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94 Cards in this Set
- Front
- Back
Remote Memory
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brings up years' worth of experiences
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Recent Memory
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evokes day to day events
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organic disorders
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Mental disorders due to brain disease of known specific organic cause
e.g. delirium, dementia, intoxication, withdrawal |
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Components of the Mental Status Examination
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ABCT
Appearance, behavior, Cognition, and Thought process |
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Psychiatric Mental Status
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Organic etiology has not yet been established
e.g. schizophrenia, anxiety disorder |
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Mental Status is inferred through individual's BEHAVIORS
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Consciousness, Orientation, Memory, Attention, Speech, Mood and Affect, Abstract reasoning, thought process, thought content, perceptions
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When to perform full mental status examination?
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Behavior changes
Brain lesions (trauma, tumor, brain attack) Aphasia (caused by brain damage) symptoms of psychiatric mental status |
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Aphasia
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loss of the ability to speak or write coherently, or to understand speech or writing due to CVA
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Abnormal Findings Level of consciousness
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Alert
Lethargic (somnolent) Obtunded Stupor or semicoma Coma Acute confusional state (delirium) |
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Alert
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Awake or readily aroused, oriented, fully aware of external and internal stimuli and responds appropriately, conducts meaningful interactions
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Lethargic or Somnolent
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Not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in normal voice but looks drowsy, responds appropriately to questions or commands but htinking seems slow and fuzzy. Inattentive, loses train of thought spontaneous movements are decreased
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Obtunded
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-Transitional state between lethargy or stupor;
-Sleeps most of the time, -difficult to arouse-needs loud shout or vigorous shake, -acts confused when aroused, -converses in monosyllables, -speech may be mumbled and incoherent, -requires constant stimulation for even marginal cooperation. |
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Stupor or Semi-coma
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-Spontaneously unconsious, -responds only to persistent and vigorous shake or pain,
-has appropriate motor response (ex. avoids hand to avoid pain). Otherwise can only groan, mumble, or move restlessly; -reflex activity persists |
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Coma
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-Completely unconscious,
-no response to pain or to any external or internal stimui (e.g. when suctioned, does not try to push the catherer away), -light coma has some reflex activity but no purposeful movement, -deep coma has no motor response |
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Acute Confusional State (Delirium)
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Clouding of consciousness (dulled cognition,
-impaired recent memory and confabularoty for recent events. -Often Agitated, has visual hallucinations; -disoriented, with confusion worse at night when environmental stimuli are decreased |
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Global Aphasia
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The most common and severe form.
Spontaneous speech absent or reduced to few stereotype words Comprehension absent or reduced to person's own name or few select words |
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Broca's aphasia
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EXPRESSIVE aphasia. The person can understand but can not express himself using language.
-Auditory and reading comprehensions are intact. -Lesions in anterior language area called motor speech cortex or Broca's area -Repition, reading and writing impaired |
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Wenicke's aphasia
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RECEPTIVE aphasia.
-The person can hear sounds and words but cannot relate them to previous experiences. -Speech is fluent , effortless, and well articulated but has many paraphasias (word substitutions that are malformed or wrong) -Reading, writing, repititions are also impaired -Lesion is posterior language area called the Association auditory cortex or Wernicke's area |
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What doesn't decrease with aging adult?
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There is no decrease in general knowledge and little or no loss in vocabulary
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What slows down in aging adult?
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Response time is slower than youth; it takes longer for the brain to process information and react to it. Thus performance on timed intelligent not advised
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Why is timed intelligence tests may be lower for the aging adult?
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performance may be lower, not because intelligence has declined by because it takes longer to respond to the questions.The slo9we th response time affects new learning if a new presentation is rapidly pace, the older adult doesn't have time to respond to it.
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Which memory decreases with aging?
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Recent memory somewhat decreases (e.g. medication instructions, 24 hr diet recall
-Remote memory is not affected |
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How can vision loss affect mental status in aging adult?
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Vision loss may result in apathy, social isolation, and depression
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How can hearing affect mental status in aging adult?
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They have problem with conversation which causes frustration, suspicion, and social isolation, makes person look confused
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Why can't aging adult hear consonants?
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because consonants are high frequency sounds
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What would you suspect a person who has abnormal posturing and bizarre gestures?
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Schizophrenia
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A nurse points to articles in the room, parts of the body, articles form pockets, and ask person to name them. What is the nurse testing for?
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Word comprehension for Aphasia
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What kind of questions would you ask a person you suspect of having violent/suicide tendencies, delusions or hallucinations?
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Ask person's daily and life long goals
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What does mini mental state concentrate on?
