ body language: signing, dancing, exaggerated movementscognition_____ is the ability to think, reason, and make judgmentcognitive impairment_____ _____ signs include: -significant memory loss -confusion -impaired communication -inappropriate affect -personal care difficulties -hazardous behavior -agitation -suspiciousness-LOC (loss of consciousness) -orientation (must do these in order) -analogies -abstract reasoning -mathematical calculations -writing ability -execution of motor skills -memory -attention span -judgment/reasoning -current eventswhat are the *11 tests of cognitive function*?LOC (cognitive function test)-is the pt awake and alert?-lethargy -obtunded -stupor -comawhat are the *4 unexpected LOC*?lethargy_____ is drowsy, responds on command then falls back to sleep; response appropriateobtunded_____ responds on command, responds slowly with some confusion; decreased intereststupor_____ brief arousal to pain, slow or absent repose, minimal awarenesscoma_____ is unarousable and unaware, may posture to stimuliGlasgow Coma Scalethe _____ _____ _____ is used to evaluate level of consciousness in person with head trauma or hypo event -evaluates best eye opening response, verbal response, and motor response -scores range from 3 to 15 with 15 being the maximum level of consciousnesseye opening response verbal response motor responsewhat *3 responses* are rated in a Glasgow Coma Scale?3 to 15what do the *scored* range from in a Glasgow Coma scale?q5what is the *highest* possible score on a Glasgow Coma Scale?4 pointsEye Opening Response: spontaneous-open with lining at baseline _____ points3 pointsEye Opening Response: to verbal stimuli, command, speech _____ points2 pointsEye Opening Response: to pain only (not applied to face) _____ points1 pointEye Opening Response: no response _____ point5 pointsVerbal Response: oriented _____ points4 pointsVerbal Response: confused conversation, but able to answer questions _____ points3 pointsVerbal Response: inappropriate words _____ points2 pointsVerbal Response: incomprehensible speech _____ points1 pointVerbal Response: no response _____ point6 pointsMotor Response: obeys commands for movements _____ points5 pointsMotor Response: purposeful movement to painful stimulus _____ points4 pointsMotor Response: withdrawals in response to pain _____ points3 pointsMotor Response: flexion in response to pain (decorticate posturing) _____ points2 pointsMotor Response: extension réponse in response to pain (decerebrate posturing) _____ points1 pointMotor Response: no response _____ pointdecorticate_____ posturing in a coma -lesions of *corticospinal tracts ABOVE brainstem* -arms in rigid *flexion* at sides, hands in fists, legs extended and internally rotated, feet in planter flexiondecerebrate_____ posturing in a coma -indicated *lesion of brainstem* -arms in rigid *extension* at sides, hands in fists, arms internally rotated, jaw clenched, feet in planter flexiondecorticatewhat type of posturing?decerebratewhat type of posturing?orientationtest for _____ to person, place, timeperson*disorientation* to _____: *head trauma, seizure, amnesia*place*disorientation* to _____: *psych disorder, delirium, OBS (organic brain syndrome)*time*disorientation* to _____: *anxiety, depression, delirium, OBS*AAO x 3 A&O x 3if a pt knows *who they are, where they are, and when it is* what is this referred to as?analogies-asl the pt what is similar or different about 2 objects -correct response required comprehension, judgment, and average intelligence -*wrong response*: dominant hemisphere *lesion* / *frontal lobe*abstract reasoning-ask pt to interpret a proverb or metaphor -requires average intelligence, comprehension, and judgment -*concrete response: metal retardation* -inability to explain: poor cognition, dementia, brain damage, schizophreniamathematical calculations / backward spelling-without paper -subtract serial 7's -requires functional dominant hemisphere and average intelligence -many errors: depression, lower intelligence, dementia, lesion dominant hemisphere, frontal lobe diseasewriting ability-ask pt to write name and address or phrase -if illiterate: draw uncoordinated: -dementia, *parietal lobe damage* -cerebellar lesions or PN (peripherally neuropathy) -omissions, additions, mirror writing--> aphasiaaphasia_____ is impaired expressed and or