Health Assessment Exam 3 Study Guide

PlEASE DO GOOD PlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOODPlEASE DO GOOD

Mental Status

a person’s emotional feeling and cognitive function

Mental disorders are apparent when

a person’s response is much greater than the expected reaction to a traumatic life event

Full mental status examination

a systemic check of emotional and cognitive functioning.

A full mental status examination is necessary when an abnormality is in affect or behavior is noted:

• Family members are concerned about a person’s behavioral changes, such as memory loss or inappropriate social interaction

• Reports of organic behavioral symptoms like nocturnal wandering, concentration deficits, trouble with simple activities, inappropriate judgment, or linguistic difficulty

• Emotional or cognitive changes noted with brain lesions

• Language dysfunction, such as aphasia, or any associated emotional problems, like agitation.

• Symptoms of psychiatric mental illness, esp. with ACUTE ONSET.

The four main components of the integrated mental status exam

appearance

behavior

cognition

thought processes

How to assess appearance in a mental status assessment

observe the patient’s posture, body movements, dress, grooming, etc

How to assess behavior in a mental status assessment

evaluate level of consciousness, facial, expression, speech and articulation, and mood and affect.

How to assess cognitive functions in a mental status assessment

check orientation, attention span, recent memory, remote memory, and new learning.

How to assess cognitive functions for patients with aphasia

test word comprehension, reading, and writing

How to assess thought processes in a mental status assessment

ask questions to evaluate thought processes, thought content, and perceptions.

Pediatric Mental Status Assessment

focuses on the child’s behavioral, cognitive, and psychosocial development

Common childhood mental disorders

ADHD

Autism Spectrum disorder

Oppositional defiant disorder

Eating disorder

Dementia is

underdiagnosed and NOT a part of normal aging

Assessing sensory status before mental status before a mental status exam( aging adults) is important bc

Changes in sensory functioning of the eyes and ears can negatively affect performance on cognitive tests.

Irritability( mental health status )

Irritability is a common sign of mental health disorders in children and teens

The Four Unrelated Words Test

a test of the person’s ability to lay down new memories

How to assess recent memory within the context the interview,

ask for a 24-hour diet recall

ask the time the person arrived at the agency

Four factors that could affect a patient’s mental response

Any known illnesses or health problems

Current medications whose side effects may cause confusion or depression

The person’s usual educational and behavioral level

Responses to personal history questions, indicating current stress, social interaction patterns, sleep habits, and drug and alcohol use.

Organic Brain disorders

Due to a brain disease of a known specific organic cause

ex. Delirium, Dementia, Alcohol and drug intoxication and withdrawal

Psychiatric Brain Disorders

Organic etiology has not yet been established

Ex. anxiety disorder or schizophrenia

Mini Cog

a reliable, quick instrument to screen for cognitive impairment in older adults

Glasgow Coma Scale

test for after a brain injury or illness

Eye-opening

Verbal Response: see if they can talk/make sense

Motor response: see if person can move on command or respond to pain

Mini-Mental State Examination

simplified scored assessment of cognitive functions

Excessive alcohol

increases the risks for chronic and infectious diseases, mental illnesses, learning and memory dysfunction, social issues, and alcoholism

Alcohol dependence

chronic progressive disease that is not curable but highly treatable.

Binge drinking

increases the risk for injuries, violence, alcohol poisoning, STDS, and unintended pregnancy

Substance use and abuse is

a developmental concern

Adolescents who use alcohol are at risk for

decreased brain development and maturity levels

Alcohol

most used and abused psychoactive drug in the United States

Amount of Alcohol that is safe for pregnant women

No amount of alcohol

Adolescents who use alcohol are at risk for

slow brain development and reduced maturity levels

What must be assessed first before evaluating mental status?

consciousness and language

What is the difference between an integrated mental status exam vs a full mental status exam

Integrated exam: a part of the normal pt. interaction and screening

Full mental status exam: systematic assessment used when abnormalities are detected or suspected

Motor Aphasia— Frontal lobe impact

Loss of ability to produce spoken or written language

Verbal comprehension IS present, but slow/nonfluent

PERSON UNDERSTANDS BUT STRUGGLES TO SPEAK

Wernicke Sensory Aphasia

Inability to understand written or spoken language

Speech Fluent

Person speaks easily but what they say doesn’t make sense

Conductive Aphasia

Fluent speech and comprehension but words/sounds may be transposed

Person recognizes errors and tries to correct them

Anomic Aphasia

Most common synonym of cerebrovascular aphasia

Circumlocution: describe n object instead of naming it

Person has difficulty finding words and naming people or objects

Causes for Anomic Aphasia:

Stroke

Alzheimer’s disease

other neurodegenerative diseases

Global Aphasia

Most severe

Patient is:

• Mute

• Cannot read or write

Cause: cerebrovascular accident

Fluent but nonsensical speech

Wernicke’s Aphasia

Slow, limited speech

Broca(Motor) Aphasia

Severe impairment of both speech and comprehension

Global Aphasia

Drowsy but easily aroused

Lethargic or Somnolent Consciousness

Difficult to arouse

Obtunded Consciousness

Responds only to pain

Stupor(Semi-coma) Consciousness

Affect

temporary expression of feelings or state of mind

Mood

more durable, a prolonged display of feelings that color the whole emotional life.

Thought content

What the person thinks—specific ideas, beliefs, the use of words.