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concentrates only on cognitive functions, not on mood or thought process.
-Valid detector for organic disease |
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How would you interpret the scores in minimental state examination?
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Score that occur with Dementia and delirium:
18-23 Mild cognitive impairment 0-7 severe cognitive impairemnet |
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What questions would you ask on the mini mental state examination?
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TPR-SR-NR-CR-WR
Time Orientation -what time of the year it is. Place orientation -"where r u at right now?" Registration of 3 words -"im going to say 3 words and say them back to me" Serial 7s (a test of attention and calculation) -Subtract 7 from 100 and continue to subtract 7 from each subsequent remainder until I tell you to stop. Recall of 3 words: What were those 3 words I asked you to remember Naming -"what is this" Repetition -"now i'm oging to ask you to repeat what I say, no ifs, buts and ands Comprehension - Listen carefully becasue I'm going to ask you to do something Reading -Please read the following and do what it says, but do not say it aloud Writing -Close eyes. Please write a sentence. Drawing -Please copy this design |
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What would you do before assessing an aging adult's aspect of mental status?
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Check memory status first before assessing any aspect of mental status. Vision and hearing changes due to aging may alter alerness and leave the person looking confused
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What is Glasgow's Test for?
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is a quantitative toll that is useful in testing consciousness in aging person's response in eye opening, best verbal response, and best motor response.
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The use of Glasgow's Test avoids what?
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avoids ambiguity when numerous examiners care for the same person.
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What is the Set Test?
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-Supplemental Mental Status Exam
-Developed specially for use with an aging population. 65-80 yr -Quantifiable test, designed to screen for dementia Easy test, takes 5 min Ask person to name 10 items in each of the 4 categories or sets: fruits, animals, colors and town. -Do not use with persons with hearing impairments or aphasia >25 =no dimentia |
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What is the use of SET test?
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Tests for Cognitive function.
It assess mental function as a whole instead of examining individual part of cognitive function |
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During Set test, when you asked person to name 10 items from each category, what are you testing?
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Person's alertness, motivation, concentration, short-term memory, and problem-solving ability
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Schezophrenia
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2or more of the following:
1. Delusions- involving a pehnomennon tha tthe person's culture would regard as totally implausible 2. Hallucinations (auditory more common) ex. voices speaking 3. Disorganized speech (incoherence) 4. Grosslyy disorganized or catatonic behavior 5. Negative symptoms (affective flattening, alogia-inability to speak |
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What is the symptom of depression in children and adolescence?
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Irritable mood
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What catagory of Integration of the health assessment is vision using snellen's eye chart?
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Measurement
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Measurement
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WHCV
weight height compute body mass index vision using Snelle's eye chart |
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Skin
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Examine both hands and inspect the nails
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Vital signs
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RRBT
Radial pulse Respirations BP Temperature (if indicated) |
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Head and Face
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Inspect and Palpate:
scalp, hair, cranium Inspect FACE: Expression, symmetry, (Cranial nerve VII) Palpate: Temporal artery, then TMJ as theperson opens and closes moutth Palpate: Maxillary and frontal sinuses. |
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Upon palpating the Maxillary and frontal sinuses, the patient tells you they feel tender. What would you next?
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If tender, transilluminate the sinuses
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What tests would you perform for the Eye during complete assessment?
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Test visual fields by confrontation (Cranial nerve II)
Test Extraocular muscles: corneal light reflex, six cardinal positions of gaze (CN III, IV, VI) Test pupil: size, response to light and accommodate |
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What would you inspect in the eye?
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Inspect external structures
Inspect conjuctivae, sclerae, corneas, irides DARK ROOM: inspect ocular fundus using an opthalmoscope. |
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When inspecting ocular fundus using the opthalmoscope, what should you see?
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Ocular fundus: red reflex, disc, vessels, and retinal background
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How would you test for visual fields and what cranial nerve?
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Confrontation Test (Cranial Nerve II)
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How would you test for Extraocular muscles?
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Corneal light reflex, 6 cardinal positions of gaze
Cranial Nerve III, 1V, VI |
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When testing the pupil, what are you looking for?
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size, response to light and accomodation
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EAR:
What should you inspect in the external ear? |
position
alignment skin condition auditory meatus |
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EAR:
Why would you move the auricle and push tragus? |
to check for tenderness
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EAR:
When inspecting the tympanic membrane, what do you look for? |
Color, position, landmarks, and integrity
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EAR:
Sing the otoscope, what should you inspect before inspecting the tympanic membrane? |
inpect the canal then the tympanic membrane
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Nose:
When assessing the nose, what should you inspect? |
Inspect external nose
inspect facial symmetry (cranial nerve VII) Test the patency of each nostril Inspect the nares |
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Nose:
When inspecting the external nose, what are you looking for? |
symmetry, lesions
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Nose: When inspecting the nares, what should you look for?