understanding of speech, reading, writingexecution of motor skills-observe pt as they execute a verbal task example: comb hair, put on shoe -praxis -apraxia -dyspraxiapraxia_____ is the ability to perform a motor activity on commandapraxia and dyspraxia_____ and _____ means an individual has a frontal or parietal lesion; unrelated to lack of comprehension or paralysis; cannot put intention into actionmemory-immediate recall: repeat a sentence or set of objects -recent memory: show a pt 4 or 5 objects and have pt list them 5 or 10 minutes later -remote memory: ask about verifiable past eventsmemory loss-infection, frontal or temporal love lesion/trauma, depression, anxiety, intoxication -dementia/deliriumdemential/delirium (AD)_____/_____ is the loss of *immediate* and *recent memory*attention span-ask pt to repeat a short phase or story or set of directions -decreased: fatigue, anxiety, medication, frontal lobe lesion, depression, deliriumjudgment-ask pt to give the solution to a hypothetical situation -requires higher cerebral function -impairment: mental retardation, emotional disturbances, dementia, psychosis, frontal lobe injuryknowledge of current events-ask about major current events: war, presidential election -requires intact orientation, recent memory, abstract thinkingvoice quality-notes throughout the exam -dysphonia: disorder of volume, quality, pitch -disorders of larynx or vocal cords cause dysphoniadysphonia_____ a disorder of volume, quality and pitch; occurs from larynx or vocal cord issuesarticulation-notes throughout the exam -not shuttering, hesitancy, pronunciation, abnormalities -dysarthria: defect in articulation -motor defect of lips, tongue, palate, pharynx, cause dysarthria -stroke, inebriation, Cpm Parkinson's may be associate with dysarthriadysarthria_____ ia a defect in articulation; could be from a motor defect of lips, tongue, palate, or pharynxcomprehension-ask pt to follow one and two step directionscoherence-evaluated throughout the exam -use of meaningless statements, rhyming words, repeating others -incoherence: drug and ETHO intoxication, psych disordersaphasia_____ is the inability to properly express oneself by speech or writing or the inability to properly comprehend spoken or written language etiologies: psychogenic, frontal or temporal lobe brain disease, motor impairment of face or tongueBroca's_____ aphasia: impaired speech or wiring (frontal) -frustrating for the pt -understands but cannot physically expressWernicke's_____ aphasia: inability to understand written or spoken words (temporal)global_____ aphasia: involves all language and comprehension (frontal and temporal)emotional stability_____ _____ is evaluated when the pt is not coping well or lacks the mental resources to meet his or her own personal needs areas evaluated: -mood and feelings -though content and process -perceptual distortions / hallucinationsmood and feelings-observe verbal and nonverbal behaviors -not any extremes in mood -ask pt how they feel, if they are having problems with their feelings -abnormalities common with depression, frontal lobe lesiondepression screening-over the past 2 weeks, have you felt down, depressed, or hopeless? -over the past 2 weeks, have you felt little interest or pleasure in doing things? -if yes to both, indicated pt should have further eval for depression -96% sensitive -57% specificthought process and content-assessed while talking with pt -look for illogical though processes, inappropriate passes, repetition -ask about obsessive thoughts, fear, guilt, and making decisions -abnormalities common with emotional/psych disordersdistortions / hallucinationsask pt: -do they hear voices -see images or shadows -smell or taste things that are offensive -feel things crawling on skin auditory and visual: psych disorders, OBS, depression acute intoxication, delirium, dementia tactile: alcohol withdrawalmini mental state exam (MMSE)_____ _____ _____ _____ estimates cognitive function and documents changes; used to flow *progression* of *chronic* disease -full score is 30 -score of 20 or lower is a significant change in mental status -typically used for pts with dementia or ADchief complaintNO _____ _____ is part of a routine PE for a mental status exam

Mental Status Examination chapter 7

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