Perception

An awareness of objects through the five senses

Hallucinations

Sensory perceptions for things that aren’t present

Example of a Hallucination

Seeing an image of a person who is not there/ hearing voices

Illusion

Misperception of an actual existing stimulus

Example of an illusion

Folds of bedsheets appear to be animated

Compulsive Behaviors

repetitive behaviors performed to reduce anxiety

Example of Compulsive Behavior

Excessive hand washing and checking

Highest risk groups of Suicide

• Male gender

• Age over 75

• Divorced

• Poor social support

• Verbal suicidal messages

• Recent unexpected event

Delirium

acute confusional change or loss of consciousness and perceptual disturbance

may accompany illnesses. eg. pneumonia

Delirium Signs

disorientation

reduced ability to focus

rapid, rambling, or incoherent speech

Hallucinations and illusions

Increased intracranial pressure signs

Decreased LOC earliest indicator

Restlessness and confusion

How to asses orientation

asking about the time, place, and who they are

How to assess memory(recent+remote)

Recent: 24 hr diet recall or asking the time person arrived to agency

Remote: ask person about past events. Eg. first job, birthday, etc

How to assess sensory function

light touches

pain sensations

temperature

ROMBERG TEST

Romberg Test

used to test proprioception(position sense) and balance

patient stands with feet together

patient must maintain balance

Vertigo

sensation that you or surrounding are spinning and moving

Dizziness

can be classified as multiple sensations:

• vertigo

• lightheadedness

• disequilibrium

• vague sensations

Crossed representation

a notable feature of nerve tracts

Cerebellar System

Coordinates movement, maintains equilibrium and posture

Experiencing “worst headache of their life”

Medical Emergency for Stroke

Vibration Sense Testing

Assesses ability to perceive vibration

Uses tuning fork on bony prominences

Pupillary Responses

Normal= PERRLA

Abnormal:

• Dilated, Unilaterally/Bilaterally

• Sluggish Reaction

• Small, reactive pupils

Abnormal Sensory Findings in Extremities

Pain sensations/ Light touches: absent

Temperature: Unable to identify warm vs cold

Position sense: Positive Romberg test, Cannot perceive vibrations

Tolerance

a decreasing response to repeated drug doses over time

REQUIRES HIGHER DOSES TO ACHIEVE THE SAME THERAPEUTIC EFFECT

Dependence

Physiologic dependence on a substance

Withdrawal

Cessation of substance produces syndrome of physiologic symptoms

Alcohol is

the most used and abused psychoactive drug in the United States

Intoxication

maladaptive behavioral changes due to effects on CNS from substance

Abuse

daily or recurrent use such that impairment and decreased functioning has occurred leading to ongoing problems

Signs of Alcohol Use Disorder

Frequent ED visits, alcohol-related injuries

Decrease in the body’s metabolic functions. eg, Vitamin B deficiencies, Liver disease

Guidelines for at-risk drinking

Heavy or at risk drinking

For men, >15 drinks a week

For women, >8 drinks a week

Light drinking raises the risk for..

Breast cancer

Physicals Effects of Long-Term Alcohol Use

Cardiomyopathy

Hypertension

Increased Afib Risk

Alcoholic hepatitis

Cirrhosis

Increased risk for Colorectal cancer

Mental Health, Depression + Anxiety

Best methods for Assessing Dietary Intake

24-Hour Diet Recall=Quick, Standard, Easiest

3-Day Food Diary: Accurate and detailed

Subjective Global Assessment: combines pt history, weight, and physical assessment data

Potentials Errors during Nutritional Assessment

The individual or family member may not be able to recall the type or amt of food eaten

Individual or family member may alter the truth

Drinks may not be included

Snack items/Condiments may be underreported

3+-6

The Aging Adult Nutrition Changes

• poor detention

• visual activity

• decreased saliva production

• slow GI motility

• decrease GI absorption

Important nutritional features

a decrease in energy requirements caused by loss of lean body mass and increased in fat mass

Age-related loss of muscle mass

sarcopenia

The Adolescent Nutrition Changes

• Caloric and protein requirements increase to meet demands of rapid physical growth, hormonal changes, bone growth, and muscle mass

Breastfeeding is recommended for full-term infants for the first year of life because…

breast milk is ideally formulated to promote infant growth and development and natural immunity through lgA antibodies

Infants

double their birth weight by 4 months nd triple it by 1 year og age

Infants increase their length by —-

50% during the first year of life and double it by 4 years of age

In children at risk for obesity or cardiovascular disease,

the health care provider may recommend LOW-FAT MILK

Infants should consume a diet of fats because

Fat is required for proper growth and central nervous system development.

During adulthood growth and nutrient needs

stabilize

When immigrants arrive in the United States

they may arrive malnourished due to limited food supplies in their country of origin.

Daily Nutrient Requirements

• ChooseMyPlate

• Dietary Guidelines

• Dietary Reference Intakes

Social/ Cultural Status impacting nutrition

Occupation

socioeconomic level

religion

gender

health awareness

Lifestyle Changes for Cholesterol Management

• Reduced saturated fats

• Increase in Fiber intake

• Consume fatty fish or omega-3 fatty acid supplements

• Leading a non-smoker lifestyle

• Regular exercise

Role of Genetics in Cardiovascular disease

Those with family history may develop disease earlier in life

Diet for Cardiovascular disease prevention

Diet lower in saturated fats

Long-term cortisol

impacts cardiovascular health