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nasal mucosa, septum, and turbinaes
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NOSE: What instrument do you use when inspecting the nares?
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Speculum
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NECK:
What do you inspect in the neck region? |
symmetry, lumps, and pulsations
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When testing the pupil, what are you looking for?
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size, response to light and accomodation
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EAR:
What should you inspect in the external ear? |
position
alignment skin condition auditory meatus |
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EAR:
Why would you move the auricle and push tragus? |
to check for tenderness
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EAR:
When inspecting the tympanic membrane, what do you look for? |
(C-L-I-P)
Color, landmarks, integrity, and position |
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EAR:
Using the otoscope, what should you inspect first before the tympanic membrane? |
inpect the canal then the tympanic membrane
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Nose:
When assessing the nose, what should you inspect? |
Inspect external nose
inspect facial symmetry (cranial nerve VII) Test the patency of each nostril Inspect the nares |
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Nose:
When inspecting the external nose, what are you looking for? |
symmetry, lesions
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Nose: When inspecting the nares, what should you look for?
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NST
nasal mucosa, septum, and turbinates |
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NOSE: What instrument do you use when inspecting the nares?
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Speculum
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Mouth and Throat:
Using you your penlight, what do you inspect in the mouth? |
buccal mucosa, teeth and gums, tongue, floor of mouth, palate and uvula
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Mouth and Throat:
When you ask the patient to say, "ahh" what are you checking? |
mobility of uvula
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Test for gag reflex and mobility of uvula upon phonation tests for what nerves?
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Cranial nerve IX and X
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When you ask your patient to stick out his tongue, what cranial nerve are you checking?
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Cranial nerve XII
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How would you palpate the mouth?
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With gloved hand, bimanually
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Neck:
When assessing the neck, what should you inspect? |
Symmetry, lumps and pulsations
Inspect and palpate: carotid pulse |
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Neck:
What should you palpate in the neck region? |
Palpate:
cervical lymph nodes Trachea in midline |
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Neck:
How should you inspect and palpate the carotid pulse? |
One at a time! If indicated, listen for bruit.
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Neck:
How will you test neck ROM and muscle strength against your resistance? |
Head forward, and back, head turned to each side, and shoulder shrug
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Neck:
What cranial nerve are you testing when you ask the patient to shrug his shoulder? |
Cranial nerve XI
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How would you examine the thorax?
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Open the person's gown to expose all of the back for examination of the thorax,
but leave the gown on shoulders and anterior chest. |
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Chest, Posterior and Lateral:
What would you inspect in the posterior chest? |
-Configuration of the thoracic cage -skin characteristics,
-symmetry of shoulders and muscles |
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What would you palpate on the chest region?
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Palpate:
-symmetry expansion -tactile fremitus -lumps/tenderness -length of spinous process |
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Chest, Posterior and Lateral:
What would you percuss on the chest region? |
Percuss:
-over all lung fields -diaphragmatic excursion -Percuss costovertebral angle (note tenderness) |
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Chest, Posterior and Lateral:
why would aucultate breath sounds? |
To note any adventitious sounds
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Chest, Posterior and Lateral:
Before lifting the female patient's gown, what should you do? |
Ask for permission to lift gown to drape on shoulders, exposing anterior chest
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How would position male patient's gown when assessing anterior chest region?
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Lower the gown to the lap
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How would you assess the patient's anterior chest region?
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Inspect: respirations and skin characteristics
Palpate: tactile fremitus, lumps or tenderness percuss anterior lung fields Auscultate breath sounds |
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Your patient is in seated position as you listen to her heart sounds. What would you ask your patient to do before?
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Ask patient to lean forward and exhale briefly; ausculate cardiac base for any murmurs
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What part of upper extremities would you test ROM and muscle strength?
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hands, arms, shoulders
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When assessing upper extremities, what node would you palate?
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Palpate the epitroclear node
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When inspecting for symmetry, mobility, and dimpling of a woman's breast, what would you ask her to do?
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The woman lifts arms over the head, pushes the hands on the hips,and leans forward.
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What other areas should you inspect when assessing the breast?
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Supraclavicular and infraclavicular areas
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When palpating the breast, what position should the patient be at?
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supine with head at 0 to 30 degrees angle.
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When palpating the axilla and regional lymph nodes, how would you do it?
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support the patient's arm
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