Chapter 6 Assessing mental status and psychosocial developmental level

Mini-mental state examination tool Time orientation Place orientation Registration of three words Serial 7s as a test of attention and calculation Recall of three words Naming

Mini-mental state examination tool Repetition Comprehension Reading Writing Drawing

Mental status Level of consciousness Posture and body movements Gait Dress Hygiene

Mental status Facial expressions Speech Behaviours Thought patterns Mood, feelings, expressions

Question Is the following statement true or false? Evaluating level of consciousness is part of a mental status exam.

Answer True. Evaluating level of consciousness is part of a mental status exam.

Five levels of consciousness Alert and awake Lethargy Obtunded Stupor Coma

Question Which describes a patient who is stuporous? Awakes to vigorous shake or painful stimulus but returns to unresponsive sleep Remains unresponsive to all stimuli; eyes stay closed Opens eyes to loud voice, responds slowly with confusion, seems unaware of environment Opens eyes, answers questions and falls back to sleep

Answer Awakes to vigorous shake or painful stimulus but returns to unresponsive sleep. Stuporous patients awake to vigorous shake or painful stimulus but returns to unresponsive sleep. Coma remains unresponsive to all stimuli; eyes stay closed. Obtunded opens eyes to loud voice, responds slowly with confusion, seems unaware of environment. Lethargy opens eyes, answers questions and falls back to sleep.

Glasgow Coma Scale Eye opening response Most appropriate verbal response Most integral motor response (arm)

Cognitive ability Orientation Concentration Recent memory Remote memory

Cognitive ability (cont.) Use of memory to learn new information Abstract reasoning Judgement Visual perceptual and constructional ability

Erikson’s developmental tasks Young adult: Intimacy versus isolation Middle-aged adult: Generativity versus stagnation Older adult: Integrity versus despair

Question Is the following statement true or false? The Erikson’s developmental task for young adult is intimacy versus isolation.

Answer True. The Erikson’s developmental task for young adult is intimacy versus isolation.

Psychological developmental level Mental and emotional health Self-concept Role development Relationships Coping Stress patterns Spiritual beliefs

Alzheimer’s disease Repeatedly asks the same questions Becomes lost or disoriented in familiar places Cannot follow directions Is disoriented as to the date or time of day Doesn’t recognise and is confused about familiar people Has difficulty with routine tasks such as paying bills Neglects personal safety, hygiene and nutrition

Depression questionnaire Falling asleep Sleep during the night Waking up too early Sleeping too much Feeling sad Decreased or increased appetite Decreased or increased weight

Depression questionnaire (cont.) Concentration/decision making View of oneself Thoughts of death or suicide General interest Energy level Feeling slowed down Feeling restless